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Thanks for a thought-provoking piece picking up on the vitally important and highly relevant theme around patient empowerment.
Those working on the frontline having been telling those not working there this for some time.
Now the evidence backs us up - Lancet Aug 4, 2014.
And GPs are already struggling - probably a good way to bring the whole system to its knees.
And why does everyone who theorises think that all those who actually do the work have an attitude problem?
This is just plain insulting. It gets us nowhere and doesn't address why the NHS doesn't adopt technology. The paper in the Lancet suggests it's because we recognise bad ideas when we see them. Not listening to those on the frontline gets you Mid-Staffordshire.
Ultimately I think the biggest challenge from an IT/workflow perspective will be managing and properly using information, akin to the 'blood' flowing around the system: accuracy, relevancy, privacy and security are hugely important here. Parallel to this, the design and procurement of IT needs to change so its better built into services and workflows.
Another key question is whether the new funding reality and efficiency targets facing the NHS will actually accelerate ICT adoption and force big changes in IT procurement as organisations look to reduce costs. There's huge potential to use IT to generate cost savings, but the devil is in the detail and I think there's a significant issue of skills shortage and complexity in the new structure that will hamper this.
“Empowerment” originally had only positive connotations but now (having been inducted into the lexicon of professional jargon) can have overtones of oppression. For every empowered person liberated by the remoteness that technology can bring there will be another that risks becoming more isolated by it. A sceptic might argue that it is the bureaucrats and the profit seekers that are empowered by the use of some technologies.
If we are to genuinely empower or liberate patients, we must also recognise the diversity that exists in the population. Apart from the difference between mothers, there are the differences in culture, class, education and income. Much of the demand for empowerment and even patient choices has been driven by the white, educated middle class. This is fine and has generally been the case over many years with the middle class driving a good deal of social, economic and political change that has benefited people of all classes. However, that does not make it entirely altruistic. Ask any parent whose child did not get into their school of choice because the sharp elbowed middle class parents worked the system better than they did.
There is evidence that the people demanding empowerment through technology do so because its use enables them to spend less time in doctors’ consulting rooms and more time at work. If you are retired or unemployed, this may not be such an important consideration and having a human interaction and conversation may be more helpful. Patients that use the internet to obtain information and make informed choices about treatment, which hospitals to attend and how to manage a health disorder are more likely to be white, educated to degree level and in a professional occupation.
Finally, if we are going to empower patients we must also empower health professionals. One reason why the nurse may not do face time is because she or he may have little or no professional or even personal experience of using the technologies involved. When we piloted information prescriptions in NHS trusts we found a wide variety of equipment much of it ancient and often unavailable to nurses when they needed access to it. We also found many of them were unfamiliar with simple actions such as use of passwords and log on procedures. This was compounded by the almost hysterical risk aversion in parts of the NHS that prevents staff using the internet fully and even communicating with patients and partner organisations by email.
So by all means let’s use technology but let’s also use it intelligently. There is a risk of creating greater inequality by thoughtless use of new technology. Much as there are people that are financially poor there are people that are technologically poor (and one often accounts for the other) and many of the people will be patients with long-term multiple conditions for whom increasingly sophisticated use of technology may not be the answer.
However it is important to remember that the patients with greatest need are often those with the least resources or least desire to change. As a result just making access easier does not necessarily lead to greater uptake and successful implementation.
The other challenge is to ensure that there are clinical models available via the technology that can deliver health outcomes. The analogy with banking remains flawed, because banks have limited delivery models. The take money in and give money out. That can be easily automated and pushed on to the consumer. Healthcare is much more complex, so if you want to push it out to the patient you need to firstly provide them with sufficiently functional tools, and secondly ensure they have the health literacy to deliver safe high quality care. We spend a lot of time and money training clinicians to do that, we need to ensure we have a model for educating the relevant patients to also be able to provide that for themselves. If we don't then we are being negligent by replacing high quality safe care for low cost unsafe care.
Patient empowerment and engagement is a great goal, but let's not underestimate the work involved in delivering it. Its not just make the gadgets available and they will do it. It requires clinical governance, evidence based clinical models and investment in education. That should deliver the outcomes we want., but won’t be a cheap and quick solution.