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Panel discussion: What makes the implementation of digital health innovations a success?
Stephen Beattie: The eHealth programme in Northern Ireland - a five year journey
Digital health and care congress- what makes implementation of digital health innovations a success
- RR: Ruth Rankine
- PB: Rt Hon Paul Burstow
- IS: Inderjit Singh
- ME: Michael Ekpe
- CL: Cleveland Henry
RR: Over the last 18 months we have been undertaking an inspection programme of providers of online general practice, sort of primary care remote prescribing. Around 50% of those providers failed to meet the regulations of delivering a safe and effective service. I am pleased to say though that on re-inspection of those providers around 80% of them had improved. The key issues are around safeguarding vulnerable people, so when you don't have the patient in front of you, how can you ensure that you're protecting those that are vulnerable? How can you safely prescribe medicines for patients when actually you don't have their full medical history? How do you know the patient or the user is who they say they are?
PB: I was the minister at the time that the whole system demonstrator project landed and the ill-fated three million lives campaign was launched. It showed a 45% reduction in mortality rates, significant reductions in emergency admissions but it was not evidence that in the end led to a wholesale transformation and adoption of the ambition that the three million lives programme had. And I think that was for two reasons in particular; one because the evidence was built around adding technology to business as usual and not actually fundamentally questioning whether the service model that you were adding the technology to itself should be transformed and changed, and secondly, perhaps there was a rush to act on the very early headlines of that research and not then to look at some of the other questions and make sure that there were clear answers. And I think thirdly what was missing from that was the connection between the ambition and the delivery mechanisms and programme management necessary to make it happen.
IS: This needs to start with actually the service transformation that's occurring across the health and care sector, this shouldn't be a set of technology led initiatives. Secondly then it's around local leadership. So actually who on your CCIO or your clinical boards, your SDP boards is actually saying, "This is a service transformation I need to enable and actually as a result, this is the role of digital that I need to be able to support this"? Thirdly around digital readiness, so actually what are the scars, what are the bumps in the road that have been felt? We know this isn't a perfect plain sailing journey. There are things that go right, there are things that need to learn from. So actually evidence based around what's worked well, what the challenges around digital implementation and how have you overcome those. And then finally painting the picture, the future. So one of the key points around the local health and care records is, yes, there is an immediate need to join up health and care information, that's in effect an expectation that most of us already have, but actually how can I then utilise that information for more effective planning of services?
MK: In my definition of digital, it's probably worth mentioning, is about evolving the way we connect with people and for PHE, given our mission, it's the way we connect with not only people at the individual level but how we mobilise and activate communities. But the idea of a people-centred approach is fundamental to digital delivery and of course, this is to an extent also about reconciling two paradigms. The idea that you only move on initiatives with a degree of certainty based on evidence and knowledge gathered over a number of years versus the digital mind-set which is really just coming up with a hypothesis and looking to test that and improve that through feedback. Our idea of how to deal with that is by taking some projects and bringing together all of the experts across PHE both from a digital standpoint but also subject experts in terms of clinical backgrounds.
CH: We're already booking, we're banking, we travel, everything we're doing online and then you walk into a building that has an NHS badge and you drop your digital space and you pick up paper and then we do the same with our staff. So they are again extremely technical and then they walk in and they start operating in the analogue model and we've got to look at what are we trying to do and actually embracing some of the opportunities that we have there. So what we've got to do from an NHS digital perspective is not direct from the centre, we've got to really understand the end user, be it the patient, be it the clinician and everything in between and we've got to take advantage of the opportunity that we've got right now with technology.