According to the NHS long term plan published in January this year, providers across acute, community and mental health settings in England will be expected to reach “a core level of digitisation” by 2024, covering all clinical and operational processes, with “robust, modern IT infrastructure services for hosting, storage, networks and cyber security”.
Although the new digitisation timeline has been described as “probably unachievable” at the first educational summit in the newly-launched HIMSS DM Series, Actionable Insights to Digital Maturity, last week, we are said to be at a turning point in the digital transformation of health and social care in the UK.
There is no denying that change has been slow, but we now have affordable technology that can deliver and a desire within the system to deploy and use it more effectively, attendees at the summit emphasised. “I wouldn’t want to be the last CIO [Chief Information Officer] using paper in 2024,” one commented.
The DM summit, which took place in Greater Manchester last week after a tour of the Salford Royal NHS Foundation Trust, draws on research carried out by HIMSS, owner of Healthcare IT News, to understand the standards, insights and communities needed to enable and accelerate digital transformation in this space.
It is based on its suite of digital maturity models, which includes the internationally-recognised Electronic Medical Record Adoption Model (EMRAM) and the Continuity of Care Maturity Model (CCMM).
Work together to make progress faster
Digital is only an enabler and not an end in its own right, attendees heard, and the challenge ahead and the harsh reality of a fragmented system, budgets that are becoming more and more stretched – the “financial envelope” is not growing despite the extra £20bn a year by 2023 – should not be underestimated.
That said, however, money is always available – it’s just not being spent on the right thing, one attendee said. Furthermore, the real barrier will be with organisations that have not invested for a long period of time in their infrastructure, systems and digital leadership. “Investing in basic infrastructure is key and must be done as a preparatory process before the deployment of any EPR capability. How do you expect to digitise when you do not even have proper WiFi?” one delegate cautioned.
Representatives from 35 organisations across the NHS attending the summit were encouraged to collaborate and work with providers that have “already been on the journey” to demonstrate that they can make progress faster.
“We are beginning to see organisations across the NHS that can stand tall and say, we are as good as the rest of the world,” one delegate added. “What we want to do is actually learn the lessons and share the lessons of how to do it.”
But an attendee explained that his trust had gone to procurement twice for an EPR system and was pushed back because of the Local Health and Care Record Exemplar (LHCRE) investment.
“The investment that was promised was then reduced centrally and that’s a real challenge. I think we’ve got the right people, I think we’ve got the right culture in place, but we do need better buy-in from suppliers and transparency about pricing,” it was added.
Will NHSX be the key to solving the complexity and confusion in the NHS digital agenda?
Since being appointed to the role in July last year, health and social care secretary Matt Hancock has made sorting out the basic IT infrastructure across health and social care one of his key priorities. Most recently, he announced the launch of NHSX, a new unit for digital, data and technology.
Mathew Gould, who was until recently the government’s director of digital and media policy, has been named as the new venture’s chief executive, and he will be accountable to the health secretary and chief executives of NHS England and NHS Improvement.
The unit, which is expected to become operational in July, has already been tasked with bringing cohesion into a market where responsibility for digital is split across various teams and organisations. “In the centre, we are equally as fragmented as you’d find in any STP [Sustainability and Transformation Partnership] or ICS [Integrated Care System],” one delegate commented at the summit.
Its responsibilities will include setting national policy and developing and mandating standards for the use of technology in the NHS, as well as ensuring that NHS systems can talk to each other, among others. Investment in technology will have to demonstrate that it is delivering against the tech vision and the national standards that will be set, delegates heard.
And while NHSX won’t be the answer to every question, it’s a “step forward”, delegates emphasised. But we need person-led transformation, technology that is usable, change processes that can make it fit for purpose, and clinicians confident to educate boards about the importance of digital, it was added.
“I think the challenge as a technologist is that it’s easy to point to the technology and it’s easy to say, here’s something we put in, it’s much harder for us to calculate and measure the impact and benefits,” one attendee said.
“I think the challenge for everyone in this room, and whether that’s an organisation that’s at HIMSS (EMRAM) Stage 4 or HIMSS 7, is to demonstrate the value within the institution and increasingly as we look at LHCREs, ICSs, STP models, looking at demonstrating the impact of technology across those communities as well.”
How does the EMRAM apply to the UK, and what does success look like?
The HIMSS EMRAM is an eight-stage model that measures EPR capabilities and their impact on systems and patients, tracking the progress of organisations against others in Europe and the world.
More than 2,500 hospitals in Europe have been assessed on the EMRAM, and the standards were updated at the beginning of January 2018, with the input of international groups of CIOs, CCIOs, industry partners and HIMSS Analytics.
In the UK, Cambridge University Hospitals NHS Foundation Trust and Kingston Hospital NHS Foundation Trust have been validated at Stage 6 of the EMRAM. Other organisations are currently going through the process, however, at the summit, delegates heard that the average EMRAM score for secondary care providers in England is 2.5 at the moment. It is believed that the expectation from the centre is that all will be at Stage 6 of the EMRAM by 2024.
Meanwhile, in Europe, there are only five hospitals validated at Stage 7 of the model, including Portugal’s Hospital de Cascais. But the aim is not to reach the highest level of the maturity model, but to improve capabilities and maximise technology investments and the resources available, delegates heard.
However, a recent HIMSS Analytics and KLAS survey indicated that physicians that have access to the full tech suite needed to reach EMRAM Stage 7 are generally more satisfied overall, having “better tools to deliver care”, as well as “better functionality” and “better integration”.
For the Portuguese hospital, it is believed that the EMRAM embodies the organisation’s commitment to continuous improvement of health outcomes, supporting, clarifying their IT strategy and providing a roadmap to achieve operational excellence.
But to make this work, you need at least three things: an alignment with the hospital’s strategy, clinical engagement, investment, and a continuous focus on process improvement. At Cascais, the board has empowered clinicians to lead change projects, and their “voices are heard all the time”. In England, delegates heard that “having the board behind you” can go a long way. “Unless you have that, you won’t succeed,” one commented.
You can’t just plug technology into things that you are currently doing, you have to change existing processes, other attendees added, and recognise that “people, process and culture are more important in determining outcomes than your choice of tools and technology”.
“Digital transformation for me is about recruiting talent, it’s all about partnerships, partnerships with tech, partnerships with life sciences, that’s with pharma, that’s with medical technology. It’s all about driving academia and actually utilising academia which is great in the digital space, but also pivoting non-digital academia more towards that stuff is really important too.
“It’s all about patient and clinical engagement, so how do you take those people to see things in a different way, particularly in the clinical communities, and that’s a big challenge, it’s also about how you set up new commercial models that are fit for the digital age,” one mentioned.
Going beyond brick and mortar
But we talk extensively about digital maturity across the NHS as being a journey rather than a destination, one delegate said. Yet we know that noncommunicable diseases are a leading cause of disability and death worldwide, and we know that unhealthy behaviours and unhealthy lifestyle choices put a significant pressure on the health system. Even in Manchester, two thirds of premature deaths are related to behaviours that can be changed, it was explained at the summit.
We also know that healthcare is predominantly based on the interactions that people have with the health system, but the system has “almost no data” on what people do when they’re not in a healthcare setting, which presents a real challenge.
Therefore, delegates heard that there is a need to shift the balance from basing all activities of the system on the limited interactions with patients to starting to consider all the data generated outside of it in order to “design and deliver proactive and personalised services in a way that supports earlier targeted interventions that helps people before they even know they need it”.
As demand on the system will continue to grow, digital transformation is not simply about digitising existing services, but about changing them, attendees concluded, while innovating can no longer be seen as “just a choice”.
The HIMSS DM summit took place in Salford last week under Chatham House Rules, guidelines that allow information from the event to be disclosed without attributing it to any of those present. Healthcare IT News is a HIMSS Media publication.