When the NHS was formed in 1948, technology was in its infancy – computerisation was still very much science fiction. Advances in health technology were seen in terms of medical equipment – but patient records were manual and the concept of data at our fingertips and artificial intelligence (AI) would have been fantasy.
In the next in a series of articles celebrating the 75th anniversary of the NHS, commercial lawyers and data protection specialists Liz Bell and Tomos Lewis delve into the benefits and challenges of digitisation of the health service.
How it started
Looking back at the NHS 75 years ago, it coincided with the birth of computing. Computers were still the size of an entire office room – they were not compatible with health services. Services were local, records held manually, and physical security and confidentiality were the key foundations. The NHS did not have any capacity to envisage computerisation, digitisation or any of the technological advances that we have today.
Moving with the times, we are now in a very different economy – a digital environment.
The mammoth task of bringing the NHS into the digital era was always going to take a long time. It is underway, but keeping up with the pace of technology advancement is a significant challenge.
Digitisation to help improve patient care
The digitisation of electronic patient records is a considerable challenge for the NHS, but an important step in streamlining of health services. The ability to quickly and securely share and view patient notes, history, diagnostic results not only improves efficiency (by reducing delays and cancellations of appointments), but also improves patient care and the patient experience.
Early examples of data sharing show that it helps deliver better and more effective integrated services – so teams supporting a patient with complex care needs have access to consistent information.
The process of implementing information sharing is complex. Although the public might think of the NHS as one big entity, the reality is that the NHS is made-up of a multitude of different organisations. From GPs, the community pharmacy, and small NHS trusts, through to large acute hospitals, mental health services and ambulance services – each has a need to keep patient records. Creating record accessibility across all these services cannot be satisfied by a one size fits all solution.
The solutions must be accurate, up to date, reliable, quick, secure, accessible from multiple platforms and software applications, and capable of integrating different computer coding and records practices, and capable of continually evolving to keep up with the pace of technology. No wonder maintaining the electronic patient records remains a massive undertaking, against a backdrop of tight budgets that rightly need to focus on front-line care.
Ironclad security requirements
Security is of upmost importance.
The NHS is a clear target for denial of service attacks, ransom attacks and data hacks. Both it, and suppliers of healthcare software and applications are vulnerable because of the sensitivity of information that they hold. Therefore, any system that is introduced has to be ironclad – which naturally reduces ease of use, and speed of interoperation between systems.
The complexity of trying to wrap the security around that so that it’s impenetrable from the outside (except when you want people to be able to come in) – and inside (to prevent domino effect with a single incident taking down multiple sites), is a huge assignment.
Technology drives so many components of patient care that any unavailability will directly impact on patients.
Bringing patients on board
It is widely recognised that solving the digitisation puzzle will bring a vast improvement to patient experience. But there is a public disconnect, and widespread concern more generally around the security of data, which is understandable when data breaches across a range of industries regularly feature in the media.
On the one hand there is a desire from patients to have information available instantly when they need it. But at the same time, privacy concerns are front of mind – none of us wants our own records or care to be compromised. Building patients’ confidence in the security of their data is a key deliverable for the NHS and could reap significant benefits. For example, the NHS holds vast data sets which can be used for clinical trials and so to contribute the advancement of medicine, but this information can only be used where patients understand and are comfortable with this process.
In addition, it is important that populations with limited access to, or confidence using, technology are still able to fully access health services. The NHS needs to ensure that the tech-confident do not leapfrog others to the “front of the queue”, and will need to invest in helping those with less experience using these services to learn how to use and interact with them.
People are naturally more comfortable with technology they are aware of, and have used in other ways. An example of this is the increased medical use of wearable devices, no longer just “counting steps”. Dramatic advancements in functionality and design enable closer monitoring at home for a wide range of conditions by both clinical teams or the patients themselves.
An impact of the devastating Covid-19 pandemic was the fact that the population as a whole had to turn to technology and apps resulting from reduced face to face experience.
In England, NHS England apps were largely unknown pre-Covid. By the end of 2022 app sign ups had reached over 30 million. There has been a growth in online booking services, telephone and remote appointments and e-prescribing.
Covid has definitely accelerated the appetite for digital connectivity and boosted public confidence in digital tools, which will help support the NHS on its digitalisation journey.
Behavioural change of patients and streamlining of NHS systems is the key to the delivery of digitisation within the NHS.
Technology is slowly integrating into everyday life. If you had said 30 years ago that you would be walking around with a wallet in your phone or watch instead of having a physical credit card, you would struggle to believe it.
But once the technology becomes more integrated, and digital tools become part of everyday life, you start to see the benefits of it. That then makes the transition for some of the wider digital programmes into the mainstream easier. With familiarity will come confidence around confidentiality.
The importance of digitisation for the NHS cannot be underestimated and the project, however complex or challenging, is necessary to enable streamlined health and care services. In turn, that will deliver significant improvements to the patient experience, which make the effort involved more than worthwhile.
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