Connecting Health in the UK
The NHS is as close to a sacred institution as you will find in modern Britain. No other body, in the public or private sector, comes close to being as revered or treasured as our system of healthcare. However, there is an unprecedented amount of strain on the NHS as we know it, and the problems it faces, though being well documented and apparent, have been difficult to address in any meaningful way.
Despite all of this, it is a VERY cool and exciting time to be operating within the healthcare IT space (HIT), not least because many innovations under that umbrella term could be pivotal in addressing said problems.
Recent times have seen the development of technologies that can be applied to the provision of care advance exponentially, and it isn’t a secret that the NHS has tried, but ultimately struggled to keep apace. But now as we enter 2016, there are signs and signals that indicate we may be witnessing the beginning of an age where wireless and mobile become consequential aspects of how we administer health & care in the UK.
The emergence of mHealth
Digital tools have been incorporated into the NHS for a number of years. Electronic Health/Patient records (EHRs/EPRs) are slowly aiding the transition to a “paperless” way of working, and as of 2015 (even though it’s been bizarrely underpublicized) every GP surgery in the country has the capability to offer online appointment booking, even if some have been slow, or reluctant, to adopt that system.
These kind of developments were inevitable, and certainly a move in the right direction, but they are functional changes that were necessary at an institutional level, as opposed to those that could actually enhance the patient experience. This is where mobile technology has made a difference.
The Nursing Technology Fund (NTF) was announced in 2012. It was a round of investment that invited NHS bodies to apply for the money by producing a plan as to how they would spend it in order to update the technology in their particular hospital or CCG. After the fund had been allocated, it placed a swathe of smartphones and tablets into the hands of nurses and doctors, which served as a catalyst for the concept of “mHealth”, and the idea that connectivity in hospitals would assist caregivers in improving the level of care they could provide.
It’s still early days for mHealth in the NHS, but the possibilities are exciting and far-reaching. With a smartphone in hand, doctors can receive notifications of their patients’ progress, in real time. Nurses can pick up a tablet and see all relevant vital signs taken from those in their ward, without having to thumb through what can be 100 page long documents that you frequently see at the end of hospital beds. These kind of progressions don’t just improve efficiency, but by reducing the latency between finding the last patient recording, to the most important at that time, the ability for hospital staff to react to potentially threatening developments is taken to a new level.
The introduction of these new techs sound like a no-brainer, and it’s easy to question why these kind of systems haven’t been rolled out on a large scale basis, especially given the way smart devices have revolutionised the way we, the public, live our lives. But the obstacles are legitimate, and notoriously difficult to find solutions for without upsetting the important framework of care in the NHS.
Two professionalisms at odds
Doctors and nurses go through many years of training in the processes that are necessary to keep us safe when we are in hospital. These processes have been honed over nearly 70 years of the existence of the NHS, and anything that might disrupt them is a real, imminent & potential threat to patient safety.
This is in stark contrast to the blinding speed at which technology has prospered particularly over the last 8 years. The iPhone was introduced in 2008, which amalgamated almost every way we interact with each other and the internet, and we never hesitated for a second, because everything was made easier for us.
There are huge potential benefits to reworking the specific, paperwork ridden routine caregivers use when a person is admitted to hospital, as opposed to logging them in on a smart device and having them immediately communicated to a central hub / dashboard, for instance. But to fully get to grips with these seemingly obscure challenges, you need to be an expert in your field. It is unfair and unrealistic to expect a nurse of 25 years to be able to accept that upending the way they behave at the point of care is a change for the better, just as it is difficult to imagine that, without inside experience, any old private company could grasp the intricacies of the patient journey as managed by our health system. The private sector has this expertise sporadically, but would take a huge leap of faith, and a ton of patience, for both parties to collaborate effectively enough to make a meaningful change overnight.
Take the issue of data security, for example. It’s amazing to think that all of a patient’s data can be digitally stored in your pocket as opposed to a huge, daunting ring binder, but health records are said to be more valuable to hackers than even financial data. According to a freedom of information request by US security firm Accelion, 80% of the trusts they questioned supply their staff with a smart device, but just over half of those “rely on the security of their server, encryption, or the goodwill of staff to adhere to an Information Security Policy to ensure patient data is kept secure”. Indeed, the Information Commissioner’s Office found that in Q2 last year, data breaches in the health sector outnumbered any other by a wide margin.
To someone familiar with e-security, this is a criminal lack of foresight, especially given the sensitivity of the data being handled, but to a healthcare professional with no formal knowledge or training in the IT arena, issues like this don’t even cross the mind. As mHealth evolves and expands in the NHS, data encryption is a perfect example of something that must be addressed before it becomes a hinderance to progress.
The appetite is there
For the reasons listed above, resistance from hospital staff to the changes in protocol that are necessary to fully utilise wireless tech is another big issue. But it would be difficult to argue that, for the first time in many years, there is an appetite from both the NHS and the government to appropriately fund (i.e. the NTF) and push technological initiatives to the forefront of the way the sector works.
I attended the NHS Health & Care Innovation Expo, held at Manchester Central last September, and it was inspiring to see both the delegates engaging with relatively (or entirely) unknown startups from all around the globe, and such an array of organisations who had real, tangible ideas as to how it can be possible to inventively incorporate unfamiliar wireless softwares into the procedural structure within which NHS staff work. Open-mindedness has traditionally been a big issue among those at decision-maker level in the NHS, but the event was created specifically to break that barrier, which shows an encouraging commitment to the cause.
The NHS also regularly runs hack days, where “geeks who love the NHS” are invited to share digitally-centred ideas and collaborate to come up with innovative solutions, and there is an ongoing open source programme that offers a transparent approach to coding, which is a relatively alien concept to the NHS.
And, perhaps most significantly to the furtherment of wireless technology in the sector, last year came the official recommendation to the National Information Board from Martha Lane Fox – the House of Lords peer and founder of Lastminute.com, who was commissioned by the Health Secretary to “increase take-up of digital innovations in health” – that every NHS building should offer free WiFi access, which has also been echoed by the government since.
It’s difficult to understate what this could mean for both patients and health workers. Not only would every trust & CCG be able to confidently empower its staff with apps and programmes that positively transform the way they deliver care without fear of connectivity issues, but it could also, as Baroness Lane-Fox said herself, “allow patients staying in hospital to self-monitor their conditions using apps, maintain contact with social networks that can support recovery and crucially help them to stay in contact with family and friends”.
At this point it is probably sensible to ask: what is the endgame for wireless in the NHS?
Digital Hospitals & Remote Care
Now feels like a moment in which the NHS is perfectly poised – and more importantly, prepared – to begin capitalising, in a meaningful way, on the extraordinary capabilities and benefits that wireless technology could bring to healthcare in the UK.
The issue of “paperlessness” has been around for years. But with the right balance between input from experts in the IT arena, and the willingness from those on the frontline to learn and adapt, it is realistic to assume that obstacles such as interoperability (how data is transferred and interpreted by two IT systems) and poor data encryption can be overcome, so that patient data being maintained and transmitted solely via mobile devices is no longer a pipedream.
Integrating health and social care has up until now seemed a clash of two fundamentally different approaches to maintaining an individual’s wellbeing, and because of the very different needs of inpatients and outpatients, there has been no clear pathway for any cohesion between the two entities – which was highlighted this year when it was revealed that delayed transfers of care were at an all time high. But by being able to communicate so much more efficiently, it provides primary and secondary carers with the tools to be able to both collaborate more broadly speaking, and micromanage on a case by case basis, which makes mobilising both specialisms and working in unison a much more realistic goal.
In January, NHS chief Simon Stevens announced at the World Economic Forum in Davos that there would be a serious initiative, as part of the “test bed” scheme, to trial futuristic innovations – in his words, “biosensors, medtech and drug discovery, mobile communications, and AI computing” – in conjunction with some of the biggest tech players in the world, including Google’s Verily, IBM, & Philips, to evaluate their viability in helping “patients stay well and monitor their conditions themselves at home.”
This takes us even further down the rabbit hole: with the plethora of apps and wearables now available to consumers, many of which are centred around healthy living, who is to say that a significant portion of care could not be self administered?
Last year, King’s College Hospital piloted a trial scheme wherein a small number of their oncology patients were given an Apple Watch to use in conjunction with a specialised chemotherapy app that reminds them when to take their medication, (see pic above) and allows them to record any negative symptoms they experience, which are sent directly to their doctor’s mobile device, and just this month 25 patients of Guy’s and St. Thomas NHS Trust are using their smartphone “as part of a health monitoring kit that takes daily readings of weight, heart rate, blood pressure and blood oxygen levels”.
Like I said at the top, it’s a cool time to be working in “HIT”, and don’t be surprised if, in a few short years, you find yourself speaking to a doctor via an app, ordering a prescription from your tablet, and automatically reporting symptoms through your fitness tracker, all from the comfort of your own smart-home.
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