Here, Martin shares his views on the results from the survey and shares his key learnings and takeaways to support health and care organisations.

Allowing 3rd party access and managing internal privileged accounts

Respondents hailing from organisations across the NHS and beyond first shared how their organisation currently allows third-party access to their network, with 47 percent currently using enterprise directory services like Microsoft Active Directory and a VPN; 29 percent using access management solutions; 12 percent using desktop sharing tools; and 12 percent using vendor-supplied solutions.

Looking at the use of legacy technology to allow access to internal networks, Martin noted the costs associated with the approach of having a VPN and an access directory (AD) account, adding, “there are risks around that, as well, because if you give someone AD credentials, you don’t know whether they’re still working for their organisation, whether they’re sharing credentials, and it’s hard preventing lateral movement.”

Our survey also sought to understand how organisations are managing internal privileged accounts, with 39 percent of respondents reporting using a second elevated active directory account; 3 percent reporting using shared credentials; 31 percent reporting using their own personal active directory account; 27 percent reporting using a privileged access management (PAM) solution.

“The risk of having a second elevated AD account,” Martin said, “is that users need to have two passwords to be able to access, which they might be jotting down on a notepad somewhere; and also it’s looking at what happens as people move through the business and their roles change – are we still controlling what access they have?”

The approach Martin’s team takes, he said, involves asking vendors and users to create their own accounts through their own domain email address, “putting the time needed to create an account onto the vendor, not the internal team managing the process, as well as removing the need to create multiple AD accounts, because if you have a vendor coming in with 500 users, that’s a lot of accounts to create”.

That also has the effect of removing that risk associated with vendors needing to know domain credentials, and with the risk of them jumping across to a different application in the server, “because they don’t have the rights to do it”. This offers more control, and means organisations can “keep the keys to their kingdom” internally, without vendors ever knowing what they are, he said.

Password rotation and dedicated individual accounts

When it comes to handling the rotation of passwords for privileged accounts, 10 percent of respondents said that they were using a credential vault; whilst 53 percent reported that it was automated through a PAM solution; 20 percent said that this was done manually; and 17 percent reported that passwords are not rotated.

Having a PAM solution does take away the “heavy manual process”, Martin said, “and you’ve also got an audit log of who’s changed a password, when they’ve done it, and all of that sort of thing as well”. There are risks with not having some kind of password rotation in place, particularly for elevated accounts that can offer ongoing access to different systems, and there’s always the possibility of someone coming across that password, he added.

“With the PAM solution we can integrate with our internal PAM solution, or another vendor’s PAM solution,” Martin told us, “to make use of their own password vaults and the rotations of passwords directly within that, which takes away some of that manual work or risks when they aren’t rotated.”

The survey asked respondents whether every vendor user for their organisation has a dedicated individual account. 77 percent reported that their organisation does create an individual account per user; whilst 6 percent said that vendors shared accounts; and 17 percent reported a mix of shared and individual accounts.

Even though most report having individual accounts, there’s still no guarantee about who is actually using those accounts or whether those accounts are being shared, according to Martin, “because what quite often happens is a generic company email address is used, and then that’s being used by multiple people”. And when individual accounts are used, there’s “still a lot of manual work involved with that” Martin told us, “as you need to make sure those users are still active at that organisation”.

Audit trails and deprovisioning access

Respondents were asked whether or not their organisation has an audit trail or video recording of vendor’s sessions. 21 percent said that their organisation had both in place; 50 percent did have something in place but reported that it was a lengthy and manual process to obtain audit logs; and 29 percent didn’t have anything in place.

“It can be a lengthy process going into an AD account and trying to pinpoint when you think an issue happened,” said Martin, “so not having a simple solution in place to simplify that can put a lot of pressure on internal teams”. That is particularly true when it comes to audit or governance reports, he noted, which can place timelines and additional stressors on teams.

With the PAM solution, Martin told us that a full HD video recording is available of each vendor session, and customers are given the option to have the full video recording, or an abridged version which simply shows key movements and streamlines the process.

When it comes to deprovisioning access in a timely manner when a vendor no longer needs access, 51 percent of respondents said that access is automatically deprovisioned after a set time; 39 percent said that access is manually revoked, but not always in a timely manner; 10 percent reported that they don’t always know when a vendor no longer needs access, or can often have access longer than is needed;

Automatic deprovisioning is relatively simple to set up when you have a company coming in for a set amount of time, according to Martin, “but when it comes to manually deprovisioning, it’s whether the organisation has that team and capacity to go through a vendor’s account and look at metadata relating to last login, etc.”. The risks with this are largely the same as those with other manual account management, he added, “as if someone’s left the business, they may no longer have access to their organisation’s account, but they could still have access to their AD account”.

The “best case” scenario for deprovisioning would be a PAM tool, Martin considered adding automation into a PAM solution, whereby it can recognise where there hasn’t been a login for a set period of time, and control a time window during which vendors are permitted to log on. “It offers a bit more security,” he said, “in that you know someone isn’t going to be coming in on a Saturday afternoon when they shouldn’t be”.

Onboarding and preventing lateral movement 

Respondents were also asked about the onboarding process for new vendor access at their organisation, with 33 percent reporting there was a manual process to create an account and provide VPN access; 21 percent stating that their organisation has a dedicated team who handles vendor onboarding; 15 percent provisioning an account to a remote access or virtual desktop solution; and 31 percent sharing that they had ad-hoc processes in place depending on the vendor and access needed.

With ad-hoc processes in particular, Martin said his team tend to find “some vendors have a tool in place” like TeamViewer or their own VPN connectivity, “which is great, but creates challenges for companies, because if they have 20 vendors coming into their network, that’ll mean managing 20 different ways they’re going to gain access”. From an internal point of view, manually creating accounts offers control over that, but there are still risks, which can potentially be mitigated through the use of a PAM solution, he continued, where a dedicated team can manage the onboarding process “to take away that time needed to bring a new technology to a vendor each time a vendor comes on board”.

The final question from the survey asked respondents whether their organisation had the capability to prevent lateral movement once a vendor is inside their network. 50 percent said that they did have this in place; a further 37 percent said that this was somewhat in place with more complex firewall configurations; and 13 percent reported that this was not in place at their organisation.

Martin focused on the benefits of having a PAM solution in place to “remove the need to configure firewalls for specific use cases”, allowing users to define access to specific applications or servers, meaning “if they try and hop onto another server they won’t know the credentials, because we’ll inject those directly into the session when the vendor joins”.

Keeping that password away from users and vendors offers an additional layer of security, “so all they know is the password they’ve created themselves to gain access to the portal, and they don’t know the credentials to move anywhere else”.

Key takeaways

Looking at key takeaways from the survey’s findings, Martin highlighted the security risks around not having complete control over individual accounts and who is using them, as well as with VPN and AD account access, whereby “a vendor could come in over the weekend and make changes to a network or system which could cause issues come Monday morning”. That’s why having a PAM solution in place is so important, he stressed, “so you can define what times vendors can come in, and there’s a workflow in place to have that just-in-time access requirement”.

Whilst there are businesses out there looking at how they can create zero-trust network access, Martin considers that “there’s still a lot of work to be done”, pointing to the tendency for people to use the “simple and cheaper route of VPNs”, which “opens up a whole can of worms on risk and creates issues with audit reports, as well”.

It’s always difficult to justify an expenditure such as this technology, Martin said, “but you have to look at how much time is being used by internal teams on creating and managing these accounts for vendors – we’ve seen a lot of customers where the solution has paid for itself within the first 12 months by removing some of those manual tasks”. It can also offer benefits when it comes to meeting regulations such as NIS2, he went on, “and being able to tick a box there is a big part of it, as well”.

Having a solution which is “fairly self-managed” can help organisations to work around the expense of having internal teams managing access and vendor accounts, Martin said, “taking away that internal pain, whilst adding that security and ease with compliance”.

When it comes to the future of PAM, Martin sees analytics as playing a larger role, highlighting the potential for the “huge amounts of information collected” to be used to train internal resources, save downtime, and in harnessing the power of AI.

Describing Imprivata’s PAM solution, Martin said that it’s “enterprise grade, simple, secure remote access” for vendors to gain access to an internal network, simplifying the process by putting some of the work onto the vendor. “We try and simplify the licensing,” he told us, “so rather than catering for every single person who wants to use a solution, we do it per vendor, so it covers the email domain, and companies can have as many users as needed”.

It’s about making things like checking vendor access and sessions easier, he said, “so that things which may have traditionally taken days can be done in just a few clicks, which not only saves time, but also makes ensuring network security that much easier”.

Imprivata’s PAM solution also offers multi-factor authentication (MFA) which ties into vendor’s own MFA solution, meaning users need to provide “that second layer of authentication to get into the system”, by receiving an email to their domain email address, “because if a user leaves a business their email is often one of the first things to be removed”.

To learn more about PAM solutions and the benefits they offer for network access management, please click here.

Firstly, let’s run through some of the main stories from the past six months with regards to digital mental health.

HTN explored the papers from NHS England’s latest board meeting this month, which involved discussion around expected data quality improvement for community mental health services and the urgent and emergency mental health pathway. In particular, the board highlighted a programme of work designed to improve these services by incorporating feedback from national surveys and complaints alongside partnership working with voluntary, community and social enterprise groups. NHSE also raised plans to launch a longer-term review in early 2025 into the whole system approach for community mental health service with the aim of improving quality and safety; this will examine the data, capital and resources required to meet demand, as well as exploring the changes required to help these services enable efficient flow and high quality care within and between services.

In September, we reported how SBRI Healthcare launched a new funding competition looking for work-related digital interventions for individuals with poor mental health, which focuses on supporting individuals to stay in work, return to work or overcome recruitment barriers. Up to £200,000 in funding is available per innovation for up to 12 months, with a closing date of 13 November.

September also brought a three-year plan to improve mental health services from NHS Cheshire and Merseyside, which highlights data as a key enabler in realigning services so that inpatient provision better fits population needs; and news of a partnership between University College London and YouTube Health, aiming to improve access and quality of mental health information on the site for young people. Future plans within the NHS regarding digital mental health were also shared in September, with North London Mental Health Partnership indicating intention to procure a digital local risk management and incident reporting system, and Oxford Health NHS Foundation Trust sharing plans to create a framework for the provision of online and digital mental health assessments, treatments and therapies across the region.

In the summer, HTN reported an update from NHS Coventry, Warwickshire and Solihull Talking Therapies which saw a new chatbot function launched on the service website, designed to take website visitors through an online conversation and exercises to process referrals to the service. Additionally, patients are encouraged to download a mental health app linked to the chatbot which can provide personalised support such as weekly reports and progress tracking. We also noted how the NHS 111 service was expanded to include a 24/7 “full package” of mental health crisis support, so that people in crisis or concerned family members can access trained support at any time.

Looking to spring, HTN shared how the charity Papyrus worked with the ORCHA to develop an app library containing “trusted apps” for young people to use to access a range of information, support, and advice on mental health. Additionally, we reported on the announcement that North London Mental Health Partnership would be moving to a single electronic patient record, with “comprehensive data migration of clinical data and consultation records from EMIS onto RIO” taking place from May.

Where should the priority be when it comes to digital supporting mental health services?

To gain audience views on the topic, we took to LinkedIn to ask a question. Where should the priority be when it comes to digital supporting mental health services: improving digital access, implementing new ways of reaching out, accelerating interventions, or improving data and information sharing?

43 percent of our respondents believed that accelerating interventions in this space should be the priority, with votes coming in from roles such as deputy chief nurse, director of performance and informatics, and digital culture and change lead.

26 percent thought the priority for digital mental health should be implementing new ways of reaching out, including practice manager, senior operations manager for a virtual ward, and deputy chief nurse.

17 percent wanted to focus on improving data and information sharing; here we saw votes come in from roles such as business change and improvement manager, data leader, and cyber security and information governance lead.

13 percent sought to prioritise improving digital access, including an EPR configuration analyst, health service researcher and psychiatrist.

Which option would you have voted for?

Digital mental health research: engagement challenges and attitudes to tech

A research study recently published in Frontiers sought to explore the engagement challenges faced by an online mental health platform in Brazil by exploring feedback sourced from focus groups, online surveys and ‘think aloud protocols’, whereby participants are asked to verbalise their thoughts whilst they work through a task. In particular, the research team sought to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions.

Contextually, the study acknowledges that a “major research gap to overcome in using digital health programs is user adherence”, with the issue “particularly acute in low- and middle-income countries”. Therefore the researchers focused on Brazil.

The solution in question offers a self-guided digital education experience designed to enhance self-awareness and mental health for participants, providing personalised feedback on “key psychological factors” as a “core element of mental health education” and as a form to engage users.

The research team observed “substantial” dropout rates across all patient samples during the study, with users predominantly engaging for a “one-time, concentrated use of the platform”.

From the online survey given to participants, lack of time was the predominant reason given as to why they did not complete the platform journey, with criticisms focusing on “excessive number and extensive length of the instruments required to be completed”. The respondents also supplied a number of recommendations for enhancements for the platform overall. These included development of a mobile application for the solution; the implementation of periodic reminders; reduction in the overall length of the journey; and inclusion of meetings with healthcare professionals.

Participants who took part in focus groups and think-aloud interviews provided further insights; the main themes of disengagement here were incompatible time, lengthy questionnaires, the long journey required by the platform, a perceived lack of “dynamism” and the necessity of a specific audience. However, they expressed “significant overall satisfaction and a deep personal connection with the personalised feedback” offered by the solution.

The study also draws attention to one cohort of participants who became involved with the solution following a public online launch. There was a “significant bottleneck” at the early stages of engagement for this group, specifically after the signing of the consent form and the following of the initial segment of the platform journey. “This pattern suggests critical engagement challenges at the outset of the user experience,” the study notes, “indicating the need for targeted interventions to improve initial user engagement and retention.”

Discussing their findings, the researchers suggest that shorter activities might foster greater participant involvement; and future versions could benefit from “more image-centric and less text-heavy content to appeal to users”. Lack of dynamism and gamification elements are believed to have induced disengagement, with “persuasive” features such as self-monitoring, reminders, dialogue support and social support encouraged to support users in engaging and promoting adhere.

The team also draw attention to the four factors deemed to positively impact adherence in digital interventions in this space; personalisation, push notifications, user-friendliness, and personal support offered alongside the digital tool.

Citation: Moretti F, Bortolini T, Hartle L, Moll J, Mattos P, Furtado DR, Fontenelle L and Fischer R (2024) Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil. Front. Digit. Health 6:1383999. doi: 10.3389/fdgth.2024.1383999 Journal on Frontiers here, license here.

On another research note, HTN previously looked at research commissioned by the MHRA and NICE, which explored attitudes and experiences of current and potential users of digital mental health technology (DMHT).

The aim was to inform the design of future regulatory and evaluation frameworks for DMHT, with key findings including participants feeling that it can be used to “try and cover over failings in the mental health care system”; that use should generally sit alongside other treatment such as regular therapy; and that apps are often seen as a “temporary substitute”, though participants did acknowledge that “in some cases an app on its own might be all a patient needs”.  Click here to read more.

Insights and learnings from health tech professionals

At a HTN Now event we were joined by Dr Joseph Firth, senior research fellow at the University of Manchester and honorary fellow at Greater Manchester Mental Health NHS Foundation Trust and Western Sydney University. Joe joined us to discuss his UKRI-funded programme of research on digital lifestyle interventions in mental healthcare, sharing key findings from his research. He provided insights on how his team are involving clinicians, patients and public feedback in their design and delivery of digital health interventions, and discussed ‘The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness’, in which Joe and his team highlight key issues and suggested actions for tackling fragmented and inaccessible physical health care for people with mental illness.

The HTN team also spoke with Dr Martin Dechant, lecturer at University College London, about his research around the use of digital interventions in mental health. Martin shared how he works with Master’s students on exploring game mechanics, particularly “looking at the power of games in improving motivation” and examining “mundane harms – how games might damage your mental health unintentionally”.

Additionally, Martin reflected on the potential and pitfalls of digital in the mental health space, in his view. “We have multiple levels where I think digital can help a lot, and also where it can be a negative, which is important to consider. On one side, through digital we have easy access to information; but on the other side, there is an incredible amount of information out there, so people start to have problems with figuring out what is trustworthy.”

Interested in hearing more about digital mental health from health tech experts? On 21 November (11am-12pm) we’ll be hosting a webinar as part of our live event series exploring how Leeds and York Partnership NHS Foundation Trust, a mental health trust, has digitised its patient records. This webinar will examine how the trust transformed paper-based processes into a fully digital system integrated with their EPR, sharing their challenges and how they tackled them as well as how they kept the process compliant with data protection standards. Register for your free NHS ticket here.

The strategy focuses in particular on the next three years, with the aim of establishing the foundations for a “safe and more effective NCA”. These foundations are to be achieved primarily through the implementation of a single EPR solution across all acute hospitals, with the programme set to commence during 2024 with a targeted go-live in 2027. Additionally, NCA plans to establish a single community services EPR intending to strengthen NCA’s connectivity to its places; this programme aims to commence in 2025. Once these foundations have been achieved, the trust expects to gain “greater clarity regarding the transformational opportunities that exist and will form the basis of an iterative and evolving digital strategy”.

NCA’s vision statement for its digital future includes standardised digital patient record provision; a single and fit-for-purpose digital user experience; increasing digital literacy; and operation as a data-driven organisation.

To achieve this, alongside implementing the EPR across acute hospitals and single community EPR, planned actions include implementing a single sign-on solution; delivering consistent, fit-for-purpose WiFi across the trust; delivering modern end user computing; implementing a single service desk across the NCA; developing and implementing a ‘people and digital skills development’ strategy; improving data quality; and ensuring accessible and consistent data collection, management and reporting.

The strategy highlights how NCA has used Gartner’s Run-Grow-Transform model to shape its plans, with the strategy focusing “almost wholly” on the grow phase over the coming three years. A components of this will see the establishment of a single digital services team, designed to align all technology teams across NCA into a single function whilst ensuring a voice to clinicians in how digital services are provided.

Additionally, NCA plans to drive rationalisation of digital systems to reduce its server footprint, readying itself to transition towards cloud-hosted solutions and away from the need to maintain a “considerable” datacentre. Clinical application systems are also to be rationalised, with NCA to focus on where improvements can be made to overall colleague and patient experience in advance of EPR implementation. This will include identifying duplication and setting out a data strategy to support the development and enhancement of data quality, insight and analytics, driving a “thorough data cleanse” as a key deliverable.

Work will go into supporting all colleagues to be able to access a consistent device and one IT account regardless of location; and NCA pledges to continue to invest in and strengthen its cyber security solutions. Improving user experience will also see work across NCA to streamline and provide patient portal services; drive improved linkage between community teams and acute clinical solutions; improve collaboration with provider trusts and other partners to support the regional digital strategy; and shape the people and skills strategy within the digital department.

With regards to the ‘transform’ phase, the trust recognises that the establishment of an NCA-wide EPR – alongside existing work to establish a trust-wide laboratory information management system – will be the biggest transformation enablers. NCA’s wider transformation aims include significantly reducing and streamlining the existing digital application patchwork within its hospitals, and reducing more than 380 different clinical systems to support improved efficiencies and effectiveness.

Other transformation activities are laid out in the strategy such as fully mapping the existing digital application systems and setting out a clear transformation roadmap; adopting and considering a cloud-first strategy for all new digital systems; aligning to a clear data strategy; seeking to attain HIMSS EMRAM Level 7; supporting a clinically-led organisational culture by ensuring digital meets the needs of its users; and enabling clinically-led digital innovation with the aim of improving services.

In terms of timeline, early 2025 expects to see delivery of streamlined user-log in across system, implementation of a single service desk across NCA, delivery of improved Wi-Fi and delivery of modern end user computing. Work to improve data quality in preparation for EPR implementation has already commenced and will continue during 2024-25, with a detailed data strategy currently in development. NCA is also working on a roadmap and delivery plan for the digital strategy this year.

Looking ahead to expected benefits, NCA highlights that at present, the trust spends three percent of its annual revenue budget on the digital and informatics function. Whilst modernisation will “inevitably place further pressure on budgets”, this “must be alleviated through efficiencies and savings that improved systems bring for the wider organisation,” NCA states, adding: “We must ensure strong linkage in our digital solutions to overall cost savings for the organisation and together enable increased efficiencies and effectiveness.”

The strategy can be found in full here.

Strategies in the spotlight

HTN has explored a number of new strategies over recent weeks, including the operational plan and quality and improvement strategy from Doncaster and Bassetlaw Teaching Hospitals, setting out ambitions around digital, innovation, and use of data.

NHSE highlighted implementation plans for the primary care implementation of the NHS patient safety strategy here, noting the role of digital and data in areas such as automatically flagging patient safety issues to support reliability, and supporting clinical decision-making by digitally embedding diagnosis advice and safety netting.

We looked into Bedfordshire Hospitals NHS Foundation Trust’s maternity service strategy for 2024-2029, highlighting innovation and technology as key enablers to develop the service and noting plans to launch a new maternity end-to-end electronic patient record in 2025.

And from The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, we examined the new strategy for 2024-2030, with digital and data highlighted as one of nine “essential focus areas”.

Firstly, we share EPR-related news reported by HTN over the past weeks.

This month, HTN explored the new maternity strategy from Bedfordshire Hospitals NHS Foundation Trust, which spans 2024 – 2029 and shares plans to launch a maternity end-to-end EPR in 2025. We looked into the recently released strategy from The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, running until 2030 and indicating how the trust plans to implement an EPR programme with the aim of improving the “currently low” HIMSS and INFRAM scores to level five and three respectively. September has also brought the news that East Sussex Healthcare NHS Trust awarded a 10-year contract for a community electronic patient record system with an estimated value of £3,060,870 to The Phoenix Partnership (TPP).

We reported on another EPR supplier selection in late August, when York and Scarborough Teaching Hospitals NHS Trust and Harrogate and District NHS Foundation Trust announced plans to implement Nervecentre’s loud-native platform for both trusts. August saw East and North Hertfordshire NHS Trust launch maternity EPR My Pregnancy Notes at Lister Hospital’s maternity unit; and NHS England issued a prior information notice worth £18 million, signalling the beginning of market engagement on an EPR system to capture health data and records across the health and justice area. Also in August, Sussex Community NHS Foundation Trust awarded a 10-year contract extension for an electronic patient record system from TPP.

Looking further back, some of key EPR updates from across the industry this year have included Norfolk and Waveney Acute Hospitals Collaborative securing £88 million in funding for their shared EPR with the full business case approved. Salisbury NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust and Royal United Hospitals Bath NHS Foundation Trust announced plans to implement their own shared EPR; North London Mental Health Partnership shared that it will move to a single EPR system for the partnership; and NHSE announced intention to provide ‘Tiger Teams’ to support EPR delivery, defined as “a partner to create an experienced, multi-skilled, rapid response intervention service”.

We’ve also explored news and updates around EPRs on a global scale over on our sister site, HTN International. We reported how the Royal Columbian Hospital in New Westminster, Canada, recently went live with its new electronic health record; and a project in Eindhoven, The Netherlands, which focuses on organising delivery of data across healthcare organisations utilising a specific EPR.

We also highlighted a non-profit partnership in the USA aiming to help develop “affordable and tailored” electronic health record strategies for providers in underserved communities; and also in the US, the launch of a new EHR-agnostic health information exchange network to facilitate health data sharing between organisations.

Will the EPR market change in the next three to five years?

To explore views from the health tech community, we put a question to our audience via LinkedIn and asked: do you think the EPR market will change in the next three to five years?

There was a clear leader, with 50 percent of voters sharing the belief that more suppliers will enter the market over that time period; these votes came in from roles such as chief clinical and information officer, digital culture and change lead, and chief information officer.

29 percent expect the market to see fewer suppliers by 2029, including voters with job titles such as chief digital information officer, associate director of digital transformation, and clinical documentation workstream lead.

In last place, 21 percent of our voters believe that the number of suppliers on the market will remain the same, coming from roles such as deputy chief nurse, digital health consultant and clinical systems development team leader.

On a related note, we recently asked another question of our audience. Where should digital investment go in the short term: to digitising or removing paper, cross-organisational workflows, patient-facing tech or data and analysis tools? Digitising and removing paper came out on top, with 35 percent of the vote.

Earlier this year, another poll gathered perspectives on how many GP clinical systems (core electronic health record) suppliers there will be in five years’ time: below three, four to six, or more than seven? Click here to see how our readers voted.

Insights from health tech experts

Here at HTN we host a busy schedule of live virtual events (HTN Now) through which we are joined by a wide variety of health tech experts to discuss key topics and share learnings across the industry.

In the summer, we hosted a panel discussion on connecting care and extending EPR value through mobility and connected devices, with the conversation covering topics such as strategies for widening the benefits of the EPR; how to understand clinical workflows in relation to the EPR; and how to utilise mobile and connected devices for a better user experience.

During the panel, Blackpool Teaching Hospitals’ chief nursing information officer Louise Clarkson shared her views on what it means to have mobility in relation to productivity with an EPR, as well as what it means when these devices are unavailable or do not work correctly. Louise acknowledged that new projects can bring investment and a sense of excitement; but when a project moves into business-as-usual, there are often issues with equipment starting to break or with funding not covering necessary replacements. “It’s a vicious cycle,” she said. “You’ve got to maintain the mobile devices in the background, they have to be working, or people lose confidence in the system and disengage. They need to be trained properly at the start too, or else disengagement will happen there. It helps when you’ve got a really strong business continuity plan, so that if an outage happens, staff are confident in knowing how to keep going.”

Another EPR-focused panel this year revolved around planning for EPR optimisation along with the impact of engagement and leadership when it comes to major programmes such as EPR implementation and change. Sharing insights from Cornwall and Isles of Scilly ICB and the Royal Cornwall and Cornwall Partnership Trust, executive CIO Kelvyn Hipperson reflected that when it comes to ensuring the representation and engagement of staff across different roles and departments, this “tends to be done quite well in big programmes, in terms of organising workshops and getting all of that input. The trick is finding ways to carry that through into the operational service delivery”. Ways of doing this in Cornwall include ward walkthroughs to chat to team members, and getting the training team to participate in collecting that kind of feedback. “I always say that feedback is the lifeblood of what we do,” Kelvyn said, “because we can’t fix things unless we know.”

From Healthy Wirral Partnership, digital lead Paul Charnley said that his organisation has “a formal feedback structure, because our digital programme board has transformed itself into a digital services board, where we can account for our services as well as for project deliverables. I think that helps us in a more formal sense to understand where we sit. One of the key things is digital maturity assessment feedback, and the key there is not for people like Kelvyn and I to sit in a room and sign it off, but to get people’s opinions of where we are on those questions.”

In our recent panel focusing on how health and care can tackle interoperability, Kate Warriner – chief transformation and digital officer at Alder Hey Children’s NHS Trust – shared an example of a project in this area. “Internally, there is an example of an electronic anaesthetic record which is a specialist system in place for patients undergoing theatre procedures. It has enabled us to bring our drugs and vital signs into our electronic anaesthetic record, reducing the need for what used to be a big piece of paper with lots of manual inputting. That then integrates into our EPR.”

Making people’s jobs easier for them “is such an important thing to keep in mind,” Kate added. “I think integrating with your day-to-day systems is the best approach, because if you can make your interoperability feel seamless, it just becomes part of business-as-usual for your team. The end user isn’t needing to log onto multiple systems. Our shared care system integrates with our EPR, for example; so with a single click of a button from within their usual system, our clinical colleagues can access information from other settings such as primary care.”

The impact of EHR “nudges” on care quality and outcomes

Next, let’s take a look at some recent research into EHRs, published last month in Jama Network Open.

Through a systematic review of 54 randomised clinical trials, the study ought to explore the association between electronic health record “nudges” – described as “interventions that subtly guide individuals toward specific behaviours while preserving freedom of choice” –  and care quality and outcomes in primary care.

Providing context, the authors note how EHRs offer an opportunity to present nudges to clinicians in their workflows along with allowing health systems to monitor the effectiveness of implemented nudges across specialties and clinician types. Nudges can also potentially benefit clinicians by providing reminders or offering pre-selected options at decision points for review or provide extra contextual information at the point of that decision.

The researchers found that most studies (79.6 percent) involved in the review used EHR nudges to facilitate the uptake of a targeted behaviour, whilst the remaining 20.4 percent used nudges to facilitate a decrease in a targeted behaviour. The association with improved outcomes was higher among the first group (54.7 percent versus 9.1 percent).

To examine the relationship between nudges and care quality, the study identified “measure types” from a quality framework which included patient safety, effectiveness, patient-centredness, efficiency and descriptive (such as documentation patterns).

Results were varied, with the most positive impacts from EHR nudges found around descriptive or patient-centredness outcome measures. Regarding descriptive measures in particular, “most studies found that EHR nudges were associated with improvements of various documentation and care planning patterns.” For patient-centredness, overall EHR nudges were found to be associated with improvements in counselling rates for exercise, diet and blood pressure.

For effectiveness, EHR nudges were associated with improvements for 19 of the 48 measures; for patient safety, there were “few” positive associations between nudges and an impact on patient safety, with only four out of 12 studies identifying an association. Regarding efficiency, the review examined four studies assessing efficiency measures, but found that EHR nudges were not associated with improvements.

Discussing their findings, the authors state that whilst EHR nudges “may improve specific dimensions of health care quality”, there were “less consistent findings” in other areas. Looking at the more positive results around descriptive measures in particular, the study states that “EHR nudges may facilitate improvements in clinicians’ documentation patterns, such a completeness or accuracy”; but this pattern was less consistent for studies targeting clinicians’ ordering behaviours.

Wider studies exploring clinician adherence to EHR nudges suggest that primary care clinicians have increasingly adopted templates to support their documentation, the authors add; this could suggest that “higher clinician acceptance of a nudge or its fit in the workflow may be important factors that influence the effectiveness of the nudge.”

EHR-based nudge interventions “are a promising strategy for improving evidence-based care delivery in primary care”, the authors conclude, and have the potential to change specific dimensions of health care quality. However, to strengthen the evidence for nudge interventions, they recommend that additional implementation studies take place to better understand the context of when nudge interventions work.

Citation: Nguyen OT, Kunta AR, Katoju S, et al. Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care: A Systematic Review. JAMA Netw Open. 2024;7(9):e2432760. doi:10.1001/jamanetworkopen.2024.32760

The strategy sets out an aim to improve care access and efficiency through use of technology and enhancement of overall digital maturity, and to take a digital-first approach to care through use of tools such as electronic patient records whilst empowering staff to improve their digital skills.

On the key objective of becoming a digitally-enabled and data-driven organisation, QEH states that digital solutions and technology will be “embedded within all care pathways”, with data recorded from care to be used as the foundation to support evidence-based decisions and strategies. The trust commits to supporting staff to develop their digital literacy to maximise the benefits of tech, and to working with ICS partners to support patients in accessing information and engaging digitally in their care.

Specific actions here include implementing an EPR and a “digital first new hospital”. In terms of measuring success, the strategy shares that a number of nationally approved benchmarks such as HIMSS Infrastructure Adoption Model and the NHS Digital Maturity Assessment will be used to map progress. In particular, the EPR programme will aim to improve “currently low” HIMSS and INFRAM scores to level five and three respectively. The latest edition of the trust’s digital strategy is to focus on meeting these targets, alongside “delivering the NHP (New Hospital Programme) digital first hospital”.

With regards to providing clinical excellence across the trust, QEH pledges to “embed continuous quality improvement, research and innovation into everything we do, including digital maturity”. Success is to be measured through initiatives such as an annual review of how advanced practices are integrated, and an ‘excellence questionnaire’ which will gather insights into what each clinical team views as excellence; their requirements for specialised training; and the current landscape around quality improvement.

Additionally, QEH highlights plans to measure success in becoming a “centre of excellence for technology integration” by measuring the number of services adopting artificial intelligence solutions into workflows, and by monitoring the number of staff trained in point of care ultrasound techniques.

Plans are laid out to establish a robust framework for governance and leadership that will promote transparency, accountability and decision-making through continuous improvement, and this will include use of technology for governance purposes such as board management software and risk management solutions.

With an objective focusing around person-centred care and experience, the trust places focus on plans to promote physical health, overall wellbeing and quality of life through a holistic approach, considering unique needs and preferences as part of the care decision-making progress. This will be supported through use of “reliable and timely” data, and data such as patient satisfaction scores and service user analysis will also be used to measure success. QEH will also undertake a thematic review of patient safety incidents related to data errors to identify trends and look to implement preventative measures.

Within the strategy QEH takes the opportunity to highlight a case study around use of tech regarding the roll-out of the patient observation management system (POMS) in March 2023, with the system including e-observations, replacement of inpatient ward boards with digital smartboards, and use of a “WhatsApp-style” app for clinical communications. The trust states that POMS is now fully operational in 16 out of 18 areas with improvements noted in patient safety and overall patient experience, sharing that the past year has seen more than 200,000 e-observations taken and just under 1,500 members of staff using the app to communicate. “Huge benefits” are noted including timely response to messages, time saved by bed co-ordinators, and freeing up ward phone lines.

To view the strategy in full, click here.

Strategies in the spotlight

Last week HTN reported on the Scottish Government’s strategic plan for 2024-2027 for the Scottish Cyber Coordination Centre, outlining the vision for a “digitally resilient nation” and setting out an overview of operating principles, functional structure and service development plans.

We explored Royal Cornwall Hospitals NHS Trust’s research and development strategy, running until 2028 and built around three key objectives: to undertake a journey of improvement including utilisation of digital healthcare tools and services, to ensure safe, high quality care, and to support and value the workforce.

From South East Coast Ambulance Service NHS Foundation Trust we looked into the strategy for 2024 – 2029, which highlights plans to “build a stronger SECAmb ready to face the challenges of the future” with digital tools to play a key role in offering a new service model.

And we highlighted how South Yorkshire ICS published its data and insights strategy for 2024-2026, setting out ambitions to build an intelligence-led system using data to improve health and wellbeing outcomes and experiences, with focus on evaluating care pathways, improving population understanding and tackling health inequalities.

Here, we share key comments and views from across the industry.

Identifying the challenges and “missed opportunities” from the past decade in the NHS

Louise Wall, managing director, e18 Innovation, said: “One of the most significant missed opportunities of the past decade, in my view, has been the slow adoption of automation technologies in healthcare. As Lord Darzi points out, the NHS is still in the “foothills of digital transformation”. This lag has contributed to many of the inefficiencies and capacity issues highlighted in the report.”

From Apira, director and founder Geoff Broome commented: “Lord Darzi’s report rightly identifies the ‘big shifts’ we’ve been talking about for years—community-based care, digital innovation, and prevention. However, the challenge we face now is that the starting position is much worse compared to when similar suggestions were made in 2002.”

“Over the last decade we’ve really missed out on inclusive communication for patients,” said Rachael Grimaldi, co-founder and CEO, CardMedic. “This inability to communicate is a major cause of healthcare inequality, delays in care, poor patient engagement and health outcomes. To make real changes, we need to break down the existing barriers in the NHS and facilitate widespread adoption of technology.”

Joseph Waller, co-founder at Aire Logic, shared his view: “What the government fail to understand is that the moment they create a commercial scope for a major programme they inadvertently create silos of disconnected data. Until they are able to recognise the commonality of technical services in the sense of a (SOA) service or micro-service, they will continue to effectively create the same system a thousand times over in the NHS.”

From iPLATO Healthcare, founder and CEO Tobias Alpsten considered: “AI could be revolutionising diagnostics and patient care, yet its implementation remains patchy. Similarly, the NHS still struggles to fully embrace cloud infrastructure… The focus must shift from small pilots and fragmented innovation projects to widespread digital adoption.”

Rachael Fox, executive vice president, EMEA at Altera Digital Health said: “While the NHS has never had so much funding, it hasn’t been enough to keep pace with a population with changing care needs, or the digital transformation witnessed in other sectors.”

Speaking from Dosium, CEO and co-founder Nicholas Appelbaum commented: “For innovation to spread and drive change, mandated open standards for interoperability are an absolute must. Right now, it isn’t the case that this infrastructure is in place, and frankly this is limiting the potential of technology to drive change. By definition, it is siloing efforts.”

“Despite policy intentions, investment has predominantly favoured hospitals, leaving community services under-funded and overwhelmed,” said Chris Hornung, MD for public sector, Totalmobile. “Embracing digital tools allows community-based trusts to gain the reliable data needed…isn’t just an opportunity; it’s a necessity to enhance service performance and patient care.”

The role of technology in helping to secure the future of the NHS…

Liz Ashall-Payne, CEO of ORCHA, stated: “While the report rightly emphasises the role of data and infrastructure, we must focus on giving patients access to practical digital health tools like mental health apps and chronic disease management platforms now.”

From Corti, CEO and co-founder Andreas Cleve commented: “To turn the tide, we need a bold, strategic vision focused on sustained investment in both infrastructure and groundbreaking technology. AI has the power to rebuild healthcare from its foundations, starting from the very first moment a patient seeks help…but for AI to fulfil its promise, it must be embraced as part of a well-thought-out, long-term strategy.”

“As a community we need to work on rebuilding trust by partnering with healthcare professionals to create solutions that genuinely work, being honest about limitations, and building a strong culture of data engagement,” shared Scott Fletcher, CEO of Real World Health. “By doing this, we can change mindsets, lay the groundwork for adopting more advanced tools, and move towards that key goal of a more proactive, preventative healthcare model.”

Mark Reynolds, Founder and CEO at Hable, said:  “Investment in technology is fantastic. But to get anything out of it and ensure we are really changing how NHS staff work, we must also close the digital skills gap.”

From Redmoor Health, founder Marc Schmid noted: “We need to take the politics out of the NHS which is plagued by short term decision making and welcome commitments from the government to build a consensus from all quarters around how we meet these challenges and focus on a much longer-term strategy beyond the general election cycle.”

Speaking from Accurx, CEO Jacob Haddad highlighted: “As Lord Darzi’s report says, the vital signs are there, and so we must now focus on scaling the solutions that have been proven in innovative parts of the system.”

Amber Nigam, Basys.ai, shared a view: “Looking ahead, the focus must be on long-term investment in modern technologies that can streamline processes, reduce clinician burnout, and ultimately improve patient outcomes. This isn’t just about the immediate benefits; it’s about flattening the cost curve and preparing the NHS for future challenges.”

“Innovative projects focused on tackling inequalities, reducing waiting lists and moving care from hospitals to homes have demonstrated the huge potential innovation has to support the productivity of the NHS and the health of the nation,” stated Richard Stubbs, chair of the Health Innovation Network. “We must focus on supporting implementation and adoption of innovation.”

Julian Coe, X-on Health, said: “Realising this digital ambition does not necessarily mean spending on brand new systems…but instead…optimising existing tools that are integral to the delivery process and making the best use of the digital systems already in place.”

 Director of public sector & unified platforms at Exponential-e, Afshin Attari, commented: “The success of using digital data platforms complimented with AI in diagnostics and transforming the NHS patient outcomes relies heavily on the availability of skilled personnel, robust infrastructure and a substantial investment in cybersecurity to protect sensitive patient data from breaches and cyberattacks.”

“The future of healthcare, as outlined by Lord Darzi, lies in the intersection of technology and patient care…requiring a blend of human compassion and cutting-edge technology,” reflected John Kosobucki, OX.DH. “There needs to be a desire to make that turn, and an understanding that making no change has consequences. All large corporations have to manage staff, help them communicate, schedule work and handle sensitive data. Of course, the NHS is different. But not that different.”

Manjul Rathee, co-founder & CEO, BfB Labs, considered: “To unlock productivity and improve care, a major “tilt towards technology” is needed, including empowering staff, tapping into the richness of NHS data, and embracing AI. The report serves as a wake-up call and a roadmap for the NHS to pivot towards a digital future focused on prediction and prevention.”

VP corporate marketing at Kiteworks, Patrick Spencer, said that the potential of AI to transform services “is enormous”, but specified that “the safeguarding of sensitive information remains paramount”.

Speaking from Lenus Health, director Jim McNair commented that the report is “not the first to point to the largely untapped potential for digital pathway tools and AI to transform care. The time to act on digital and data driven transformation is now.”

Professor Hatim Abdulhussein, CEO at Health Innovation KSS, noted that in his view, with “the right investment and partnerships, AI and digital innovations can significantly increase capacity and efficiency. This will enable the NHS to overcome its current challenges and emerge stronger, more efficient, and better equipped to serve the nation’s health needs in the long term.”

From Rackspace Technology, healthcare executive in residence Jason Jones commented: “We must focus on clinician-led transformation initiatives…Additionally, aligning individual trusts under integrated care boards will ensure better investment decisions in digital technology and infrastructure, ultimately serving the population more effectively.”

“One game-changing technological improvement would be ensuring a single patient view with role-based access,” pointed out David Hammond, deputy chief strategy officer, Wirral Community Health and Care NHS Foundation Trust. “This level of information sharing is necessary though not sufficient. We also need to ensure our capacity, both of people and technology, is focused in the right places.”

Dr Ruby Bhatti, OBE DL, stressed the need to “stop the tick box exercises of completing interviews with stakeholders… We can only realise the ambition if we all work together and address the challenges without being defensive, leaving the blame game behind and truly looking at the fractured system through the patients and staff’s voices and eyes to move forward.”

Kevin Douglas, co-CEO, Alertive, raised the need to ensure that “enablers like improved connectivity aren’t overlooked to get more value from investments made to date, such as EPR, and the technology on the immediate horizon, such as FDP and the broader use of AI”.

Steve Sawyer, managing director, Access HSC, commented: “All too often pockets of success sit in silos and are duplicated across the country.  By creating more momentum to deliver digital ecosystems that span the care continuum – with the help of industry partners that can meet these cross-cutting needs – the NHS can achieve greater value and outputs from technology and data.”

From Answer Digital, CEO Richard Pugmire reflected:  “If the government is to deliver on its promise to move the NHS from ‘analogue to digital’, this will require funds to be directed in such a way that will help scale the technologies that have the biggest impact on enhancing productivity.”

“Using technology to address the issues around access to community-based and general practice is vital to the wider achievement of the aspirational shift from diagnosis and treatment to prediction and prevention,” said Antoine Lever, commercial director, babblevoice.

Fast and efficient diagnostics are “key to addressing the backlog,” said Maddy Phipps-Taylor, managing director (EMEA), Magentus, “and the workflow around pathology and radiology services will remain critical in enabling the vital shift towards early detection and prevention.”

Dr Mark Ratnarajah, NHS paediatrician and UK managing director for C2-Ai, concluded: “With the NHS empowered with new permission to learn and improve, scaling such technology could equip teams with the insight to prevent avoidable emergency admissions, safely reduce waiting lists with existing resources, prevent scandals through early intervention, and make the most impact with resources across healthcare systems.”

… and the role of data

Commentators also highlighted the potential for data to play a role in the future of the NHS, with comments focusing on the importance of data for the development of technologies such as AI, and in learning more about the current status of our health system.

Roberto Anello, regional president for Northern Europe, AGFA HealthCare, stated: “Despite efforts made so far, we’ve really only scratched the surface, in terms of the efficacy of digital solutions that are truly representative of a connected acute and community health system. Using the vast amounts of data that is largely untapped, the NHS could spearhead instrumental changes in patient outcomes.”

AI and data are two examples highlighted in the report of where tech has the power to transform services,” said Tara Athanasiou, director of advisory practice, Ideal Health. “But to achieve their potential we need to move beyond pockets of brilliance… Rather than wrestling with things like information governance at organisation and ICS level, why not do it once, do it well and make it available at scale?”

From Stress Point Health, Sheena Pirbhai shared: “The report echoes much of the discourse we’ve already seen, but what the NHS desperately needs now is not more diagnosis, but bold, transformative steps that move beyond reiteration…The NHS should be focusing on the rapid implementation of technology instead of going over the same challenges we know exist.”

Cara Afzal, programme director for data & digital, Health Innovation Manchester, shared: “Key digital tools such as the shared care record, digital patient apps, and secure data environments are foundational in addressing the growing demands on our region’s healthcare system.”

“There’s huge opportunity to further transform healthcare with the use of data for early detection and predictive analytics but investments, standardisation and regulations all need to be considered,” stated Henry Gallagher, managing director, G2 Speech.

Jonathan Elliott, managing director at Epro, said that “many great British companies, including many SMEs, have developed some fantastic solutions that deliver real value and tangible business case benefits yet operate below the radar of many in the NHS. Unlocking and promoting some of these world class solutions must be a central plank within the strategy.”

Data is key, said Darren Goode, CTO, Egress Group: “If we are to pivot to preventative care as Lord Darzi sets out in the report, NHS trusts need real-time access to this data in the right context. Only then will embracing innovations like AI also deliver its true potential… it’s time we started thinking differently about data.”

Phil Bottle, managing director at SARD, pointed out that until greater focus is placed on strengthening the understanding of clinical capacity and demand, “NHS trusts will not be empowered to make informed decisions about their workforce and digital expenditure…it will be impossible to hit whatever productivity targets the Government set…and patient outcomes will suffer as a result.”

“As the NHS continues its recovery, I believe that data quality will be crucial to long-term success. Accurate and well-managed data is essential for transforming the way waiting lists are handled and ultimately improving patient outcomes,” highlighted Basil Badi, director for data management, Ideal Health.

From Radar Healthcare, CEO Paul Johnson commented on the “real need for joined-up, automated, integrated data to be the driving force for this continuous improvement”.

Insights on challenges for innovators

Paul Landau, CEO of Careology, said: “The brilliant but overstretched workforce doesn’t have the tools right now to move care from being reactive to preventive….Our combined goal must be to provide clinicians with information at their fingertips not only to help patients on an individual basis, but to improve services and outcomes at a larger scale.”

CEO at Naq, Nadia Kadhim, added: “If digital health is not governed in new ways, NHS transformation teams and innovators will continue to be held back by ever increasing requirements, confusion and regulation costs.”

Further questions from the industry

The report not only inspired comments and reflections on challenges facing the NHS as it moves into the future, but it also elicited further questions and scope for future focus.

Martin Bell, director, The Martin Bell Partnership, asked: “So, we’ve had the review, it had told us what we already knew – what is now the actual, practical, on the ground plan, properly resourced and funded, to make it happen?”

“It is clear that this country has the ability to deliver a universal healthcare system that could be a shining example to the rest of the world, as it once was, but there is a long and difficult road ahead to get there,” said Dr Suvir Venkataraman, general manager, Harley Street Fertility Clinic. “This review provides the opportunity to go further and question not only ‘how to get back the good old days of the NHS’, but consider what might the best in 21st century integrated universal healthcare look like?”

Chris Robson, Living With, considered: “In many ways, the technology analysis was very high-level and will need much more work done…if we are going to move to what Lord Darzi is advocating as “predict and prevent’ then it is going to need a lot more thinking, given that so many of the basics are not working well.”

Chad Holmes, Cynerio, questioned the “complete lack of attention focused on cyber security” within the report and emphasised: “While adoption and adherence of these resources still has a long way to go, the heroic efforts of IT and security teams should be noted, particularly as the results of austerity measures and capital shortfalls have negatively impacted all members of the NHS.”

Nick Wilson, CEO of System C, said that he would “like to see the government prioritise the integration of care with existing technology systems to minimise delays and substantial disruption…. post-implementation people must be held accountable for delivery. It is the only way that the real benefits will be delivered.”

Dr Rishi Das-Gupta, CEO of the Health Innovation Network South London, shared a hope that the report “will result in more of a focus on the digital innovations which can improve staff experience and care in the short term such as ambient voice technology and automation… and will help speed up the adoption and spread of proven innovations that can improve the lives of patients and staff in the NHS.”

And last but not least, Chris Barker, CEO, Spirit Health, concluded: “The key now is how we action this and make a difference for patients, staff and the system. Increasing what is understood about the difficulty of deploying improved ways of working in the NHS at scale…Listening to patients and doctors in the context of this report and work out how together to drive change.”

We’d like to thank everyone who shared their insight with us on this topic.

To read HTN’s breakdown of the major findings on digital and data from Lord Darzi’s report, please click here.

Professor Lord Darzi was selected to lead the report and has considered available data and intelligence in order to assess patient access, quality of healthcare provision and overall performance of the NHS. Here, HTN explore the findings and implications around digital and data.

The report outlines key findings including that the NHS “has been starved of capital”, with the capital budget repeatedly used to fill holes in day-to-day spending. Lord Darzi notes outdated buildings and impacted productivity as a result with “outdated scanners, too little automation, and parts of the NHS [that] are yet to enter the digital era”. Over the past 15 years, whilst other sectors have been “radically reshaped” by digital technologies, Lord Darzi states that the NHS is “in the foothills of digital transformation” and highlights the last decade in particular as a missed opportunity to prepare the NHS for the future by embracing technology and its ability to support a pivot from a ‘diagnose and treat’ model to one focused on prediction and prevention.

Also on funding, the report states that the health service as a whole, as well as individual trusts, lacks the authority to decide how NHS budget is divided, impacting on investment in digital technology and buildings.

Lord Darzi reflects that “important themes” have emerged from the report with regards to how the NHS can be repaired, which will require consideration alongside strategies to improve the nation’s health and reforms to social care. A “tilt towards technology” is one of these themes, with Lord Darzi stating that a major tilt is needed towards tech in order to unlock productivity. In particular, he notes high numbers of NHS staff working outside hospitals who “urgently need the benefits of digital systems”, and recognises the “enormous potential of AI to transform care and for life sciences breakthroughs to create new treatments”.

Focusing specifically on technology, Lord Darzi reflects that the NHS “continues to struggle to fully realise the benefits of information technology” and “always seems to add to the workload of clinicians rather than releasing more time to care”. Additionally, the richness of NHS data is “largely untapped” for clinical care, service planning and research, the NHS struggles with data-sharing, and digital maturity is reported to still be low across much of the NHS.

The report acknowledges significant investments such as the federated data platform and examples of start-ups committing to improving healthcare quality and efficiency, but comments that “too many of these remain subscale”.

Additionally, investment in IT focuses largely on acute hospitals rather than other providers, with technology platforms that have existed in the private sector for more than 15 years such as automated route planning “rarely found in the NHS”. Lord Darzi stresses that there are many technologies with the potential to support community care, but they are “largely absent”, and adds that with the shift in disease burden towards long-term conditions, there is a “greater need for information systems that work across different settings”.

In common with community services, the report adds, there has been underinvestment in technology with the potential to improve mental health community teams. Research indicates that productivity in this area has not dropped, but Lord Darzi comments that it was not “likely to be high to begin with, given the poor use of technology and the absence of sufficient management information to drive up performance”.

Additionally, Lord Darzi explores issues with patient flow from emergency departments due to a number of factors including capacity of the departments themselves; workforce and physical space; availability and speed of diagnostics; and availability of beds for admission. He emphasises that this is the result of intersection of high levels of demand, often caused by lack of investment in the community, as well as “chronic capital underinvestment in both facilities and technology” alongside operational planning and management issues.

On AI, the report suggests that we are “on the precipice of an artificial intelligence revolution that could transform care for patients” and highlights a submission from the Royal College of Radiologists indicating that 56 percent of NHS trusts are already using AI within radiology. In order to capture the benefits afforded by AI more widely, Lord Darzi repeats the need for a fundamental shift towards tech.

With regards to access to NHS services, Lord Darzi brings attention to the concept of the digital front door and comments that whilst the pandemic led to a rapid increase in registrations for the NHS App with nearly 80 percent of adults registered, less than 20 percent are reported to use it on a monthly basis. He states that the app is not delivering a ‘digital-first’ experience similar to that found in other aspects of daily life, noting that “just one percent of GP appointments are managed via the app” – however, he also notes the “huge potential”, calling on the App to improve both efficiency and patient experience.

Looking at changes in the population and strategic priorities for service change in the NHS, Lord Darzi notes that the fundamental driver of change in healthcare provision is change in the needs of the population, with a need to better plan interventions based on strong evidence; integrate care; and place more focus on community care. A challenge here is availability of resources to provide high-quality, multidisciplinary care, including modern facilities, digital infrastructure and supporting diagnostics as well as the right professionals with the right skills. The report calls for a shift in the distribution of resources towards community-based primary, community and mental health services, pointing to research from NHS Confederation which indicates that “on average, systems that invested more in community care saw 15 per cent lower nonelective admission rates and 10 per cent lower ambulance conveyance rates together with lower average activity for elective admissions and A&E attendances”. On access to community services, the report points out that proper assessment is hampered by lack of data, with information on the total waiting list size only available from 2022.

The report draws focus to the wide variations in performance by providers within the same settings, with “plenty of scope for improvement in many organisations”. Many of the productivity problems in the NHS are caused by interaction between different parts of the system, Lord Darzi reflects. Using congestion in acute hospitals as an example, he writes that the “only sustainable solution” here is to “build up the capacity, capability, infrastructure and technology base of care that is delivered in the community, including general practice, community services and mental health services”.

When it comes to resources and productivity of general practice in particular, Lord Darzi acknowledges the wide array of challenges in this space and comments that “some GP practices have embraced extraordinary innovations” in the face of this, including shifting towards a digital model, introducing “impressive” approaches to triage, and boosting responsiveness to patients. “I saw some remarkable examples of local innovations that were improving access and quality of care,” Lord Darzi writes, “while also relieving pressures on acute hospitals.”

On the role of digital around inequalities in health and care, the report highlights a survey of Faculty for Homeless and Inclusion Health members which found that health services are “very difficult for inclusion health patients to access”, with concerns raised around digital exclusion in particular.

Moving on to look at staff attitudes, the report highlights that many staff feel disempowered and disengaged; research for the investigation found that the top three words NHS staff used to describe their experiences were ‘challenging’, ‘tiring’ and ‘frustrating’. Again, chronic underinvestment is raised into processes and infrastructure. “While the evidence shows that health information technology improves care, the National Audit Office found that the NHS track record on digital transformation had been poor,” Lord Darzi writes. Focus groups undertaken for the purpose of the report found a “strong perception” among staff that IT creates an additional burden. This, alongside poor definition of operational processes, are believed to be “at the heart of the feelings of disempowerment and disengagement”.

Click here to access Lord Darzi’s report in full.

Other news from the government

At the start of the month HTN highlighted that The Department of Health and Social Care has selected Norfolk County Council, Medway Council and Lambeth Council as test sites for the digital NHS Health Check, with the platform to be trialled with a small number of patients in early 2025.

In July we reported how five new quantum research hubs are to be launched in the UK with an investment of £100 million, tasked with developing quantum technology for industries including healthcare.

HSE notes that an annual digital health budget of between four percent and six percent of the overall healthcare expenditure is being sought to deliver the initiatives outlined in the roadmap; as such the roadmap serves as the business case for this funding.

The strategy highlights a need to reimagine how transformation is delivered, noting challenges from existing processes and structures including large programmes running in parallel and consuming the same resources, increased technological complexity, implementations that are not fully completed and lack of focus on patient workflows. The required change will see “strong emphasis on reusability and alignment”, built on the concept of platform-based architecture – leveraging pre-existing platform components and services to speed up solution development, reduce costs and develop a solid foundation.

HSE goes on to explore each of the six principles in more depth, starting with the patient as an empowered partner and highlighting two particular programmes designed to support in this area. The QUIT programme aims to help people stop smoking by offering services such as counselling, medication support and online resources; and the Text About It programme offers mental health support including a confidential text messaging platform. Other initiatives include remote monitoring and appointment scheduling and management; the national shared care record to consolidate data from different systems and provide a cohesive view of a patient’s history; and the telehealth programme, offering improved accessibility to services and streamlined workflows.

On the second principle, workforce and workplace, HSE pledges to invest further in staffing and infrastructure to enhance the permanent capacity of health and social care services and expand the range of services available in the community. This includes plans to develop a platform offering “seamless access to comprehensive health information” including diagnostics and clinical tools, with reliable and secure connectivity designed for resilience and adaptability.

Focus will also be placed on enhancing digital literacy within the workforce and improving employee experience by providing fit-for-purpose digital tools and resources. These will include an application and digital wallet allowing the workforce to access information, education and learning resources, annual leave requests, occupational health management and interactions with the wider team; simplified processes for new, moving and leaving staff; and work environments designed to help workers “effortlessly transition between different settings while retaining access to the resources they require”. Additionally, HSE commits to prioritising mental and physical health for employees with utilisation of digital tools to tackle stress and reduce burnout, and also highlights plans for continuous skills development and evaluation to support staff in adapting to new ways of working.

On the principle of digitally enabled and connected care, HSE notes plans to integrate information and systems into single digital longitudinal health records, with the vision to have a single comprehensive EHR for every individual. EHRs will “serve as the central tool for managing all patient-related health and social care documentation and will interface with the overall digital platform, allowing for the assessment, analysis and use of all health-related data”. HSE acknowledges that the approach to introducing EHRs “will be complex, as we are not starting from a green field setting”, with multiple systems already existing across the healthcare landscape; however, the strategy highlights how collaboration with partners to define critical national standards for data sharing and use will help to establish a national procurement framework and a shortlist for successful enterprise-level EHR vendors.

It is expected that a consolidated number of EHR systems will be regionally deployed for data sharing within and between regions; the digital solutions present within primary care will be supported and developed; and private hospital systems will develop interfaces to enable bidirectional flow of clinical information.

Specific high-level initiatives in this space include development of a shared care record with comprehensive data integration and modern standards-based APIs; a collection of digital tools designed to support population health management, such as screening services, disease registries and population health analytics; and electronic observations and vital signs monitoring to support diagnostics.

Another key plan is the “comprehensive standardised data capture and digitisation of health care records, that will quickly deliver value, speed up digitisation within the healthcare system, and prepare essential groundwork for the introduction of EHRs”. Activities in this area include digitising existing paper records, developing an eForms platform to facilitate data exchange and standardising terminology to ensure consistent representation of clinical information.

Moving onto the fourth principle of data-driven services, HSE emphasises how real-time monitoring of data will highlight capacity challenges as they arise and support informed decision-making as a result, with data on patient flow and length of stay or treatment used to ensure appropriate resource management. In particular, HSE points to the Integrated Information Service, the main data analytics service for the wider health sector in Ireland, and highlights the implementation of a health performance visualisation platform designed to provide data flows and analytics capacity to examine activity and blockages across the hospital network.

With regards to the digital health ecosystem and innovation, HSE notes the establishment of the Health Innovation Hub Ireland, supporting the adoption of new technologies and processes across the system, and highlights the potential of AI to improve diagnostics, support precision medicine, enhance patient monitoring, aid data quality and assist in drug discovery and development. A strategy built around AI is set to be developed, and HSE also shares plans to explore AI therapists (chatbots), robotic process automation and blockchain technology for health data management.

Collaboration with partners such as  universities, innovators and academic health networks will “play a crucial role in supporting innovation,” HSE states, bringing together expertise, resources and diverse perspectives to drive advancements.

Around the final principle, secure foundations and digital enablers, HSE highlights the need to establish effective governance, foster a supportive culture and create a secure and resilient infrastructure, which can be “achieved by integrating architecture, service design, cyber security, agile delivery, and data engineering into our health service”. This principle is the “anchor of this comprehensive transformation”, HSE states, and to ensure success the system requires key foundational elements including strong leadership and governance and comprehensive change management support.

Work will go into establishing clear legal frameworks and regulations to govern digital initiatives, where appropriate, along with establishing decision-making authorities and structures to promote accountability and transparency. Other planned actions include developing a platform to support healthcare system-wide federated identity and access management between healthcare organisations; introducing architecture practices to restructure the digital and operational aspects of the care system to support interoperability; and incorporating agile delivery methodologies to keep a focus on responsive and user-driven solutions.

With regards to staff, HSE also plans to develop a workforce strategy to address recruitment, retention and performance management; conduct a comprehensive assessment of existing digital skills and knowledge across the workforce; and offer cross-disciplinary training such as workshops, webinars and mentorship programmes to support the workforce in digital upskilling.

The strategy also places specific focus on integration, interoperability and data engineering in this area, noting plans to establish a “national data coordination framework for seamless healthcare information management”; to build a unified set of data management standards; and to build data engineering and integration capabilities across the system.

In terms of timings, HSE shares “immediate actions required”, including the establishment of a governance framework; a dedicated transformation team; and data, standards and interoperability requirements “to serve as a critical foundation”.

Going on to look at year one and two of this roadmap, priority actions will include developing a patient portal, HSE App and HSELive Contact Centre; focusing on remote care monitoring, digital therapy, ensuring reliable secure connectivity and modernising the workplace and productivity tools; developing the shared care record, diagnostics and medication management; and focusing on population health management, EHR procurement and delivery and national clinical information systems. Other actions include exploring patient journey analytics, healthcare data analytics and scheduling, rostering and resource management; legislation and governance; patient identity management; integration, interoperability and data engineering; and the ICT cyber programme.

Focuses for year three and four of the plan include developing a mobile ecosystem for the frontline; medical device integration; integrated referral management; healthcare research; healthcare worker identify and access management; crisis response healthcare; and a 24/7 support function.

Looking ahead to the future from year five onwards, HSE will be focusing on developing a patient feedback platform and open health AI framework; public facing engagement and learning programmes; an employee feedback platform; AI in healthcare; and launch of the first EHR.

To access HSE’s digital health strategic implementation roadmap in full, please click here.

Ireland in the spotlight

In July, HTN reported on the publication of Ireland’s Health Information Bill 2024, designed to provide patients with increased access to their own information and providing a “clear legal basis” to establish a Digital Health Record across Ireland.

Earlier in the year we interviewed Aislinn Gannon, general manager for digital health at HSE.

And we explored HSE’s telehealth roadmap for 2024-2027 here.

The digital health strategy of Jersey as a five-year programme sets the aim of making Jersey a “digitally-world-class health and care systems” utilising technology “everywhere to deliver accessible, joined-up, person-centred care”.

Three activities are listed as having been completed to date, including the implementation of a strategic method for clinical image storage, referred to as a vendor neutral archive; the replacement/upgrade of obstetric sonography system software; and the replacement of an audiology legacy system.

With regards to the EPR programme, workstreams have been delayed “due to dependencies on the hospital Wi-Fi improvement plan”. The report adds that “once the patchy Wi-Fi issues in the hospital have been addressed, the Wi-Fi modules can be progressed” and thus “EPR workstreams are now scheduled to be implemented into mid-2025”.

The report goes on to include systems planned for introduction with work currently on track include an e-referral process and e-prescribing for chemotherapy as well as an e-consent system for surgical procedures.

Additionally, the document highlights positive progress around plans to replace the picture archiving and communications systems (PACS) legacy system; the undertaking of an IT service model review for commissioned services; upgrading the cervical cancer screening service to increase efficiency and automation;  provision of virtual consultations; improving Wi-Fi connectivity in hospital; and providing digital support for faecal immunochemical testing.

The government notes confirmed delays around plans to introduce an EPR for adult social care and deployment of infrastructure for electronic patient medicines administration (EPMA).

Yet to begin is a project set to implement a new EPR system for ophthalmology.

The report also shares a range of key metrics being measured by Jersey’s health and community service, including waiting times on elective paths, elective theatre list utilisation and outpatient did-not-attend (DNA) rates. On the latter, the document highlights that Jersey’s DNA rate “remains static at around 11 percent for the first half of the year” and draws focus on ongoing work across outpatient improvement projects, including “digital initiatives which have a longer-term implementation timescale”.

View the report in full here.

Earlier this year, HTN explored a review on Jersey’s EPR implementation which highlighted the need for “greater focus on effective stakeholder and user engagement, as well as more effective discipline around the identification, monitoring and delivery of benefits”.

Strategies and plans

Last week we reported on the data and insights strategy from South Yorkshire ICS for 2024-2026, which sets out ambitions to build an intelligence-led system using data to improve health and wellbeing outcomes and experiences, with focus on evaluating care pathways, improving population understanding and tackling health inequalities.

Earlier in the month, we looked into a new strategy from the North West London Acute Provider Collaborative, outlining shared priorities and plans to “address complex, system-wide issues more effectively in the years ahead”.

From Royal United Hospitals Bath, HTN explored the research strategy spanning 2024-2029, highlighting how “the digital explosion in healthcare provides us with much data” and outlining the use of this data to support the trust’s key strategic priorities as “core business”.

From Scotland, we examined the climate emergency and sustainability strategy for 2024-2027 along with an action plan for delivery.

And from Wales, we took a look at Digital Health and Care Wales’ organisational strategy for 2024-2030.