It’s time for the first instalment of our Health Tech Trends Series 2022, in which we consider the latest topical issues and questions across the industry and ask experts from the sector for their perspectives and opinions.

Our first foray into 2022’s trends takes us towards the role of a ‘digital champion’ – a phrase used to describe staff who are trained to support digital work within the NHS, or similar organisations.

The title can appear as somewhat of a buzzword at the moment – but its frequency reflects the importance of the role in helping unleash new technologies or ways of working, during a period of transformation in which the NHS had advanced at scale with new implementations and roll-outs in data, digital, and beyond.

But what is a digital champion, really? what do they do? how do they do it? and, more importantly, what makes a great one?

At HTN we were prompted to consider the latter question by a combination of research from the University of Melbourne’s Centre for Digital Transformation of Health, and the release of Health Education England (HEE)’s latest toolkits to help embed digital skills, confidence and best practice within the health and care workforce.

The latter organisation’s Digital Champions Programme Toolkit (from April 2021) and Digital Champions Toolkit Adult Social Care (released in January 2022) are designed to assist those who can, in turn, then support other learners with their ‘understanding of digital technologies and their confidence and motivation to use them’. Overall, the ultimate goal is to help improve the digital literacy of the workforce and, consequently, the quality of care received by patients.

The most recent toolkit release for adult social care also posed the question, ‘What is a champion?’ – succinctly describing the role as an “individual, usually a volunteer, who promotes a particular topic and shares their knowledge and skills of that subject with colleagues and / or service users.”

Other terms used to describe digital champions in the document include ‘go-to people’, ‘first point-of-contact’ and ‘approachable individuals’ who can ‘share enthusiasm and knowledge of digital’ in an easy-to-understand way, or a ‘colleague or volunteer who likes helping others’ and ‘enjoys solving problems’.

However, it also adds that the chosen digital champions do not necessarily need to be from inside your own organisation – but can instead be external and ‘in the community supporting digital skills from the outside in’.

The toolkit continues its profiling of the role by outlining its three main aims: to empower staff to use digital tools more effectively; increase confidence, understanding and motivation; and increase the overall digital skill pool.

According to HEE, the actual work of a champion can take the form of sharing their work, skills or knowledge through shadowing or observing, buddying, peer-to-peer learning, or through supported self-guided learning or sharing of resources.

Melbourne’s Centre for Digital Transformation of Health, meanwhile, has created a helpful graphic which condensed answers to the question, ‘What does a digital health champion look like?’, based on responses from a selection of fellows.

We asked our #LHSAcademy Fellows what a Digital Health Champion looks like to them. Looking forward to helping them reach their Champion potential! ‍@RahulDBarmanray @HilmyIsmail121 @drJunJung @Lorelle_Martin @DrJoannaL @Unimelb @unimelbMDHS #DigitalHealth #HealthTech #health pic.twitter.com/StoaAJSDKY

— Centre for Digital Transformation of Health (@DT4Health) February 15, 2022

Some of the most thought-provoking replies that were mapped out by the graphic included a vision of a Digital Champion as someone who:

• Asks questions, learns and is always curious
• Makes mistakes and learns from them
• Is ‘visible and approachable’
• Is a ‘go-to person for advice’ and an ‘excellent communicator’
• Can be described as a ‘problem solver’, one who empowers and is also a ‘mentor’
• Will ‘have impact on and be a source of inspiration for the team’
• Is a knowledgeable DH [digital health/health tech] technologist
• Is a ‘creative and innovative user of data’ to ‘drive change and deliver quality healthcare’
• Can be an ‘ideas incubator for solving the inefficiencies and inequalities in the systems’
• Brings a culture of embracing change, constantly innovating into the workplace
• Acts as a ‘path clearer’ and ‘paver’ who ‘creates the pipeline and process for the next wave of ideas’
• Is an ‘expert’ who can ‘enact change and guide progress on a broad scale’.

These qualities feature a mix of both technical and personal characteristics, suggesting that an ideal ‘digital champion’ would have a sufficient level of expertise in digital, IT and/or data, but that what sets them apart may be their ability to transfer and share that knowledge in a clear and accessible way – so that they also possess the traits of a good teacher.

When we turned to our expert commentators for their thoughts on, and experiences of, what makes a great digital champion, the ideas from Melbourne were somewhat echoed across this side of the globe, by NHS leaders.

“They create a waterfall of learning and knowledge sharing”

Alexis Farrow, Head of Strategy and Transformation at Connected Nottinghamshire, told HTN: “Digital champions are a powerful resource in enabling the spread and uptake of digital, which couldn’t be achieved with traditional training and support. They create a waterfall of learning and knowledge sharing. Digital champions don’t have to be technical in background; the skills and attributes which make a good digital champion are patience, understanding, [being] committed to driving change and communication skills. This is particularly important in community settings, which is why our community and voluntary champions are so essential in addressing barriers to accessing digital within our communities, as they understand the specific challenges that individuals within those communities face.”

As well as bringing crucial local insight and understanding to digital projects, Alexis explained that Connected Nottinghamshire has had success with including digital champions in its work so far, stating: “Digital champions have been an invaluable resource across Nottingham and Nottinghamshire. Across the ICS [Integrated Care System] we have recruited and trained over 50 digital champions for our workforce, in order to support the implementation of digital transformation programmes. The ICS has also worked in partnership with the community and voluntary sector in order to recruit and train digital champions – this has proved vital in addressing digital exclusion and uptake across our communities.”

“Digital champions must come from any and every personal and professional background”

Moving from the East Midlands to Hampshire, where Dr Tamara Everington, a consultant and the Chief Clinical Information Officer for Hampshire Hospitals NHS Foundation Trust, explained how she sees the role of a digital champion – also highlighting the need for specific personal skills over high-level technical traits.

Tamara said: “Being a digital champion isn’t about being a technical wizard – it’s mainly about being a champion of operating in the 80:20 head space (80 per cent of your job time actually doing your job, 20 per cent of the time developing ways of making the same job deliver a better end result). Digital champions will not only seek to improve themselves but also work to improve the digital systems that support change. Highly successful digital champions additionally have the key behavioural trait of being great teamworkers – people who are naturally drawn towards helping improve the performance of the team as a whole. The super successful digital champions are those who can share and explore the story of their team’s digital success with others in a way that brings translatable learning.

“If an organisation wants to succeed through digital champions, these people must come from any and every personal and professional background. This approach will ensure diversity of purpose and intent, giving end solutions which really work for folk on the ground.”

Returning to HEE’s latest resource for adult social care digital champions, the many potential benefits of utilising digital champions are listed as including: illustrating an ‘organisational commitment to understanding the needs and experiences of staff’ and being proactive; providing allies for staff, as embedded champions will know ‘staff and their roles better than anyone’; providing a bridge between leaders and staff to feedback about any challenges; improved staff engagement; taking pressure away from busy managers; sustainable support and an improved culture.

The case for digital champions, it concludes, is strengthened by an estimated 17.1 million – 52 per cent- of people in the UK workforce lacking digital skills in the workplace, according to findings from the Lloyds Bank UK Consumer Digital Index 2020.

Within this context and against a digital health landscape where national frameworks and strategies are still being shaped, HEE says that local leaders can ‘support the development of digital capabilities while those national capabilities are being worked through’ and ensure that their staff are ‘digitally ready and confident’ by utilising digital champions.

With that in mind, it’s more important than ever to consider what makes a truly great digital champion. It will be interesting to monitor how the role evolves over the next 12 to 24 months, as well as how digital champions are employed by ICSs.

For more content on digital champions, revisit the HTN Now webcast by Henrietta Mbeah-Bankas, Head of Blended Learning and Digital Literacy at Health Education England, which took place last year.

Our first HTN Now Focus event of 2022 took place on 10 January, with sessions focused on how to support digital mental health.

The first of our two live presentations of the day featured the specialist digital transformation consultancy, Ideal Health, and focused on the challenges and benefits of validating data within the mental health space.

Katy Lethbridge, Ideal’s Marketing Director and Basil Badi, Practice Director for Data Management, hosted the webcast, providing their insights on all things related to data quality and data management.

“Good data management is a golden thread”

Following the introductions, Katy kicked-off the session by discussing the importance of data management within the mental health sphere. “Our experience has shown that good data management is really a golden thread that needs to run throughout transformation, in order to make it work,” she said.

“A good example is some work we’ve been doing with a large mental health trust in the South East,” Katy continued, “we’ve been their strategic digital transformation partner since 2017.”

“We’ve done data centre migration, interoperability integration projects, EPR optimisation, an electronic data management system, various health tech projects, we’ve also worked with primary care and GPs on the PCN (Primary Care Network) programmes, and also through the pandemic on an Attend Anywhere roll-out.

“So, a huge variety of different things. But that theme of data quality and the need for validation and management was definitely a core component of those projects [and], also, of the ongoing transformation programme there,” she stated.

However, Katy also noted the challenges within the mental health data validation space, recognising both the need to “get data right” and the “increasing demand” on mental health services, which she said had “highlighted the need for better data quality through NHS services and in the mental health space.”

“Data validation is crucial to understanding where patients are”

Katy then asked Basil about the work required in digital mental health around data validation, as well as for his wider take on why data validation and management is important.

“In an ideal world, it shouldn’t be required…systems are becoming more intuitive and better integrated…[but] in the reality we live in today, data validation is crucial to understanding where patients are on their pathways,” Basil said.

He went on to explain: “Data validation is about reviewing the clinical information stored about a patient and their condition, and then comparing it against the activity recorded on the electronic records. In most cases, it’s about correcting that information so that it’s accurate and reflects the truth…it’s a bit like investigating and piecing the story together, so we can map a patient’s journey from beginning to end, until they are discharged.”

“We recently did a short piece of work over the festive period and the amount we were able to close down – in terms of patient pathways – was more than 60 per cent,” Basil continued.

“That means, out of every 10 patients [who] were listed as a priority, [it] reduced that just to four patients. That has a tremendous impact…if you scale it up across the entire patient tracking list…that’s 60 per cent less administration time required to manage patient pathways, that’s 60 per cent less capacity to plan for, that’s 60 per cent less clinical attention. That means that 40 per cent [then] becomes 100 per cent of the focus for operational clinical staff,” he stated.

“Validation basically provides an accurate view of waiting times and facilitates prioritisation, escalating patients at risk. Having an accurate waiting list just improves your ability to plan for the future, [and to] understand your capacity and demand. Ultimately, this saves time and money, and improves patient safety.”

“Mental health trusts need to get their data into a better position”

Moving on to why data quality is becoming more of a focus for mental health, Basil added: “As part of the Long Term Plan for the NHS, there has been increased focus on mental health trusts. Services are now having to submit data about the access and waiting times, as the acute trusts have been doing since 2007…mental health trusts need to get their data into a better position and understand how to manage it.”

On that topic, Katy quizzed Basil further, asking, “with that reporting in mental health now becoming more of a requirement, what are the challenges going to be?”

Basil said: “The biggest challenge working in this space [is] there isn’t a defined road to follow. We’re working closely with the services to help pioneer this by working together and reviewing current practices, and by helping them refine and standardise the processes to manage their mental health data more effectively.”

“[With] RTT (Referral to Treatment), we have over a decade of experience working with NHS trusts, and we’re used to the management of pathways with multiple specialities, and there are established best practices to turn to, to ensure that the clinical information and the data management practice have been integrated.”

He later added: “Within the mental [health] services we’ve worked with, they don’t currently use pathways and this is something quite new to them…it’s different and slightly nuanced…because they have different teams that cover different aspects of a patient’s mental health. It’s crucial that all the stakeholders – clinical and operational – work together to help understand that and ensure it’s done in the right way.”

“There are fundamental aspects of data validation that we had to adapt”

Providing a recent example through his work with a mental health service in London, Basil commented: “There are fundamental aspects of data validation that we had to adapt. We wanted to ensure we got the fundamentals about the patient record accurate. It was about working with them to categorise the data into three distinct groups – either the patient is discharged back to their referrer, has some kind of activity booked, or they require some kind of intervention…that helped them to understand what the bird’s-eye view of their data should look like.”

On how he helped the example trust with their data issues, he elaborated: “Initially we did a proof of concept and that was 1,000 patients – that covered a section of the most voluminous mental health teams with the most patients. As this was a new space, we worked very closely with the clinical and operational leads to ensure we were all on the same page and completed the validation according to the right parameters.

“Once we completed it, we were able to categorise…and then we drilled down further and, in terms of the discharge [rates], we were able to discharge roughly 35 per cent of the referrals that we validated. Using that data, we were able to provide the trust with a report that gave that bird’s-eye view on patient outcomes, which prompted wider discussion across the remaining teams and was shared internally.

“We had very positive feedback and, as a result, it fostered more engagement and we’re currently working on a follow-up project with that trust.”

“They just hit that point where they’re beyond capacity”

Summarising the benefits of data validation for mental health trusts, Basil highlighted planning capacity and forecasting of the demand, better clinical management, escalation of the patients who are at risk and ensuring that patients are prioritised according to urgency and length of wait. He also noted understanding data issues and how they relate to discharge rates, making it easier for staff on the ground to make changes, and allowing services to have more control of their data.

“We work with a number of trusts – again and again – and not because we’re not helping them to understand their root causes. But because they just hit that point where they’re beyond capacity and need that extra elbow room. We can come in and support them for a month or two,” he explained.

Asked by Katy to summarise how he feels about data validation in mental health services, Basil concluded: “I feel privileged…this is an area I’m really passionate about…I’m an IT person but I do my part to help improve patient lives…I want to be a flexible and approachable resource for trusts to turn to.”

Watch the full session via the video below:

Feature by Bryn Sage, CEO, Inhealthcare

Some patients like remote monitoring because it makes them feel reassured about their NHS care. Others enjoy the freedom of being able to live independently with long-term health conditions. For Gurmit Bhamra, who joined Surrey Heartlands Health and Care Partnership’s new service for patients to manage high blood pressure at home, there are a multitude of reasons.

Mr Bhamra said: “Joining the BP@Home service has been very helpful to me. It means I can monitor my blood pressure without having to go to see my GP every two or three days and I have become more aware of what the blood pressure readings mean. As a result of monitoring my results, my medication has been changed and I have made lifestyle changes to help manage my blood pressure better.

“I have been doing regular exercises at home and I am eating less – especially in the evenings. These small changes are already helping me to feel in control and have had a positive effect on reducing my blood pressure. I feel supported and encouraged to make the right decisions and I know that there’s help at the end of the phone if I need it.”

More and more patients like Mr Bhamra are signing up for NHS remote monitoring – and more than one million have used Inhealthcare’s services since the start of the pandemic. Surrey Heartlands used our software to roll out the Oximetry at Home remote monitoring service for COVID patients early on in the pandemic.

The ICS extended the service to deliver remote monitoring of hypertensive patients last year with support from NHSX. Clinicians anticipate it will improve health outcomes for patients and create valuable capacity within the NHS by helping people to manage their conditions, reduce their blood pressure and save millions of pounds in reduced use of NHS services.

Using a simple device provided by the NHS, patients record their blood pressure and heart rate readings on a twice-daily basis. Patients submit these for clinical review via a choice of communication channels including email, SMS text message, app or phone, making the service fully inclusive – and capable of delivering remote monitoring at a population level.

After years of laying the foundations for remote monitoring with NHS partners across the UK, we expect 2022 to be transformational for the expansion of the technology-enabled care services. The Prime Minister, Boris Johnson, has promised new health and social care funding “will enable radical innovation to improve the speed and quality of care, including… new digital technology so doctors can monitor patients remotely in their homes”.

In her landmark report, ‘Putting data, digital and tech at the heart of transforming the NHS’, Laura Wade-Gery urged the NHS to be bolder in stating the health and care system should empower citizens to manage their health and wellbeing and give them the tools to take ownership. The former Tesco and M&S director called for care pathways to be centred around patients rather than settings and said citizens should have a choice between remote and face-to-face services.

With the number of people in England waiting for planned care forecast to hit a staggering 13 million in the coming years, the House of Commons Health and Social Care Committee, chaired by former health secretary Jeremy Hunt, said the NHS has a big opportunity to change ways of delivering care that are no longer fit for purpose and build on the new integrated, safe and effective models that emerged during the pandemic. “For the good of patients, staff and the public this opportunity must not be wasted,” concluded the committee’s report, ‘Clearing the backlog caused by the pandemic’.

NHS England has told healthcare providers to use the lessons learned during the pandemic and “rapidly and consistently” adopt new models of care that exploit the full potential of digital technologies. Chief executive Amanda Pritchard said systems must “fully exploit remote monitoring technology and wider digital platforms to deliver effective and efficient care”.

The extra cash announced by the Prime Minister includes £250m this financial year for an elective recovery tech fund to help Integrated Care Systems transform care pathways with the support of innovative digital technologies. NHSX has published a list of digital products that can assist with elective recovery and, in this special feature for HTN readers, we explain how Inhealthcare can help ICSs to reduce long waits for tests and treatments for patients and deliver on the government’s ambition to “build back better”.

• Early discharge and home rehabilitation: Inhealthcare has connected care home residents across London and the North East to their family doctors. The service helps clinicians to identify any patients at risk of developing health problems and intervene early with treatment. It aims to keep vulnerable residents safe and well in their homes and prevent avoidable hospital admissions and readmissions. Importantly, the service can ease delays in transfers of care by enabling people to be monitored in the comfort of their own home rather than in a hospital ward.
• Home-based pre-surgical support: Inhealthcare has partnered with Olympus to help patients awaiting endoscopy procedures and increase NHS diagnostic capacity. The service aims to improve health outcomes, reduce missed appointments and ease the strain on overstretched hospitals by digitising the patient journey from referral through to post procedure patient feedback. Dr John Greenaway, a consultant gastroenterologist at The James Cook University Hospital, said: “The service empowers patients with improved communications and helps them overcome any fears they might have ahead of their procedures.”
• Productivity benefits: Inhealthcare has rolled out digital services to help NHS organisations deliver enhanced immunisation schedules and free up employees from labour intensive paper-based procedures which require significant staff time and resources. Improvements include reduced risk, enhanced accuracy and reliability of data and many thousands of hours saved in administrative tasks.
• Patient portal and record-sharing: Inhealthcare last year completed the integration of its technology platform with NHS login, making it even quicker and easier for patients to use its digital health services. It also completed its integration with the Message Exchange for Social Care and Health (MESH), the secure large file transfer service used across health and social care organisations.
• Real time operational data or population health management tool: Inhealthcare is helping providers and commissioners to analyse near real-time NHS data about patients and pathways to boost operational and strategic decision-making. The company has built a ‘data lake’ to enable new views into the growing amounts of data generated by NHS remote patient monitoring services.
• Robotic process automation: Inhealthcare’s toolkit allows clinicians to design and deliver new care pathways using cutting-edge processes commonly deployed in global industries like advanced manufacturing and financial services. This ability enables NHS organisations to model, execute, monitor, measure, analyse and improve their health and care services.
• Streamline elective administrative processes: Inhealthcare has launched a self-referral programme for people with musculoskeletal conditions. It is believed to be the first digital health service in UK that uses the Spine national IT infrastructure to allow patients to self-refer onto a local NHS service. The use of the NHS Spine verifies patient identity and validates entitlement to the service.
• Support people at home: Inhealthcare has driven the expansion of a breakthrough programme for the remote monitoring of people with confirmed or suspected COVID. The company is helping to deploy Oximetry@Home across the UK, making it widely available to patients in primary and community care settings and helping to reduce mortality, length of stay, intensive care admissions and readmissions. The underlying technology is being repurposed by resourceful staff to support people with other conditions including hypertension, heart failure and respiratory diseases.
• Remote consultations: Inhealthcare is powering a digital clinic designed by its NHS partner Health Call Solutions to connect clinicians with patients at home and minimise the need to attend hospital appointments in person during the pandemic. The video conferencing service provides an all-encompassing approach to help hospitals build capacity and meet outpatient demand, catching up on the growing backlog of cancelled or delayed appointments. It integrates directly with hospital patient administration systems and books appointments, delivers reminders, records attendances, distributes and gathers patient questionnaires and shares outcome forms with electronic patient records.

In the words of Surrey Heartlands patient Gurmit Bhamra, citizens using our NHS remote monitoring services feel supported and encouraged to make the right decisions and know there is help at the end of the phone if they need it.

Clinicians are also voicing their support. Dr Jagjit Rai, partner at a family practice in Stanwell, said: “We have demonstrated that patients are happy to monitor their conditions from home, and when they do, they not only develop a better understanding of their condition, but feel empowered to manage it better through remembering to take their medication and making lifestyle choices. This will lead to better preventative care for our patients, and also reduce the burden on GP practices as we will receive the patient’s results electronically rather than having to see them each time. This should result in better health for our patients, fewer patients needing emergency care, and it frees up valuable appointments for more acute patients.”

If you would like to find out more, give us a call or drop us a line at Inhealthcare in Harrogate, North Yorkshire via 01423 510 520 or contact@inhealthcare.co.uk

* Bryn Sage is Chief Executive of Inhealthcare

As we warmly welcome in another year, we’ve gathered industry reflections on 2021, and NHS priorities for 2022. But what about health tech predictions for the next 12 months?

HTN asked the experts what they expect to happen, and what they’ll be working on, in 2022 – and we received a great response.

“We are on the path to unlock data silos, automate data pipelines and apply advanced analytics”

Jenny Chong, Non Executive Director of Medway NHS Foundation Trust, shared her predictions focusing on digital skills and literacy, stating: “A silver-lining of COVID is that we have accelerated up the technology curve. Many of us inevitably learnt data skills as we attempted to decipher mountains of data to detect patterns and logic. The combination of digital awareness, technology infrastructure and data literacy enables us to derive deeper insights from the data that we hold. The connected contextual data across the whole patient journey will augment diagnosis and treatment. We are on the path to unlock data silos, automate data pipelines and apply advanced analytics. If we can do data collaboration as a system, our patients will ultimately benefit.”

Liz Ashall-Payne, founding CEO of ORCHA, let us in on her predictions, and honed in on digitising the workforce, commenting: “There will be a big focus on up-skilling healthcare workers in 2022. Whilst social prescribers and the new roles created through the Additional Roles Reimbursement Scheme will likely lead the field in activating digital solutions, it’s vital that all frontline staff are familiar with these new approaches.

“Our clinical teams at ORCHA believe digital health is extremely well placed to help the NHS tackle the elective surgery backlog. The BMA estimates that, between April 2020 and October 2021, there were 4.13 million fewer elective procedures. Digital can support across a broad spectrum of the priority medical conditions, in particular ophthalmology, MSK, cardiology and dermatology.”

Richard Wyatt-Haines, Director of HCI Digital, meanwhile, turned the attention to digital adoption. He said: “The pressure on the system will be so great that getting digital solutions adopted will be tough. Somehow we all have to find a way to get tools into use in as many places as possible, and as quickly as possible, because without large and wide scale adoption of digital the health system, weaknesses will become fissures through which many patients and staff will fall. And that’s not right and not what any of us want.”

Vijay Magon of CCube Solutions, meanwhile, explained what the provider would be focusing on: “We’ve been both inspired by the mobilisation of the NHS response to this virus, as well as shocked by the impact it may have on the National Health Service, which we all cherish and work to support in the ways that we do.

“During 2022 (and beyond), we will continue to ramp up our support and delivery services for digital records which will provide practitioners [with] the ability to access patient information anywhere and support virtual clinics, and support the NHS Long Term Plan – [as] NHS England has pledged that digitally-enabled care will go ‘mainstream’ across the NHS over the next decade. Development work is in progress to extract and use contextual information from the huge volumes of unstructured content held in our systems, to help clinicians identify better treatment options. We will also be releasing new patient-facing software designed to improve a patient’s engagement in the delivery of their care, including Patient Initiated Follow Up (PIFU).”

“2022 will see the realisation of integrated care systems”

The topic of integrated care systems (ICSs) was also touched upon, with Brian Painting, UKCloud Client Director, considering the security implications and the potential for social care.

“2022 will see the realisation of integrated care systems and, with that, the certain need for organisations to derive real value from the data in their systems,” said Brian. “We’ve spent years talking about unified architectures. With the standards, requirements and governance in place, the time is now for delivery. Coherent data management tooling across local economies will prove pivotal, especially with non-health systems from the third sector synthesise information into public health tools.

“This will likely have a knock on effect on security – and the security of health data is everyone’s concern. As we start to bring in new ways of working, there is a widening of the threat landscape and increase in risk. We know health data is of value to cyber criminals and as the proliferation of consumer devices and applications grows, so too must the awareness and support of health leaders to cyber security teams.

“Another priority for 2022 is to shift the focus onto social care, and the much-neglected role technology can play in this crucial area. The remote monitoring tools that have come to the fore in acute and GP care are evidentially of value to service users in certain scenarios. There is a real opportunity for ICS to review work with care providers to provide essential digital services, as well as to start to generate insight from this growing area of the marketplace.”

Lynette Ousby, UK managing director, Alcidion, shared excitement about the potential of not only ICSs but also Electronic Patient Records (EPRs), stating: “As integrated care systems develop in 2022, more joined up orchestration between organisations and their technologies will become a priority. Changes to NHS procurement rules may also help to support innovation, integration, and collaboration in digital adoption decisions. But I’m particularly excited about new opportunities to shake up the EPR market. This direction will in part come from the health tech market, with new options presented to the NHS around cloud-based, flexible and clinically focused platforms. But it will also come from within the NHS, with initiatives like the Digital Aspirant Plus programme influencing the urgency of innovation and change.”

Alan Lowe, CEO, Visionable, added: “At Visionable, we’ve been working on a lot of exciting projects that will launch in 2022, including our Connected Healthcare Centre in partnership with Verizon, and a solution specifically for emergency services to support in easing the huge pressures they are currently experiencing. The last two years have shown why it’s important for healthcare services and tech companies to come together and find real solutions to tackle the great challenges that lie ahead. I’d like to see ICSs nail basic interconnectivity, and then look to the future to make digital transformation the bedrock of healthcare improvement.”

Richard Strong, Vice President International Services & Operations, Managing Director EMEA for Allscripts, was another commentator who highlighted ICSs. Richard said: “Technology suppliers must continue to work with clinical colleagues to ensure solutions we provide make their lives easier, and free them up to spend more time caring for patients.

“In 2022, we will see continued progress in sharing health data within ICSs, which will make a huge difference to clinicians and patients across care settings. A key focus for ICSs will be building inclusive digital strategies to support equitable care delivery for all. In Allscripts’ role as a solution provider, we’re committed to supporting regional systems to integrate and helping leaders create the right culture for technology to make a difference.”

And for Martin Bell, Director of the Martin Bell Partnership, integrated care was also top of the predictions list, as well as a number of other areas. He said: “An obvious ‘one to watch’ is what happens with a combined central IT function now under NHS England. What will be their new ‘big agenda’? Personally, I hope they tackle the fundamentals and go small on ‘new ideas’.

“The evolution of ICS’s will be another to watch – a re-arrangement, more expensive and complexity in the system – or a genuine effort to truly deliver integrated care in the various regions of England?”

Martin also added, “Oh, and social care. A total and absolute focus on fixing social care”, although he felt this may not happen. “Overall…I think for health and care, 2022 will be another tough year,” he concluded.

“Digital health technology will be the driving force for personalising care in 2022″

Tom Whicher, Chief Executive, DrDoctor, presented his predictions on personalised care for the next year, saying: “Digital health technology will be the driving force for personalising care in 2022. We’ll see a marked change in the way we manage how patients attend and book appointments including patient-initiated follow-ups (PIFU) to reduce non-attendance. There will be a greater need for everything to be done through EPRs which will give greater convenience and a better patient experience. 

“Home-based and remote care will be a hot topic and tools like electronic patient communication platforms and remote assessments will be fundamental to this. We’ll see a need for tech that streamlines cumbersome processes to meet people where they are and help treat patients better and faster, while reducing the strain on NHS resources.”

“Moving into 2022, we’ll focus on backlog management, deploying at scale our appointment scheduling platform and improving our remote monitoring platform,” said, Kenny Bloxham, Managing Director, Healthcare Communications. “We’ll also be developing our Patient Initiated Follow Up technology to include voice alongside digital options. Telehealth has been deployed at scale during the pandemic and will become a more permanent fixture in 2022. However, to improve effectiveness and acceptance, I expect to see more formalised research and training to support the delivery of best practices. This is something our transformation team are focusing on. As a CISCO company, we’ll also be driving innovation in support of the digital hospital agenda.”

Mark England, Chief Executive of HN, said: “In 2022 predicting rising risk in population segments will become much more embedded and critical to service recovery from the pandemic. Using AI we can now predict eight of 10 emergency admissions, which means we can focus resource on the right patients. With the strain the NHS is under it’ll be even more important to consider innovative ways of providing proactive care in people’s homes. We’re going to see a shift to more personalised care, especially for those living with multiple long-term health conditions. Through personalised support, we will begin to see patients themselves as part of the solution to the pressure on services.”

Felix Williams, Chief Technology Officer, Ethical Healthcare Consulting, also covered this area, explaining,“In 2022 we expect the out of hospital trend to continue. The focus will continue to be on data sharing of both images and reports, from CDC to acute but also pan and inter-network. We anticipate a general move to image-sharing standards and away from supplier-proprietary mechanisms and to bust pandemic backlogs, a renewed focus on centralised reporting across networks/consortiums. 

“The emergence of the ICSs as constituted bodies may also see them operating services in support of the imaging networks: regional patient indices, cloud data repositories, centralised messaging capabilities. Use of AI in support of diagnostics will continue to grow, enabled by the centralisation of imaging data.”

While, for Luke Percy, Public Sector Account Director, ITGL, the emphasis was on building smart hospitals.

“If we take anything positive from the last couple of years, then for me it’s the heightened focus on using good value technology to provide tangible clinical and patient benefits,” Luke said.

“Going into 2022, we expect to see the continued evolution of the smart hospital. These optimised care settings will allow for new clinical processes and efficient care, taking advantage of developments in IoT and connected medical devices, while also tying in smart facilities and asset management to enable temperature or lighting control, alongside asset management and patient experience solutions such as way-finding. All this will be enabled by the underlying secure digital networking infrastructure.

“While it might sound daunting, once hospitals put in the right networking foundations it’s much more manageable to then build in smart hospital features as they are needed – and crucially, to get the most return on investment in terms of patient safety, experience, and clinical efficiency.”

“The move to the cloud [is] set to become an even greater enabler in 2022”

A move towards more cloud technology was also a popular prediction from our commentators. Anshu Sharma, co-founder and CEO of Skyflow, shared:  “The massive amount of capital flowing to health tech startups will only increase, which will drive the pace of innovation in 2022. But with dozens of countries around the globe passing data privacy and data residency laws, building meaningful technology will be constrained by the challenges of properly managing health and personal information. Look to the cloud platform and infrastructure builders to solve these problems, and for a few of these to emerge from 2022 as clear leaders. The healthcare market is ready for the emergence of a new cloud stack to power its transformation.”

Peter Corscadden of Hyland Healthcare, also said: “The pandemic has accelerated digital transformation across the entire UK healthcare sector, with the move to the cloud set to become an even greater enabler in 2022.

“Healthcare providers are seeking greater operational flexibility, efficiency and resilience, to support the fundamental objective of improving patient outcomes. There is growing recognition that by delivering, say, content services capabilities through a secure and scalable cloud platform, institutions are in a stronger position to advance digital engagement and the overall patient experience, as well as supporting new clinical working practices. Enterprise diagnostic imaging and digital pathology are just two specialties where the cloud will continue to have a transformational impact.

“However, as with any infrastructure strategy, it’s critically important to ensure the interoperability of all applications. Also, cyber risks are becoming more prominent, which will require technology vendors to arm their clients with software that enables security, protection and accessibility to patient information.”

For Jane Rendall, Sectra’s Managing Director for the UK and Ireland, the cloud was mentioned alongside a prediction about the increasing importance of digital pathology. Jane noted: “Digital pathology will take centre stage as the pace accelerates for the modernisation of NHS diagnostics during 2022. New government funding combined with clinical need will transition digital pathology to being ubiquitous, with almost every part of the country either deploying solutions, or at least in planning and procurement stages. I’m fortunate to have seen the impact first hand from pioneers in this space, and can say with confidence that fast followers will be able to leverage learnings and proven models. Cloud too, will play an important role, helping to facilitate deployments and scalability. And this will also open doors for integrated diagnostics as more ‘ologies’ integrate into imaging records and as geographical footprints expand.”

Digital safety was another area covered by contributors, with Stuart Harrison, co-founder & CEO of ETHOS, noting: “Digital safety as a core competence for healthcare practitioners is an emerging field, with frameworks being published by the Faculty of Clinical Informatics and Health Education England. However, it can feel like a big hill to climb for busy clinicians post-pandemic. Although the NHS is leading developments in digital safety, we’d like to see more training on offer which would add value to healthcare professionals’ portfolios, audits by regulators and aid practice development.  

“In 2022, we expect to see more organisations with a registered clinician who is a Clinical Safety Officer. As we move forward with the ‘re-set of services’ post-pandemic, we need to raise awareness of mandated standards and must actively support clinicians to optimise their use of digital clinical risk management methods. Alternatively, we can invest in training clinicians as Clinical Safety Officers to improve patient digital safety across frontline services.”

While for Thomas Webb, CEO, Ethical Healthcare Consulting, a move towards open data architectures was the main expectation: “I expect to see more and more of a move towards open data architectures with an increasing number of NHS organisations exploring options in this space. This is only going to be accelerated if NHSE/I/X support these initiatives with funding this year, which I fully expect they will align with the national data strategy. Conversely, at the other end of the spectrum, I expect that investment in user-centric design and behavioural change to continue to grow, and to see the NHS catching up with other industries.”

“Health inequity is now part of mainstream conversation”

Many of our contributors also focused on patients and predictions – or perhaps hopes and expectations – for greater digital and health equality.

Dr Rachael Grimaldi, Co-Founder and CEO of CardMedic, explored this important theme, stating: “Health inequity is now part of mainstream conversation as a result of being brought into stark focus by the pandemic. In 2022, I hope that we see momentum continue across the industry for identifying innovative digital solutions to the challenges that exacerbate health inequalities. As the NHS recovers, we need to make sure we don’t go back to doing things how they’ve always been done, as the digital solutions developed and embraced by clinicians and patients during the last 12 months will have a huge part to play in a future sustainable care system for all.”

Sheena Pirbhai, CEO and Founder at Stress Point Health, and creator of SPHERE, similarly focused on the impact for mental health. Sheena said: “The COVID pandemic has highlighted how crucial it is to drive efficiencies and free up resources to help the ever-growing number of patients in need. Looking at mental health care alone, NHS waiting times are increasing, leading to mental health issues deteriorating and putting more pressure on GPs and social services. Meanwhile, front-line key workers in the NHS are impacted by the pandemic and are reporting symptoms of PTSD.

“Hopefully we will see an acceleration and continued transformation of healthcare services towards digital and virtual services. They have the potential to democratise access to effective and affordable treatment anywhere, anytime – breaking the next frontier of patient care, to offer patients the support they need, when they need it, delivering the right service, at the right time.”

“The vigorous national debate we have witnessed during the pandemic about the future delivery of primary care will continue in 2022,” predicted Paul Bensley, Chief Executive of X-on. “Patient expectations about the care they can expect from their GP practice are set high, but with the shortfall in GP numbers, and the changing balance between primary and secondary care given the move to population health management, technology is going to play an even more important role in driving delivery change. Technology – and cloud supported communications such as provided by X-on – will develop to better signpost and manage new pathways for patients to get care and support.”

Moving back towards topics such as co-production and patient safety, Ruby Bhatti OBE, a public contributor who supports lay views at NIHR, NHS England and at various universities, said: “Health tech will become more resilient. The trust relationship between patient and carers and the digital world will become stronger, as there is better co- production and collaboration between professionals and patient and carers. 

“Using technology, we will be able to begin to have a greater impact on the journey for patient-centred care and shared decisions between professionals and patient/carers to take place virtually, where we are further empowered and feel comfortable.

“The cutting-edge technology, which is developing minute by minute, will enhance quality of care [and] patient safety. I predict we will produce the best innovations through research, which will improve lives and give patients a real opportunity to live longer and [have] a better quality of life.”

Concluding our contributions, and our health tech predictions for 2022, was Jenny Camaradou, EUPATI Patient Expert, Knowledge Exchange Fellow and Healthtech bid writer.

Jenny stated: “As a patient expert and lay member on the NIHR AI AWARD panel, I expect 2022 to bring more opportunities for the adoption of AI and blockchain healthcare solutions that can help to increase the speed of innovation ultimately benefitting the whole healthcare ecosystem of patients, manufacturers and policy makers.

“I would like to see patient preferences better feed into providing recommendations on enhanced stratification cohort designs, data collection, quality, traceability and management activity and am looking forward to the publication of large report that I have been involved with a range of stakeholders on public patient attitudes to AI. I will continue to provide patient insight into translational research and RCTs in personalised medicine through a range of different activities and would particularly welcome collaborating with SMEs that wish to engage end-users, patients and citizens in different environments and contexts.”

HTN would once again like to say a huge thank you to everyone who shared their thoughts and predictions with us across our whole range of festive features. We wish all of our contributors and readers a fantastic 2022!

Offering HTN the view of digital priorities from an ambulance service, Stephen Bromhall, Chief Information Officer, East of England Ambulance Service NHS Trust, explained, “East of England Ambulance Service will be continuing in 2022 with the front-line digitisation, as more clinical content is provided to our front line to support improved patient care. We will be also be deploying the National Record Locator portfolio.

Richard Wyatt-Haines, Director of HCI Digital Delivery, who works alongside the NHS, focused on the expected upcoming challenges this winter, stating: “Delivery, delivery, delivery. Just trying to get stuff done in an NHS with this much pressure will be really hard. We have shown it can be done, but we and our fellow tech providers will need to work in partnership with the teams in the NHS to find novel and the best ways to get new solutions live as quickly as possible. We’re certainly up for it. Let’s go.”

Setting out personal work priorities was Glenn Winteringham, Chief Digital Officer for the Royal Free London NHS Foundation Trust. Glenn said: “My digital priorities for 2022 are to: 1. Support our EPR adoption and optimisation programme so we realise the benefits to  deliver better, faster, safer care and improve the staff experience; 2. Work in partnership with NCL ICS colleagues to augment our shared care record and population health management solutions; and to collaborate on new ICS wide digital  opportunities such as community diagnostic hubs, digital pathology and cyber security; 3. Enhance our patient portal to improve their experience and enable new models of care such as remote monitoring, asynchronous messaging and virtual care pathways; 4. Lead on the professional development our digital teams and to protect their well-being following their unbelievable efforts to develop new ways of working through the COVID pandemic.”

Speaking to us from West Yorkshire, meanwhile, was Andy Webster, Consultant in Emergency Medicine and Chief Clinical Information Officer at Leeds Teaching Hospitals Trust. On digital patient priorities for the Leeds team, Andy explained, “Next year, we’ll be focusing on a number of projects within two key areas. The first is improving the digital experience for patients. We’re investing in a new Patient Portal, and also developing the ability to send electronic forms to patients to get information directly from them without always needing to see them face to face (where appropriate).

There would also be upgrades for staff too, as Andy added: “We’re also developing further improvements to the digital experience for our staff – modernising our infrastructure, reducing log in times, and upgrading more systems to modern software, including a new electronic document system and releasing new functionality for our new PAS. Additionally, investment in a new data platform will provide access to richer data and the insight that brings to help improve the care we provide for our patients. We’re also continuing to build on the achievements we’ve already delivered as part of our Paper Lite strategy, investing in a new digital solution for nursing care plans. This will provide a live feed of acuity, metrics and ward assurance data, enabling quicker and easier decisions about care, simplifying daily work and saving time.”

We know this year has been hugely challenging again, for anyone involved in health and health tech, so it once again seems important to reflect on the challenges and work undertaken, as well as sharing the successes and the learnings.

In this part one, you can find out industry, supplier, patient engagement and NHS opinions on the last 12 months. You can also find out our audience’s health tech predictions for the year ahead in part two, before part three shares NHS priorities for 2022. Stay tuned!

“The people I work with have shown super-human strength”

Jenny Chong, Non Executive Director at Medway NHS Foundation Trust, kicks off our retrospective with some thoughts on the people working to keep healthcare afloat: “2021 has been a year that demonstrates human resilience. The people I work with at Medway NHS Trust have shown super-human strength in pushing past the boundaries of mental and physical fatigue to continue serving our patients. Despite wave after wave of chaos during 2020, despite the fear and uncertainty of dealing with the unknown, despite the huge personal sacrifice and isolation from their loved ones, despite the bleakness at times when light does not seem forthcoming at the never-ending tunnel – our staff have taught me that we will not be beaten down, we summon the energy to carry on.”

Martin Bell, Director of The Martin Bell Partnership, similarly gave pause to think about NHS staff and patients, noting: “Personally, and professionally, there were many positives to 2021. And from an industry perspective, we continued to see the ‘Rise of Health Tech’ (and perhaps some of the limitations).

“However, for me 2021 will forever be remembered for the many who died in the pandemic, whether directly because of COVID-19 or indirectly with the knock on consequences…and despite everything thrown at them, all the NHS and care staff, those in the digital space included and the suppliers supporting them, striving on and delivering the vital health and care services needed. Our thanks should be to them.”

Vijay Magon, Director of CCube Solutions shared his thanks and appreciation for healthcare staff, as well as his own, adding: “All our staff continued working from home providing support services to NHS trusts and health boards and we also deployed our solutions at two new sites. We saw significant rise in adoption of electronic medical records – access and use of digital data held in our EDRM solutions in widespread use in the NHS, as the amazing NHS staff relentlessly continued delivering care services. Digital health records do help to reduce face-to-face contact to protect patients and staff, minimise the risk of COVID-19 infection, and provide practitioners with the ability to access patient information anywhere without compromising the integrity of care provided.”

On personal achievements for CCube, he reflected: “2021 was an eventful year for CCube Solutions, under varying pandemic restrictions. We successfully achieved certification for four ISO standards: 9001, 14001, 27001, and 27701. In addition, we achieved accreditation for Cyber Essentials Plus (CE+) and our EDRM and eForms software passed DCB 0129 Clinical Safety Standard.”

Tom Scott, UK Commercial Director for Alcidion, was another contributor who paid tribute to the NHS, stating: “For me, any reflection on the last 12 months starts on the commitment NHS and other frontline staff continue to demonstrate during extremely pressured times. Digital adoption has been happening at the fastest rate we have ever seen. The NHS should be commended for embracing that change. Now we must maintain momentum, and ensure that digital systems put in place actually respond to real needs of clinical teams – not just the needs that health tech vendors think exist. The 2021 Data Saves Lives strategy, and in particular the separation of data and application layers can play a role here, supporting an increasing focus on modern and flexible modular EPR strategies demanded in the NHS to give more choice to the people who use technology.”

“The extraordinary vaccination success has prevented many more lives from being lost, and has proven that providers across all care settings can come together at scale to achieve common objectives. It will be interesting whether this collaborative effort can be sustained as we enter the new dawn of Integrated Care Systems,” added Kenny Bloxham, Managing Director, Healthcare Communications.

“From a Healthcare Communications perspective, 2021 has proven that a multi-channel, digital and non-digital patient engagement platform is critical to meeting the needs of patients, and our partner organisations. We’ve seen a resurgence in communication activity supporting backlog management and demand capacity, while ensuring patients are continually communicated with, regardless of the patient cohort,” said Kenny.

CardMedic’s Dr Rachael Grimaldi, Co-Founder and CEO, also shared that, “2021 has been such a difficult year for everyone, but despite the challenges the health service has faced we’ve seen incredible resilience and innovation as the healthcare sector and suppliers pulled together to help find ways to minimise the impact of COVID. On a personal note, the team at CardMedic and I have been supported by a host of organisations championing the development of new solutions including DIT, TheHill, Mass Challenge, Innovate UK, Inclusive Fruit, She Loves Tech, Include.org, and the NHS Clinical Entrepreneur Programme. I’d like to thank them all as well as all the NHS colleagues we work with.”

“The digital tools need to be more inclusive”

Ruby Bhatti OBE, a public contributor who supports lay views at NIHR, NHS England and at various universities, shared experiences of working across the past year, stating: “The pandemic has taken PPIE [Patient and Public Involvement and Engagement] to the next level for me, 2021 was one of the busiest years. I embraced the virtual world with open arms and I feel the support I have given virtually has had a tremendous impact in supporting research and PPI, particularly through the pandemic. 

“The access to different digital platforms allowed me to have greater impact and reach out to communities whether it was through something simple as social media WhatsApp or leading on webinars.  

“However, it also made me reflect on how hard it has been to ensure the digital world continues to place at the forefront inclusivity  and diversity. This year highlighted how communities have been excluded due to digital poverty, those living in remote villages where access to the internet has been difficult. The need to have accessibility to documents to include those with disabilities has also been difficult where it has resulted in people who are deaf or partially blind being excluded.”

Jenny Camaradou, EUPATI Patient Expert, Knowledge Exchange Fellow and Healthtech bid writer, also provided a different perspective, commenting: “This year, whilst being a part of the UK Nice Covid Expert Panel as a lay member, I learnt the delicate balance between evidence-based recommendations and need to be flexible as things evolve, as well as applying patience and gratitude more on a personal level.

“Time and space are needed to deal with the range of emotions everyone has experienced as a result of the COVID pandemic and the phenomenally difficulty this has created on workforce morale, planning and healthcare overall. Though, the possibilities for broader change with the creation of better infrastructures that evaluate technologies faster, that can focus on efficacy/impact and cost effectiveness and hybrid trials which reduce patient burden through the adoption or more flexible practices, are perhaps some of the good things that come out the pandemic.”

While, Paul Bensley, Chief Executive of X-on, focused on primary care and its relationship with technology, and said: “The vigorous national debate we have witnessed during the pandemic about the future delivery of primary care will continue in 2022. Patient expectations about the care they can expect from their GP practice are set high, but with the shortfall in GP numbers, and the changing balance between primary and secondary care given the move to population health management, technology is going to play an even more important role in driving delivery change. Technology – and cloud supported communications such as provided by X-on – will develop to better signpost and manage new pathways for patients to get care and support.”

Richard Wyatt-Haines, Director of HCI Digital, added that it had been, “A year of enormous progress. More and more sites and patients are using CONNECTPlus and we are seeing increasing impact on appointment numbers, patient feedback and patients better able to self care at home. Lessons?  Digital can and does deliver transformation – better care, better quality of life, better workplace experiences for staff, and higher levels of efficiency.”

“We can work better, faster and smarter than we had previously believed”

Many of this year’s submitted reflections were also hopeful for what was still to come in health tech, emboldened by the change in 2021. Thomas Webb, CEO, Ethical Healthcare Consulting, said: “2021 has been about ‘pandemic normalisation’- the realisation that although the health tech space can’t sustain the rapid pace seen throughout the last 18 months, what has been achieved has given us all confidence that we can work better, faster and smarter than we had previously believed. A sea-change has occurred and there’s no going back now, it feels a little like the genie is out of the bottle – health tech is now being taken more seriously by NHS executives, and it’s being recognised as being cost of business, not just a nice to have.”

Allscripts’ Richard Strong, Vice President International Services & Operations. Managing Director EMEA, also stated: “Positives to emerge from what has been another difficult year for everyone involved with our health service have been the continued collaboration of technology providers, and more focus on open standards that are the future of digital health. 2021 has shown us the importance of using the many types of data that we have at our disposal to maximise the opportunity to help the NHS predict demand and provide more care out of hospital, through preventative intervention. This will be increasingly important as we tackle the challenges that lie ahead.”

For Jane Rendall, Sectra’s Managing Director for the UK and Ireland, there were also reasons to be positive: “A decisive mandate to make critical digital programmes happen and renewed agility, are two important things to take lessons from, as the NHS has continued to respond to COVID-19 during 2021. Despite the pressures of the pandemic, we have been working on more go-lives and have been supporting more digital diagnostic programmes with NHS partners than ever before. Hospitals and entire regions have identified access and availability of medical imaging as mission critical to patient care. People in the health service have committed time, energy, intellect and resource to driving this forward at scale, backed by c-level endorsement. Doing this in a collaborative and agile way is leading to earlier realisation of value as significant deployments have happened at pace.”

For Tom Whicher, Chief Executive of DrDoctor, meanwhile, “2021 was all about helping the NHS to shift back into recovering services with many choosing to find a hybrid model for follow up appointments using virtual consultations.”

Tom added: “Broadcast messaging helped to reduce the number of calls from referrals being chased. We also saw digital tools being quickly implemented to aid COVID-19 vaccinations as trusts looked to vaccinate their staff. The NHS also launched its ambitions for AI in order to proactively explore its potential and help develop their strategy for health and care. The government saw the need for solutions that optimise efficiency. Hopefully 2022 will see AI streamlining the analysis of patient feedback, medical records, and clinical data and providing a better experience for patients.”

Stuart Harrison, Co-founder and CEO of ETHOS, noted: “There has been a significant shift during the pandemic as healthcare professionals moved to digital/online and remote working at scale. This is catalysing the CPD (Continued Professional Development) requirements for clinicians as ‘digital’ practitioners. Healthcare professionals are used to carrying out risk management activities in day-to-day practice, but there is little awareness of the core set of standards relating to the risk management of digital technologies that are mandated in health and care.”

“In 2021 the workplace and the workforce changed,” said Mark Walton, Chief Technology Officer at Block. “We re-imagined the office as a place for innovation and collaboration. Remote working became the norm for many and a focus on user experience was critical. Cloud became critical to transformation, acting as an enabler of speed, flexibility and scale. Data too was a focus with AI unlocking business insights to support better, faster decisions and change. Security and compliance were key, regulatory pressures increased and the cyber-attack surface grew. Intelligent, automated services were needed to protect critical data and systems and close the growing digital and cyber maturity gap.”

“The pandemic has reminded people just how central diagnostics are to the work the NHS does. 2021 has seen significant funding released to the networks as part of Restoration and Recovery and major themes have been the continuing growth of the consortiums and a gear change in the establishment of Community Diagnostic Centres (CDC), noted Felix Williams, Chief Technology Officer, Ethical Healthcare Consulting.

“In imaging, as contracts come up for renewal, this has meant a consolidation of network technologies around single PACS suppliers. The increase in out-of-hospital examinations is a natural by-product of COVID and trusts/networks are looking for flexibility from suppliers as they establish their CDCs and data sharing solutions.”

“2021 has been a year of growth and great partnerships”

Many commentators also shared their reflections on company-wide achievements, highlights and progress, as well as their hopes going forward, from what has been a busy year.

Juliet Bauer, UK Managing Director, Livi, stated: “Last year saw tremendous growth for Livi as appetite for digital health sustained even when society opened up. We saw month on month increases from both patients and partners, showing people appreciate increased access to high-quality healthcare. Livi also became the first digital healthcare provider to be rated ‘Outstanding’ by the Care Quality Commission, demonstrating how a digital player can offer great healthcare for everyone.

“Digital will be pivotal as increased use of batch messaging will facilitate fast-paced population health management programmes. Our messaging platform MJog by Livi continued to play a key role in delivering messages to the public on receiving a COVID booster, flu jab, or other health-related services. In 2022 our partnership with more than 4,000 GP practices will enable remote monitoring of patients’ mental and physical health, with results uploaded directly into patient records. This will help to improve patient safety and provide a more efficient way for practices to collect structured patient data for Quality Outcomes Framework reporting.”

Alan Lowe, CEO of Visionable, also looked back on events of the last year, adding: “2021 has been a year of growth and great partnerships for Visionable. We can see that the best way of solving healthcare’s biggest problems is by combining efforts with others wanting to make healthcare equitable and accessible to all. We’ve spent a lot of time speaking with senior healthcare leaders, learning from them, discussing what problems exist, and how we can provide solutions. Big changes are afoot in healthcare, particularly in the NHS, and I cannot wait to see how a combined and targeted effort will implement effective change in digital healthcare.”

Peter Corscadden of Hyland Healthcare, added: “The realignment of NHS Digital and NHSX promises to foster yet more collaboration between industry and care providers. This will help speed up the process from idea to execution, while ensuring solutions are tailored or even co-created, to solve problems and enhance patient care.

“Vendors need to show leadership in interoperability. Initiatives, such as IHE Connectathons, have become more important in the current climate, due to the rise of telehealth, remote work and digital interactions with patients.

“I regularly talk to hospitals who struggle with viewers that don’t seamlessly link up with EMR systems; or pathology reports that don’t reconcile to the correct patient record, or web viewers that don’t quite work as intended in the clinician’s home or off-site MDT meeting; and I’m proud of the ongoing commitment we continue to make in this crucial area of healthcare.”

And finally, sharing learnings from the year, and looking back at the challenges faced, was Liz Ashall-Payne, founding CEO of ORCHA.

“This year successive policy papers have stressed the need for digital health and new NICE guidelines called for therapy to be prescribed before antidepressants. There is a massive role for digital here,” said Liz.

“The problem is that unless we have a straightforward infrastructure in place to support digital health, we’re effectively building our house on sand. We need standards in place which define the threshold for quality. We need a formulary that clinicians can prescribe from and a system to track the delivery, with safety recall in place and adverse event reporting.”

On ORCHA’s last 12 months, she added: “This year we’ve partnered with seven ICSs across the entire South West of the country to provide a series of digital health libraries, each themed according to local health priorities. This fantastic project underlines yet again why we need policy makers to take our infrastructure concerns seriously. ORCHA’s international presence has grown again in 2021, with digital health libraries created in Dubai (a first for the Middle East) and Canada. Our work to ensure digital health interoperability across five Nordic states has taken a massive leap forward, with the creation of a draft Nordic baseline review.”

Thank you to everyone who shared their reflections on 2021 one with us – the team at HTN wishes you all a safe and happy 2022!

Our latest Interview Series segment talks to not just one health tech professional but a full panel’s worth. The Web Development team at Royal Cornwall Hospitals NHS Trust recently joined HTN for a virtual chat about the importance of website accessibility.

Royal Cornwall Hospitals was ranked first in the web governance platform Silktide’s NHS Trust website accessibility rankings earlier this year, while the team also topped the charts in a later Silktide leaderboard for Clinical Commissioning Groups (CCGs) due to its work on the NHS Kernow site. They’ve also more recently supported colleagues in Cornwall Partnership NHS Foundation Trust to reach third place, only just missing holding the top two places, while Royal Cornwall Hospitals also hit a ‘perfect’ 100 score for accessibility this week, retaining its first place ranking among NHS  trusts on the Silktide index.

To compile its indexes, Silktide compares millions of websites and analyses areas such as accessibility, content, marketing, mobile optimisation, speed, and legal compliance. With this in mind, we asked the Royal Cornwall team to tell us about their web accessibility journey, and to share some advice and learnings with the HTN audience.

The interview panel was comprised of: Ian Nicholls, E-health Transformation Manager; Jamie Smith, Senior Web Developer; Dave Wilson, Senior Web Developer; and Shanaya Kirkbride-Ryan, Apprentice Web Developer.

Together, they cover the internet and intranet for Royal Cornwall Hospitals, Kernow CCG, and Cornwall and the Isles of Scilly Health and Care Partnership, and contribute advice to the Cornwall Partnership NHS Foundation Trust sites.

“It’s been a bit of a journey, I think it’s fair to say, over the last 12 months…accessibility has been something we’ve worked hard on,” said Ian, who is a pharmacist by background but joined the team as manager in January 2020, and has been learning about websites ever since…

Talk us through your web transformation journey

Ian: We went through a bit of a transition…Dave was appointed to the job of Senior Web Developer and that’s when he told me there was something we really ought to have been doing better that we didn’t know much about. We didn’t even really know what accessibility meant, or what compliance looked like. The first thing we had to do is figure out the state of our current website, how good or bad was it?

We got audited, we paid for a third-party company to come in and point out the issues in our existing system which is a WordPress website theme. There were a lot – I think we were pretty non-compliant, we weren’t anywhere close to being right. That’s when Dave, Jamie and Shanaya really started working through the different issues on the sites.

Over the last 12 months, by changing the ways that we are working – in sprints and in a more agile way – we’ve picked away at the issues and delivered this. It was all based on existing things, so we didn’t have to go and completely start from scratch, we worked with what we had. We thought we’d have to commission a whole new website, but we figured out that we could pretty much do it ourselves.

Jamie: Since we’ve had Ian, that’s allowed us to focus on the [IT] things that we need to be doing. We didn’t really have a dedicated developer in the team [previously], the way we do now since Dave took that role on formally. It’s not that we weren’t aware of accessibility, but we didn’t have the  focus or resource to deal with it.

Dave: Journey-wise, I think the turning point was when we started to realise you have these regulations and you must follow them. Luckily, everyone in the team was on the same page, so we quite quickly changed from looking at what you must do, to understanding why you should do it and why it helps. As soon as that point hit – having one in five people who can’t use the service, as an NHS [Trust] – it made everyone [realise].

Ian: We started off with regulatory compliance and what it meant – which isn’t anything about regulatory compliance at all – it’s about service users being able to use our website. I think that’s very much the approach. We’re not doing this because we know we must comply with the law; we’re doing this because if we don’t do it then people can’t use the website. That’s why it’s there and why it exists.

Jamie: I think for all three of us, and yourself Ian, it’s [to do with] caring about the patients. That’s what’s driving it more than anything else. It’s about the users being able to get what they need from our sites and not being blocked, disenfranchised or inconvenienced.

What did the work involve?

Ian: We thought this was complex and complicated. But, when you start scratching away at it, it isn’t. It’s a lot about changing colours on the website to make them accessible or making sure the fonts are sensible. It’s actually not that big of a deal.

You don’t necessarily need to have high-end development skills to deliver the changes you need to make an accessible website. There is still probably quite a lot of scope within the teams that don’t have their own development resources, to make some changes to do this themselves.

Dave: I’d agree with that. You get started and it’s amazing how you almost miss some of the things. Obviously, tech progresses so quickly, and regulations are relatively new to the world of web. You think, ‘that makes sense, why weren’t we always doing this?’

Shanaya found the product that we use, called Silktide, which do the rankings online, and we got in touch with them. They have software that you can run on your website that gives you instant feedback, rather than just monthly reports. In-built within that they have simulations for people with different levels of colour-blindness and dyslexia.

Seeing is believing. It’s amazing when you look at it. You run something on it and you go, ‘oh, someone colour-blind actually can’t see our jobs post on the page, or the wait times for emergency care’, just because of the colour of the font and the contrast.

Jamie: Ian arranged some training for us earlier this year on document accessibility  and what really came home to me was that disability or visual impairment, affects 20 per cent of your potential audience.

I had the preconception that the biggest issue was visitors who need to use a screen reader  – but we learnt that’s only five per cent of the 20 per cent statistic – for the other 15 per cent, it’s the colour contrast, or how the way you write affects people with  dyslexia..

The greater challenge, I find, is educating people who are supplying you with the material for their content eg [being] user-friendly, getting the reading age right, or thinking about colour contrast and use of images…

Ian: Finding that [Silktide] software really changed the game for us. Even somebody without development skills for websites as me could spot where the problems were without any training. It’s a fantastic tool.

We’re aware that testing of that type is not 100 per cent of the issues – it doesn’t tell you everything and it doesn’t guarantee that your website is perfect and accessible – but it’s a useful tool for finding things, to direct your focus to the things that you need to do first, and to spot when you put new things up.

We’ve done things in the past that would then cause issues but, if we only had periodic auditing like we started with, we never would have found those issues.

What were your biggest challenges?

Ian: The first challenge was understanding what it was all about, what it meant and not just the technical [aspects] but what accessibility meant and the types of disabilities. The next thing is knowing about the problems on your site and what you can address. Once you know what they are, the third problem is, how do you schedule fixing them in line with all the other work you have, and how do you prioritise?

We still have some quite significant problems in that, whilst the website is really accessible, a lot of the document content that people within the Trust want to be available via the website, isn’t accessible.

How do we get the level of understanding across the Trust, to such a level that everyone is producing accessible documents that can go on the web? It’s possibly a bit wider than that as, although these regulations only apply to the website, if you email someone and they are among the one in five people [with a disability or visual impairment] then they still can’t access it.

Whilst we need to get the Trust’s general level of understanding and the quality of content on the website up, so that we are compliant with the law, we also need to get people more broadly understanding what accessibility means. [This is] so that all our communications are accessible and we’re not causing anyone any disadvantage. That is our current biggest challenge.

Our level of understanding across the Trust is still low but growing and, I think if you went to any NHS Trust, they’d find themselves in the same situation. It would help if there was some sort of national advice, training or guidance from the centre.

Dave: There’s some conflict with general design principles and the way people like to design. Generally, in web and tech, the flashiest user experience and eye-catching thing is what you are trying? to do. Being in a public sector, it’s not, [it is about] trying to find a balance.

You look at colour contrast and suddenly you don’t have this world of colour to use to attract attention or send messages, you have a relatively limited colour palette. So, trying to align those design principles is difficult and something you must think about every day.

Jamie: I’d add to that a good single example – we have a document library and produce policies that are in the public domain. One of the challenges, in terms of people understanding accessibility, is around clinicians who write policy that is very technical with detailed information around patient care processes.

Ideally, it should be the author that ensures their document is accessible as otherwise there is a risk that the clinical content is not as intended.

Ian: The NHS brand guidelines and accessibility guidelines do not line up entirely, which is interesting – Arial is the preferred font but probably not the clearest.  The word ‘ill’ is a good example of this and you can see why people get confused. [In some fonts] the capital ‘I’ and two ‘ll’s are exactly the same.

Jamie: The BBC is apparently developing a fully, accessible font, which hopefully they will make available for use. That will be interesting.

Ian: One of the things Shanaya has developed for us this year is our accessibility tool bar…there are a couple of fonts out there designed for people with dyslexia, which she put in.

Shanaya: Yes, it’s called ‘OpenDyslexic’ and it’s a free font.

Ian: I’ve heard differing opinions on whether it’s useful and [works] for different types of dyslexia. You can, however, go and change our website to Times New Roman or OpenDyslexic, if that helps you view it.

What are you working on next?

Ian: As a whole, we have a website we put stuff onto because we think that’s what people want. But we don’t know what people are coming to our website for and what they want from it. That’s our next job – to figure out why it should exist and what people want.

We have ways of getting feedback, but we need to start asking questions along the lines of ‘what did you come here for?’ and ‘did you find it?’

Dave: We’ve been looking at a way of getting feedback per page, really, so that people can comment. We can analyse that data…and really get the content that people need, right there.

Ian: That’s what I’d love to get to, that’s nirvana, really.

Any advice for our audience?

Dave: The big thing I’d say to most people is – just get started. It all of a sudden comes together and you realise [it’s important]. It’s not just paid tools like Silktide, you can get Chrome extensions and things like that which can simulate some of the impairments.

Ian: Just because you don’t understand all of it, doesn’t mean you shouldn’t do anything. You can do some quite significant things, really easily.

Jamie: One of the best ways to test your document, from the perspective of a person with  a visual impairment, is to run a screen-reader, so we’ve had a free one [NV Access] added to our application catalogue, which all staff can install. Another useful resource is the Diagram Center website, which provides in depth information on the use of images and appropriate alt-tagging for accessibility. There are also some very informative websites for colour contrast and dyslexia,

Ian: You don’t need to be a web genius to figure out what is appropriate alternative text for an image, to start making your website better.

Visit The Royal Cornwall Hospitals website to see the team’s accessibility work in action.

As part of our HTN Now Focus event on AI, Analytics and Data, we welcomed North of England Commissioning Support (NECS) to share their experiences of using data to generate insight and interventions, and discuss their work around population health management.

Joining us for the live chat and webcast was a panel of three health tech professionals – Ian Davison, Business Information Services Director, and his colleagues, Edward Kunonga, Director of Population Health Management, and Kim Teasdale, Deputy Head of Analytics.

NECS encompasses 1,500 staff across 26 locations, and provides a wide range of services within consulting and transformation, applications, and managed services.

On analytics, Ian explained that NECS’s service has five layers – DSCRO [Digital Services for Commissioning Regional Office of NHS Digital] data management, business intelligence (BI) tools, information analysis, intelligence analysts, and clinical commissioning intelligence – which all support population health management.

Speaking about data management, Ian added, “it relies very much on our large data warehouse, our single point of truth, which we have upgraded to something which we now call ‘Axiom'” –  a persistent data store and system that provides healthcare professionals with secure access to a wide variety of information for planning, redesign, and operational health reporting.

Regarding insight and intelligence, Ian noted that ‘deep dive’ reports, travel impact analysis, A&E simulation to understand bottlenecks and flow issues, as well as System Reconfiguration Modelling, are all areas covered.

Ian then handed over to Kim, who provided a demo of how the tools work and a snapshot of some of the ways they can be used to glean insight from data, for the purposes of population health management.

Providing a background on RAIDR [Rapid Actionable Insight Driving Reform], Kim said, “RAIDR is our business intelligence reporting tool, it’s Qlik-Sense infrastructure and we’ve just recently diversified into PowerBI, as well. It’s based on the secure NHS network but it’s ideally a web-based tool for users to log into. From our perspective, it’s about making data and information very accessible to end users, so potentially the audiences is those [people] that aren’t necessarily used to using and looking at a range of complex data.”

“Users can drill into data, access reports…we very much developed the system ourselves, within the NHS, for use for the NHS clinicians – and our analysts worked very closely with those clinicians to develop what you can see,” Katie stated.

Explaining that there are a range of dashboards within the RAIDR system – including population health, primary care, patient activity, urgent care, prescribing, COVID, care homes, and more – Kate opted to demo examples related to population health management.

The live demo then took the audience into RAIDR, landing first in the Population Health Management Dashboard for the North East, North Cumbria, and Yorkshire and Humber, specifically highlighting to viewers the population segmentation tooling and how long-term conditions data is mapped against hospital admission and activity data.

“What the algorithm does is it looks across the population and it drops every patient across the population into one of these 13 segments. If you have a disease such as cancer, advanced organic brain disorder, sever mental illness, or [are someone with a] learning disability then you’re automatically put into those cohorts, and then you are segmented based on the number of long-term conditions, and your age,” Kate said.

Kate added: “What the segmentation tool enables you to do, from a population health management perspective, is that you can start to understand segments of your population and their usage of activities and services across your system, rather than doing more traditional style analytics.”

She then went on to outline example approaches with this particular dashboard, and how to use it, including bringing in wider determinants – such as the most deprived decile – to better understand what people from different segments of the local population are accessing hospital services for. Lifestyle factors, issues and risk factors, such as a BMI greater than 30, high alcohol consumption, a history of substance misuse or smoking, are also able to be included, which could enable professionals to highlight them for potential interventions and care plans.

“What the dashboard is trying to understand, and trying to show, is where the areas potentially might be, for more ‘deep dive’ analysis to occur,” Kate noted, before also guiding the audience through an example of a risk stratification tool for risk of emergency hospital admission, through a population health management lens. This she said, could help professionals to understand how many patients are high risk and where they are located, as well as identify which patients do not have a named GP or don’t have a care plan in place.

“That gives you a flavour around some aspects of how we are supporting that broader population health management ask, and how you can dive-in from quite a high-level of the population, all the way down to a GP practice level,” she said, before also taking a look at how elective waiting list data can be linked with risk stratification to help clinicians with management.

Edward then stepped in to host the final part of the presentation and used his section of the session to share case studies about how some of the RAIDR functions have been used.

“We wanted to understand the level of deprivation across our area,” he stated. “Because we’ve got access to all of that data, we can profile by deprivation but also look at the patients who are in ‘the deep end’ – the most deprived decile…we’ve got a third of our population living in the most deprived communities…that’s very useful in terms of beginning to understand the profile of our population and how that then plays out in resource utilisation.”

Regarding emergency admissions, he noted that, “people from our most deprived, most vulnerable populations, tend to utilise these services more. But we wanted to really get to see how that plays out across our region.” Edward questioned whether the emergency and high readmission rates were a reflection of the quality of care delivered, or were indicative of the complex issues those patients were facing. He explained that they had compared emergency admission rates with patients who were at GP practices in ‘the deep end’, against those with similar levels of deprivation but who may be registered at practices that were not in the ‘deep end’.

“That helped us to think about, this is not about the quality of care, this is about the volume our different practices have and the challenges we have with socio-economic deprivation…how then should these practices be funded?”

Edward also ran through how the RAIDR dashboard can be utilised to help people on elective lists to optimise their health while they are waiting and explained work that had been undertaken with Durham County Council, to help them identify potentially medical and socially vulnerable patients.

“There’s lots more that we can do because of the access to the data and it then allows you, when you’re transforming services, to really identify what to do and to support those patients,” he said.

Catch up on the full session below:

The NHS Race & Health Observatory, an independent body which works to identify and tackle ethnic inequalities in health and care, has released a new strategy for the next three years, covering 2021 – 2024.

Titled ‘Driving Race Equity in Health and Care’, the document covers a number of areas and priorities, including health and care, empowering vulnerable communities, equitable environments, global collaboration, and innovating for all.

In the dedicated section on innovations, the publication addresses technologies and inequalities – specifically how health tech, data and digital initiatives must be used to reduce inequalities, rather than exacerbate them.

The theme is a topical and crucial area within healthcare at the moment, considering the widespread NHS adoption of digital tools during the COVID-19 pandemic, and the push towards new technologies, with the Secretary of State for Health and Social Care, Sajid Javid, having recently ordered a review into racial bias in medical devices.

“Technological developments and a proliferation of data in health and care offer incredible opportunities for the future. Harnessing this technology could transform medicine forever,” states the NHS Race & Health Observatory strategy, “but we must recognise that the size and complexity of the health and care system means the adoption of new technologies is slow and often patchy.

“If properly adopted, these new technologies can help us eradicate ethnic inequalities in health and care,” the authors say but also highlight that, “alternatively, inattention to these new developments could further ingrain those inequalities.”

In its workstream in this area, the organisation reveals that it plans to “look at the development and deployment of digital tools – such as video consultations, health monitoring apps, and workforce management systems – and help gather evidence on how they can be used equitably.”

The organisation’s other focus is to “also look at what existing data can tell us about health inequalities and, where necessary, recommend areas where more data should be collected. This includes considering how ethnicity is coded across existing health and care pathways, and how disparities are measured as part of existing performance reporting.”

Keeping an eye on the future, as well, the Observatory says that a better understanding is also needed around “developments in areas such as genomics and precision medicine, the adoption of artificial intelligence in diagnostic processes, and beyond.”

Actions and intentions laid out in the strategy, to help the NHS Race & Health Observatory meet its aims, include: establishing an ‘advisory group of expert analysts, policymakers, clinicians, and academics’ to guide its focus over the next three years and ‘steer new research into digital inclusion, use of data, and emerging technologies’; developing an ‘interactive digital platform’ which will help ‘draw together data from a variety of sources to create a tool for system leaders to identify areas for attention, and to offer evidence-based solutions’, as well as acting as a repository for good practice; and engaging with ‘experts in emerging technologies’ to ‘commission and collaborate on experimental and forward-looking research’.

To read the new NHS Race & Health Observatory strategy in full, click here.

Today, the Observatory has published its strategy for the upcoming years. The strategy provides additional insights into our aims and priorities as an organisation.

Some of the highlights are detailed below 1/5 pic.twitter.com/asWGrKSS08

— NHS Race & Health Observatory (@NHS_RHO) November 29, 2021

Feature by Highland Marketing 

Digitising hospitals was the focus of NHS IT policy for twenty years. The job is still unfinished: so what are the options for trusts – and the integrated care systems that are planned to take over health tech strategy and funding next April? The Highland Marketing advisory board asked three leading chief information officers for their views.

Covid-19 and the latest reforms of the NHS have focused attention on health tech to an unusual degree. The first few months of the pandemic saw a rapid roll-out of remote working, virtual clinics and digital-first primary care and triggered a lively political and media debate about their future role in healthcare.

Meanwhile, the health tech market has been focused on integrated care systems and the shared care records, data platforms, and apps they will need to join-up services, introduce population health management, and create a new ‘offer’ for places and citizens.

In the middle of all this, the digitisation of hospitals seems to be in danger of being overlooked. Which is odd, because for 20-years it was the focus of NHS IT policy, and it is still far from complete.

With the global digital exemplar programme wound down, the Unified Tech Fund planning to allocate the last of Jeremy Hunt’s tech money by March, and ICSs due to take over IT strategy and funding in April, it doesn’t look like there’s a central strategy to improve things.

Yet, as the ‘What Good Looks Like’ document for ICSs acknowledges, there is a need to ‘level up’ trust electronic patient record provision, if hospitals are to work efficiently, support their staff, and feed into those shared care record and data platforms.

So, the Highland Marketing advisory board asked three leading chief information officers what their trusts are doing, to inform a debate about the challenges and opportunities ahead.

Big box? Best of breed? Ecosystem? Or new thinking?

Adrian Byrne, the chief information officer of University Hospitals of Southampton NHS Foundation Trust, started by challenging some of the terminology that is used around hospital systems.

Traditionally, he noted, people have contrasted ‘big box’ or single supplier with ‘best of breed’ models for rolling out EPR functionality, such as patient administration, order comms, e-prescribing and, more recently, e-noting and e-observations. But this may be unhelpful and outdated.

Unhelpful, because even the biggest of ‘big box’ EPRs don’t do everything, so trusts are going to have to integrate them with other systems at some point; and the real question may be how much integration they want to handle.

“There seems to be an idea that it’s ‘go with one of the big boys’ or ‘let chaos reign’, but I don’t subscribe to that,” Byrne said. “We are said to have a best of breed approach, but we want to integrate where we can and get down to as few systems as possible.”

Outdated, because most of the current discussion about EPRs is focused on how they are evolving into platforms that can collect and then flow data into different systems, including patient-facing apps.

“I spoke to Will Smart [the former CIO of NHS England, who now works for Dedalus] a couple of weeks ago,” Byrne said, “and he didn’t want to talk about EPRs anymore. He wanted to talk about platform, flowing data, and patients: and I think that’s right.”  (Highland Marketing also spoke to Will recently, and there’s more on his views here).

Hospital IT is like an onion…  

In practice, the basic distinction is well understood. Martin Sadler, the chief information officer at Sandwell and West Birmingham NHS Trust, said his organisation “put in an EPR 18-months ago” and “it has given us a platform to say: ‘this is what we have done to the patient’ and ‘this is where they are in our system’.”

Whereas Neil Perry, director of digital transformation at Dartford and Gravesham NHS Trust, said that in 2017, when his organisation refreshed its IT strategy, it first “decided what it wanted to do” and then decided that “best of breed was the way to get there, fastest.”

But there was agreement between presenters and advisory board members that it is not enough.

Since then, his trust has adopted a modern approach to integrating data from its different systems and re-exporting it to apps that ‘fill gaps’ in its EPR functionality, working with an open platform from Alcidion.

However, there was agreement between presenters and advisory board members that an EPR, however, developed, is not enough.

Sadler said that while his trust had deployed Cerner Millennium, this was not the end of its IT strategy. Perry showed a slide that set out his strategy as an ‘onion’ with core functionality at its centre, and open, innovative systems for e-prescribing, analysis, and remote patient monitoring in the outer layers.

“An EPR is important, but to my mind, in our onion, it will be doing the core stuff and around the edge will be all the really exciting stuff: and that’s more or less what Will says,” he said.

Options, pros and cons

Bearing this in mind, the presenters and advisory board members felt there were pros and cons to the two approaches that less mature trusts will need to consider. A single supplier approach can get trusts a long way fast: one vendor pitches its system as “HIMSS 4/5 out of the box.”

There is a perception that this makes ‘big box’ the preferred option for NHS England, which picked a lot of single supplier trusts for the GDE programme, and NHSX, which has structured the digital aspirant funding and the UTF around a PAS plus EPR modules approach.

It’s also understood by boards. Neil Perry said one of his challenges was getting new leaders to understand his strategy. “You get the board asking why we don’t have an EPR, or why we don’t go and buy Cerner or Epic,” he said. “Regulators can also be a challenge.”

On the other hand, a single supplier approach is expensive. Sadler said his trust chose to retain its patient administration system and running Cerner Millennium still costs half his IT budget.

There is also a danger of trusts deploying their ‘out of the box’ EPR functionality and getting stuck at its level. The GDE programme was set up to take trusts in this position to the top of the HIMSS EMRAM maturity model and to create a ‘blueprint’ for others to follow.

It worked for the trusts involved; but many “semi-digitised” hospitals will be running systems they got around the time of the National Programme for IT, with a bit of e-prescribing and e-observations, for which there has been national money.

So, perhaps the biggest argument for ‘best of breed’ these days is that it can encourage innovation. Perry said that as part of its 2017 strategy reset, his trust decided that “we didn’t just want to be an early adopter, we wanted to be right on the left-hand side of the adoption curve, in the red zone, working with start-ups and innovators.”

Byrne’s team has developed its own technology, including the My Medical Record personal health record that is being quite widely adopted, particularly for prostate cancer follow-up (the Highland Marketing advisory board has been following the progress of MyMR, and there’s more information here).

Challenges and opportunities

Parking the current lack of national focus, why haven’t more trusts made similar progress? Board-level support and funding are definitely issues. Sadler said that in his previous CIO role, at young fashion website Missguided, his IT budget was 22% of turnover. The three presenters estimated their budgets at 2-4% and said they needed 6-10%.

But it’s not just money. Cindy Fedell, a former NHS CIO who now works in Ontario, said people were also an issue. “You need a good CIO, who can understand strategy and understand their options,” she said; arguing that more should be done to support professionalism and certification initiatives.

Then, there’s local politics. James Norman, another former NHS CIO who now works for Dell Technologies, said when it comes to collaboration across a health economy, two of the potential reasons trusts go out to tender are that they’ve been formed in a merger, and it’s easier to pick a “compromise” system than it is to get people to work with each other’s IT, or they want to be on a different system to their neighbour/s to stop a merger happening.

Although Sadler said he’d have been happy to use a neighbour’s technology; if they weren’t trying to charge so much that it wasn’t an option. “All of that needs to stop,” Norman argued. “We should be working together as one NHS and sharing ideas and skills and systems.”

ICSs: a chance to level up to where the best are now, not where the GDEs were five years ago?

In the absence of a national strategy, one of the questions for the future is going to be how integrated care systems approach the job of drawing up IT strategies for their trusts and patches.

Byrne argued there is a danger that some could be tempted to bring in management consultants who will advise buying a new kind of ‘big box’ – a single EPR for trusts, with a health information exchange / analytics package / patient portal attached.

Which, he argued, was likely to be a bad idea because it would mean swapping out one v1.0 system for another v1.0 system. As an alternative, he outlined a three-pronged approach.

First, a proper evaluation of the level of digital maturity that trusts have achieved for the money they have spent, to identify best-practice and where best to allocate ‘levelling up’ funds.

Second, ICS or ICP-led, system-wide procurements in areas where these make sense: pathology, imaging, areas like maternity that are not covered by EPR functionality and have a strong patient component. And third, system-wide integration of existing IT, so organisations can exchange messages with each other and with patient facing technology.

“I think it has to be an evolutionary approach,” he said. “If people have some digital maturity, they should keep going, and keep thinking about how to build on those foundations. And it has to be clinically-led.”

Nicola Haywood-Alexander, the CIO for the Lincolnshire integrated care system, said she was hoping to develop a strategy around this kind of idea. “I want to build up an architecture across the ICS,” she said. “Instead of asking: ‘does this hospital need an EPR’ I want to ask: ‘what do we need across the system?’

“That way, we can use investment to support new kinds of thinking. A lot of work that is done in hospital at the moment is going to be done in the community or homes in the future. So, we need to look at what works in hospital and ask how we can get it into the community or homes.

“Then, with a bit of luck, we can get the aspirants to where the best people are now, and not where the GDEs were five-years ago.”

Highland Marketing’s advisory board: Jeremy Nettle, former global advisor for Health Sciences, Oracle Corporation; Cindy Fedell, former chief digital and information officer at Bradford Teaching Hospitals NHS Foundation Trust; Andy Kinnear, former director of digital transformation at NHS South, Central and West Commissioning Support Unit; James Norman, healthcare CIO, EMEA, at DellEMC; Ravi Kumar, health tech entrepreneur and chair of ZANEC, and Rizwan Malik, divisional medical director of Bolton NHS Foundation Trust and managing director of South Manchester Radiology 

Highland Marketing is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies and healthcare providers, built over almost 20 years. Read more analysis and interviews on the Highland Marketing website, follow on Twitter @Highlandmarketng, or get in touch on: info@highland-marketing.com