Digital Health and Inter-operability in the NHS


Choluteca Bridge – 1998. The bridge stayed up but the river moved following a storm! Why is this here? Read to the end and you’ll find out.

First talk of the Interoperability summit based on the talk by Robert Watcher – writer of the Watchter report

Watchter – The four stages of health IT are:

  1. Digitizing the clinical record.
  2. Connecting all the parts
    1. Enteprise system to enterprise system
    2. Third-party apps to enterprise
    3. Patient-facing systems to enterprise systems, and to one another
  3. Gleaning meaningful insights from the data
  4. Converting these insights into action that improves value.

Things get really interesting when you connect things – the intercontinental railway connecting up in the middle was the beginning of great innovation and trade in the US. Traditional enterprise is one set of those tracks (EHR’s, Epic, Cerner etc). The second part is consumer-facing IT (big data, apps, sensors, etc.) When these two combine great things will be possible.

Unfortunately in America, the situation of: ‘No electronic medical record’ in a hospital is now seen as a selling point in the US.

You see, because of huge efforts spent on data entry – the US then digitized the system first without thinking about the people and their work in a deep enough way. This resulted in technical maladaption.

According to Ronal Heifitz there are two kinds of changes in work – adaptive vs technical changes. Technical changes think only about how the technology changes; Adaptive changes consider the people involved and how it might impact them – people are both the problem and the solution all at the same time. Healthcare technology must be adaptive – that is why we have managed to get it wrong in the past.

Erik Byrnjolfsson talks about the productivity paradox of health IT. In industry after industry, digitilization was supposed to bring improvement; however, these changes often actually produced more problems and productivity plummeted. “You can see the computer age, in everything except the productivity statistics”. It takes 10-15 years at least for the productivity to follow.

We are at the beginning of becoming a primarily digital industry.

Solving the productivity paradox: Improve the technology and re-imagine the work itself! Both have to happen in order for success to follow! We need to move towards collaborative charting – this is the only way to succeed.

Features of the Wachter report:

Implementation needs to move at an appropriate speed – staged approach, including global exemplars will be necessary.

We need to give local trusts authority to buy best system for them – and not just follow NP-fit which failed as it tried to centralise everything.

We need to build and nurture the clinical-informatics workforce – we must see health IT as change management, not just a technical project. We need chief clinical information officers and a national lead – currently: Prof Keith McNeil

Interoperability is crucial to success and Leaders must...

  1. Connect the digital pieces, learn to use data for improvement and build decision support.
  2. Build skills, culture, governance to re-imagine the work not just digitise it.

Finally. Why is the bridge at the top of the article? Well the Choluteca Bridge in Honduras was a technical masterpeice. It withstood an enormous storm in 1998 and all the engineers congratulated themselves. Except there was one problem… The river had moved. If we are not careful our digital bridge could look the same. That’s why we need to make the solution people-centric!