Andreas Haimbock-Tichy is the director of ecosystems at IBM, chair of the health and social care council at techUK, and a non-executive director of Dorset HealthCare University NHS Foundation Trust.

So, when he took the hot screen for an Institute of Health and Social Care Management HealthChat with Roy Lilley there could only be one subject of conversation – how to get the NHS on board with digital technology.

Andreas Haimbock-Tichy has worked at IBM for twenty-years in a variety of roles. So, he has plenty of experience of seeing health tech initiatives come and go.

When he took part in one of the IH&SCM’s HealthChat, chair Roy Lilley asked him to put that experience to use. “Why”, he asked, as he has asked other health tech experts over the past couple of years, “is the NHS so bad at IT?”

Haimbock-Tichy disputed the basis for this question. The Covid-19 pandemic, he suggested, “has been a great enabler for technology” and “it has demonstrated that both consumers/citizens/patients and services can get a lot of things done using technology.” Now, it needs to make that stick.

Making Covid change stick

Lilley argued this would be difficult, given the NHS’ funding models. During the pandemic, the internal market with its tariffs and contracts was effectively suspended. Money flowed straight to providers, and large additional sums were available for Covid-initiatives.

Going forward, commissioning will return, and commissioners are simply not going to be prepared to pay for digital work at the same price as they pay for face-to-face work, creating a massive disincentive to maintain digital-first approaches.

This time Haimbock-Tichy agreed – but saw two reasons for optimism. First, the arrival of integrated care systems, with their remit to spend a single budget to join up care and introduce population health management. And second, the availability of technology to enhance the basics rolled-out during the pandemic.

“The question for me is where do we go now?” he said. “Video consultations are great, but what are they really good for, and where can we do things to enhance these consultations?

“Where can we bring in remote monitoring, or digital scribing, so the patient can do what we are doing now and focus on the consultation? The pandemic plus the ICS changes give us the opportunity to say: “if we were not here, where would we start?”

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Tech solutions and funding challenges

Lilley suggested that one place a lot of services may be looking to start is with solutions that can take over or enhance the work of increasingly scarce staff. Radiology, for example, where AI is increasingly being used to handle routine scans.

Haimbock-Tichy agreed there was a lot of milage “in what we in technology call point solutions” where “you train AI in a very specific area, using humans, so it can do what they do.”

He also argued that there were many use cases for using the same kind of technology to determine which patients really need to be seen face-to-face by a human expert. Some specialist and mental health services have already gone down this road and started to use digital assistants so that “you only see a consultant if you really need to get one involved.”

However, this took the conversation back to funding. Other sectors of the economy adopted these models of customer interaction a long time ago. A member of the HealthChat audience asked whether the NHS is unique in struggling to do the same?

Haimbock-Tichy said he didn’t think it was unique, but he felt there are some factors that make it hard for the service to adopt systems that should, on the face of it, make it cheaper and more efficient to deliver services, while putting more control into the hands of end-users.

For example, he pointed out, a lot of health tech funding is parceled up for central programmes, like the global digital exemplar programme for electronic patient records, or the local health and care record exemplar programme to test out shared care records and the use of the data they contain for population-level analysis.

Whereas companies tend to use their own funds for technology that will support their operations. “From a culture point of view, we need to move to the point where, as an ICS or a trust [technology] is fully funded from your own organisation,” he argued.

“From a cultural point of view, that means you can take ownership. It stops being something that you are told to do and something that you own as a board.” Lilley has often said that he disagrees with this perspective, and he said it again to Haimbock-Tichy.

“Tesco,” he pointed out, “does not give money to branches and say, ‘go and buy some computers’ and ‘let us know when you have done that.” It puts them on vans, trains people on them, “and says ‘we want them in use by the weekend.”

“Whereas the NHS is still letting organisations buy their own computers, and they’re not interoperable, and we just keep making the same mistakes.”

Interoperability

Perhaps inevitably, this led to a discussion of interoperability. Haimbock-Tichy argued that “centralisation is not the answer to everything when it comes to technology”, given the complexity of the health and care system.

But it might be the answer to sorting out the NHS problems with using standards to make sure that whatever computers it buys can ‘talk to each other’ when they need to.

He pointed out that techUK’s health and social care council has a member on the board of INTEROPen, the industry body that has done a lot to agree interoperability standards and argued that: “Where the NHS needs to be firmer is making sure that these standards are used when procurement takes place.”

He argued that there is an appetite for this from local health and care organisations and the suppliers represented by techUK; who need to be able to slot into an ecosystem of systems and apps supporting work along the patient pathway.

“There is a need for more support for local buying teams on what good looks like, because people want to buy good solutions, but if you are not a specialist buyer of technology, it can be hard to work out what is useful,” he said. “We are working with NHSX on that.”

Cloud, AI, Watson

Taking the conversation in a different direction, Lilley asked if cloud computing would solve all the NHS’ problems, by making it easier for organisations to use systems that they didn’t have to deploy and manage. Putting his IBM hat back on, Haimbock-Tichy said there was a place for cloud, but the mainframe computer was far from dead.

“The future is hybrid,” he said, arguing that there would always be systems that required dedicated, secure hosting, or that would be too expensive to run on a ‘pay as you go’ model. On the other hand, he said, AI was one of the services the NHS might pull down out of the cloud when it needed it.

Asked what had happened to IBM Watson, the super-computer that famously won the US gameshow Jeopardy! back in 2013, he said it was now available on this basis. “Our learning from Watson was that to come up with successful uses of AI you need to collaborate with experts,” he said.

“So, increasingly, we give access to clinicians so they can create machine models to do things like automate pre-treatment screening or to use natural language processes to mine insights from unstructured data. They can go onto the IBM cloud and use the services of Watson to do that.”

Lilley suggested it would “take a generation” to get this kind of change. But, again Haimbock-Tichy disagreed, looping back to the start point for the discussion, and suggesting that Covid had changed everything.

“Covid showed that when there is a compelling reason to do it, people go out and do it,” he said. “I think the NHS is up for this.

“It just needs to work out how to make change resilient, and which services are better than before, and which aren’t. Then, we can have blended services that make the best use of technology.”

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