Ideas, innovation and technology – answers for NHS change

Jonathon Edwards

Technology can drive the change needed in the NHS but we must elevate the role of IT leaders and give them a voice, Jonathan Edwards from The Advisory Board Company tells Highland Marketing

The NHS can improve a lot when it comes to embracing new ideas and innovations, says Jonathan Edwards. As managing director of the global eHealth membership programme at The Advisory Board Company, he holds a key position in an organisation that is dedicated to finding the best ideas for improving healthcare.

“But day to day pressures, the burdens placed on NHS managers and cultural challenges do not make it easy for healthcare leaders to think outside the box and foster innovation,” he says.

Injecting a culture of innovation, supported at the core by advanced technology, is now the challenge. Edwards’ organisation is working with healthcare organisations around the world to achieve this. In the UK, he and his team are focussed on five areas of IT-enabled change that will ultimately allow healthcare providers to deliver better patient care.

IT is essential for integrated care to become a reality

Integration and population health management are vital in a world where hospital centric care is now too expensive, says Edwards.

“The economic and demographic facts are unavoidable, we can’t afford to deliver healthcare in a hospital centric model,” he says. “We have to push more care out into the community. We need to become better at prevention and improve patient engagement. We need the incentives to be in place.”

He believes that IT must be at the heart of this change and will be central to any integrated care initiative that involves sharing data. Evidence can already be seen in the UK, with risk sharing contracts across health and social care emerging and wide interest being shown across the NHS in information exchange technologies like clinical portals and patient portals.

“Primary care, acute care and community care have to be joined at the hip,” says Edwards. “They have to work together to manage patients in a more efficient and effective way. It is inevitable this will happen and evidence shows this is already happening around the world.”

EMRs – take the gradual approach

Electronic medical records, or EMRs, will be essential for healthcare organisations to deliver safe, effective, efficient and well informed patient care in the future, says Edwards. He believes major challenges in implementation could be overcome by taking the right approach.

EMRs incorporate everything from e-prescribing to documentation, decision support, knowledge management and workflow all in one integrated system, which is definitely preferable to having to interface so many different systems.

But an integrated approach does not mean that systems need to be implemented in a big bang fashion. “It is a common fallacy that EMRs need to be integrated in one fell swoop,” says Edwards. “We are working with members to help them take gradual steps to implement EMRs and get value in a gradual way.”

Achieving value is another big challenge when it comes to EMRs. “These are very large investments and there is naturally a lot of concern about the value they deliver.” Enterprise content management can offer cash releasing savings quickly by eliminating storage costs for paper records. However a lot of the value from EMRs takes time to be realised and comes from advanced functionality such as e-prescribing.

Elevating the role of the chief clinical information officer (CCIO) can help to address these challenges, says Edwards. “The CCIO needs to have responsibility not just for championing the cause of IT or choosing and implementing a system, but actually for getting value from an EMR system.”

BI and analytics – how to achieve the predictive and prescriptive

As terms like big data are increasingly discussed in healthcare organisations, so too are terms like business intelligence and analytics.

Most healthcare organisations across the world are already engaged in descriptive analytics, where they can look back and see past bottlenecks in emergency departments, for example.

Now many are advancing into predictive analytics, which allows them to predict that a capacity bottleneck will occur, or even prescriptive analytics, which involves taking action to prevent the capacity bottleneck ever happening and making sure capacity is optimised.

Whether opting for analytics as a service, looking to EMR vendors to provide analytics, or building their own enterprise data warehouses, healthcare organisations can now gain access to advanced analytical tools. But barriers must be overcome first before these tools can be harnessed.

Data governance is a “significant problem”, says Edwards. The NHS needs to ensure data is accurate, consistent and complete and that there is a clear owner for that data. “Organisations that move quite far with business intelligence (BI) often get stuck at some point because they haven’t solved data governance problems,” he explains.

Having the right skills and staff is also a challenge, he says, and with a skills shortage in the UK, many organisations are looking to analytics as a service as the answer.

Culture is one of the biggest barriers of all. Edwards says the challenge NHS organisations now face is to “create a culture that values data and will take difficult decisions even when the data tells us things that we don’t want to hear, where people will trust the data”.

All of these elements need to be at the same level of maturity for BI to work. “It doesn’t make sense to buy an advanced analytical tool suite when you don’t have the skills, governance or culture to take advantage of it,” he says.

“Developing a data-driven culture is going to be critical to making any of this work.”

Mobility – from smartphones to unanswered questions on sustainable telehealth

Mobile working and monitoring are no longer a nice to have but are an essential element of healthcare delivery, says Edwards.

Clinicians now expect to use their smartphones and tablet computers in delivering patient care, something that EMR vendors are trying to catch up on. However mobility means more than this when it comes to the potential of technology. It is also about real time locating, says Edwards. “We can put tags on devices, equipment, put wrist bands on patients and even staff, so that we can better track where things are and where people are, make best use of assets and not waste time looking for the people who are needed for a particular patient intervention.”

Telehealth and telemedicine also offer great potential. But despite the fact that remote monitoring has been technically feasible for many years, most pilot projects have not developed into sustainable ongoing programmes.

“There has been a lack of financial incentive to keep those projects going,” says Edwards. “It is not clear who should be paying and who should be benefiting.”

There are also unresolved questions on clinical liability, he says: “Who is responsible for looking at data generated by devices? Who should respond to alerts? Should it be a doctor or a care co-ordinator. How should that role be staffed? These questions haven’t been thought through.”

IT leaders have no voice in the NHS – it’s time to communicate

Despite the central importance of technology-enabled change, IT is still not being given recognition at the highest of levels, argues Edwards. The status of IT as a true partner to healthcare leaders must be raised, he says.

“This is a big problem in the NHS,” he tells Highland Marketing. “IT leaders do not have a physical seat at the executive board level table or even a voice. Decisions are made about IT without IT leaders being consulted. Decisions are made which involve IT, without thinking through the implications and manageability.”

To raise the status of IT and fix the problem, IT departments must be as efficient and as effective as possible. They can even use lean techniques that have been applied widely in operations and in clinical departments throughout the NHS, but have not been applied thus far in IT departments.

There is also a need to fix IT governance so that IT doesn’t become a dumping ground for requests. “Often the IT department is seen as a yes machine, that doesn’t have the power to say no, and so becomes overwhelmed,” warns Edwards.

But crucially IT must be connected with strategic issues. “We must make sure that the IT strategy is completely in sync with the organisation’s strategy,” says Edwards. “We must make sure that everyone has a clear understanding of how IT is serving the organisation’s principles and goals. This is very much about education and communication.”

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