The benefits of electronic healthcare are widely acknowledged. But will clinicians change to grasp them?
The long-awaited information strategy for the NHS was finally published at the end of May – almost a year behind schedule. Despite the wait, its contents provided no real surprises. Most had heard it all before. But too many in the health service had done little to make sure it succeeded.
The Power of Information is the latest attempt to create a framework to capitalise on the obvious potential of electronic healthcare. It follows in the footsteps of previous efforts to transform the NHS by harnessing the power of information, most notably the failed National Programme for IT. Much within the latest strategy will be familiar to those who have followed the long and expensive journey to drag the health service into the digital age. It shares many of the same lofty ambitions, drivers and justifications that decorated its predecessors. But crucially, plans to develop a centrally managed national system have been placed in the trash. The ‘information revolution’ is upon us again. This time it needs to work.
Success may largely depend on achieving a seismic shift in the cultural mindset of those at the heart of the NHS. Traditional GPs and consultants have developed a paternalistic Victorian view of the delivery of healthcare. They have a widespread belief that the whole process is owned and run by the clinician. On the face of it, whilst clinicians understand the benefits of electronic healthcare at a cerebral level, many have a deeply entrenched view that patient data belongs to them and they are unwilling to share it. If the NHS really does want to put the patient at the centre, the whole model of healthcare delivery is going to have to change, and clinicians’ tribal approach to informatics is going to have to change with it. In an integrated care system, building islands of information will only kill off the promise of electronic healthcare.
The Power of Information outlines a ten-year framework for transforming information for health and care. It covers healthcare, public health and social care in England. The strategy describes the acknowledged benefits of information and how, in the ‘electronic era’, the ability to access it quickly and securely can positively impact care – for health professionals, commissioners, carers, users of care services and, of course, patients. It lists the following as key ambitions:
- Information used to drive integrated care across health and social care, within and between organisations
- Information regarded as a health and care service in its own right
- A change in culture and mindset, whereby health and care professionals, organisations and systems recognise that information in care records belongs to the individual – and can be accessed easily
- Information is recorded once and can be shared securely across interoperable systems
- Electronic care records become the source for core information to improve care and services, and inform research
- A culture of transparency, where access to high-quality, evidence-based information about health and care services is openly accessible
- An information-led culture where all health and care professionals take responsibility for recording, sharing and using information to improve care
- The widespread use of modern technology to make health/care services more convenient, accessible and efficient
- An information system built on innovative and integrated solutions and local decision-making – within a framework of national standards that ensure information can move freely, safely and securely around the system
The final objective represents a departure from previous attempts to develop a national information system. To succeed, national standards for system interoperability must be agreed to provide local decision-makers with reassurance that their chosen technology will be able to communicate with others around the NHS and care system. The Government believes that if this can be achieved, being able to access, contribute to and share care records will dramatically improve the planning and commissioning of services and help clinicians and care professionals to develop improvement strategies that reflect local need. Moreover, it believes that improving access to quality information will support a patient-centric culture it describes as ‘no decision about me, without me’.
The blueprint draws attention to the importance of mindset change. “The success of this strategy depends as much on a cultural shift – in the way patients, users of services and professionals think, work and interact – as it does on data or IT systems,” it says. “It depends on making the shift to give us more control of our health and care and on recognising that sharing good information is pivotal to improving the quality, safety and effectiveness of our care, as well as our own experiences of care.”
Implications for pharma
A key aspect of the NHS Information Strategy is the notion that patient data can be aggregated, anoymised and shared to help inform strategic decisions about care services. The strategy document highlights that the research and life sciences communities will have access to a greater wealth of information to help drive improvements in health and care. Whilst the ability to use anonymised ‘real world’ data to guide commissioning, improve services and identify health trends has great potential benefits, the proposal to share it with commercial organisations is a contentious one. Critics already claim that data security within the NHS needs to be strengthened significantly to protect patient privacy. The suggestion of sharing data with the pharmaceutical industry, no matter what the perceived benefits may be, will need some careful PR before the wider public accepts it. But with the ambitious objective to ensure that everyone will have electronic access to their own care records by 2015 – starting with GP records – the opportunity to improve health research using patient data is within reach.
Call to action
The Information Strategy has largely been welcomed by senior figures within the NHS – but with the caveat that success will only arrive if the health service unites to turn the rhetoric into reality. NHS Confederation Chief Executive Mike Farrar said the strategy will bring ‘enormous benefits’ to patient care. “Having access to the right information is crucial for clinicians to make the best decisions for patients, and to improve the safety and quality of care they provide,” he said. “Information systems will help underpin the new system of commissioning and will play an important role in engaging clinicians in the planning, coordination and improvement of local care. Improved data will allow frontline clinicians to understand and address variations in the quality of care they provide and allow them to quickly go to work to bring about improvements.”
But he warned that the strategy would be key to the Government’s reform programme and that, if it didn’t succeed, the reforms would similarly fail. “NHS leaders are acutely aware that previous information strategies have not succeeded and if we try to implement this work in the same way as we have done in the past, we will fail again. The implementation of this strategy needs national coordination but will require local ownership and responsibility. That balance is critical if we are to be successful. There will not be any second chances for the NHS if we fail.”
Rapid advances in information technology, the benefits of which have been realised across most other business sectors, are providing a tremendous opportunity to redesign the model of healthcare delivery in the UK. Despite this, the success of the NHS Information Strategy will depend upon achieving a comprehensive change in mindset. The barriers to progress are not technological, they’re cultural.