This report explores the areas of IT and digital services that doctors say are most in need of improvement, such as:
- infrastructure, including:
- hardware,
- software,
- and broadband;
- interoperability of clinical information systems;
- user involvement in the design and implementation of digital strategies;
- digital inclusion so patients can access digital health services; and
- financial investment.
Digital transformation can support health service recovery and resilience, but some key barriers need to be addressed.
Infrastructure
Significant clinical time can be saved by improving IT equipment and software
The parlous state of even the most basic IT continues to result in significant losses of clinician hours (amid serious workforce shortages), and impacts patient safety.
It is crucial that basic hardware, information systems, connectivity and broadband speeds are improved expeditiously.
Key recommendations
- Defective or inadequate IT equipment must be updated or replaced. Doctors should immediately raise concerns over any IT problems that may present a risk to patient safety.
- Hardware provision must be improved. Doctors could be provided with laptops or mobile devices such as tablets to save on space and prevent them from having to share equipment with too many other clinicians which can lead to delays. Consideration would need to be given to the environmental impact of such arrangements, however.
- Software and systems must be streamlined and/or consolidated where possible.
- High-speed broadband must be accessible in all healthcare facilities. Where it is not, urgent upgrading must take place.
- Wi-Fi must equally be available and be able to support high levels of use.
Interoperability
Interoperability of information systems, supported by clear standards, must become the norm to ensure the safe and speedy of delivery of care
A lack of interoperability affects the quality, timeliness and safety of care that patients receive. For instance, more than 4 out of 5 (82.4%) doctors answering to our survey reported that delays occur ‘always’ or ‘very often’ in accessing data from secondary care.
The implementation of interoperable clinical systems must be prioritised, to enable the safe exchange of essential patient information instantaneously between healthcare settings and between health and social care.
Doctors must feel confident in sharing patient data seamlessly and instantly throughout the health service.
Key recommendations
- Interoperability must be improved to facilitate effective communication and data sharing across health care systems, especially across the primary-secondary care interface.
- Robust standards for interoperability must be developed by the appropriate UK health service regulatory bodies.
- Purchasers must be required to enforce these standards, to guarantee that any software meets the required standards. Work must begin to extricate providers from any contracts with suppliers that do not meet the standards as quickly as possible.
- Robust cyber security measures must be in place nationally and locally to protect health information systems and mitigate against widespread disruption to patient care.
Involvement
Clinician involvement, up-to-date digital skills and effective Government strategies are all needed to ensure IT systems are safe
The involvement of clinicians in the design of systems will ensure that these are user friendly, safe and effective. Similarly, the involvement of doctors in digital strategies will ensure that systems work for doctors, and in turn have positive impacts for patients.
However, 32.5% of doctors reported that, while they had some training to use IT systems, they needed or wanted more. Thus, it is vital that doctors are supported to develop and maintain their digital skills in order to use the systems safely.
Key recommendations
- Users of digital systems should be closely involved with or leading the design and implementation of digital programmes and strategies. Providers must go further to actively consult with doctors at all levels and at all stages of digital procurement and transformation.
- Digital transformation strategies should be part of a package of coherent strategies (including on workforce and funding), to enable staff to use technology and systems with ease and enable them to deliver safe care.
- Digital skills must be embedded in medical education and training curricula and skills kept up to date over the course of a doctor’s career through in-house training and Continuing Professional Development (CPD).
- Doctors must have protected time and support to upskill themselves, and the training offered should be varied to meet different learning needs. Managers must ensure that staff are aware of and can make the most of any training offered.
- Doctors and other healthcare staff who handle sensitive patient data must be trained and supported to do so safely and in line with accepted IG (information governance) practices.
Inclusion
More must be done to level the digital divide and ensure patients are well informed and no patient is left behind
Digital exclusion or digital poverty has been described as a social determinant of health. According to ONS data from March 2020, almost 3.4 million adults in the UK had never used the internet.
Health services must lead work on developing and implementing national digital inclusion strategies, and patients must be supported and have the flexibility to access services in their preferred way.
Furthermore, increasing transparency around the use of patient data will build confidence among patients that their medical information is secure.
Key recommendations
- Health services must lead work on developing and implementing national digital inclusion strategies, building on work already being done in local areas such as digital health hubs to ensure that patients are not excluded from healthcare as digital transformation takes hold.
- Patients who do not feel confident in accessing care remotely must be supported so that they have the choice and flexibility to choose different methods of care available.
- A greater degree of transparency around how data is collected, stored and used is required to build confidence among patients that their confidential medical information is secure. Patient/public education campaigns should be run in each of the UK nations and clear guidance provided to clinicians so that they are supported to respond to patients’ questions or concerns.
- More must be done to tackle disinformation in the media about how patient data is collected, stored and used by UK health services.
Investment
Underfunding digital transformation will leave health services on the backfoot
In our survey, more than two thirds (66.4%) of doctors ranked funding as a ‘significant barrier’ to digital transformation in the NHS. Underfunding digital transformation will leave health services at a disadvantage as they continue to respond to increasing demand.
It is essential that IT and digital transformation programmes are protected from health service budget cuts, and capital funding is increased to improve basic IT infrastructure.
Key recommendations
- In the short-term, it is essential that IT and digital transformation programmes be protected from health service budget cuts, recognising their value in terms of efficiency and productivity.
- A full audit of the digital estate in each of the four UK nations should be undertaken to understand funding needs in the medium-long term.
- Increasing capital funding to improve basic IT infrastructure is necessary in the short-term if long-term digital ambitions are to be achieved.
- There must be a greater degree of transparency around how funding is being spent on digital transformation in the devolved nations.