NHS seeks answers in digital health technology

UK health leaders insist technology is key to doing more with less

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As Britain’s National Health Service struggles with an unsustainable mismatch between resources and demand, health leaders are making the case ever more insistently that technology will be key to allowing it to do more with less.

Simon Stevens, chief executive of the NHS in England, has sketched a future in which patients will, more and more, interact digitally with the health service.

For those in their teens, 20s and 30s, according to Mr Stevens, “the idea of booking appointments and physically turning up to GP surgeries for routine things is an alien concept.”

Some parts of the NHS, which is entirely funded from taxpayers’ money, have indeed enthusiastically embraced technology, both to improve the service they offer patients and crucially to ease the strains on the system.

Yet the NHS, traditionally slow to spread innovation, has struggled to establish current best practice as the norm.

Robert Wachter, who has been at the forefront of realising the benefits of digitalisation in the US health system, recently warned of the “productivity paradox” — the delay between technology being introduced and a corresponding rise in output.

Prof Wachter, interim chairman of the department of medicine at the University of California, San Francisco, told a summit organised by the Nuffield Trust that employees tended to have a vested interest in continuing the old ways of working.

Humans were generally “just not very good at envisioning fundamental changes in the way they work”, he said, citing a quotation often attributed to Henry Ford, pioneer of the mass production of motor cars: “If I’d asked people what they wanted, they would have said ‘faster horses’.”

Prof Wachter is leading a review of computer systems across the NHS for NHS England. Local health leaders who have had the resources and vision to develop IT-based solutions are becoming increasingly powerful advocates for its benefits. They argue it is better for patients — who are more likely to be able to remain in their own homes — and for the taxpayer, as it will help make more efficient use of dwindling resources.

Bridget Fletcher, chief executive of Airedale Hospital, West Yorkshire © NHS England

One such pioneer is Bridget Fletcher, chief executive of Airedale Hospital in West Yorkshire, who has placed her institution at the forefront of so-called “telemedicine”.

Equipment placed in 300 care homes, and in the homes of 100 patients suffering from multiple long-term conditions, means patients and their carers can receive immediate advice at the touch of a button from staff who monitor the screens 24 hours a day, 365 days a year.

A new “digital care hub” opened last month, allowing more than 20 nurses to access screens at the same time, and providing space for all the hospital’s digital services to be located in a single place.

In expanding this approach, the Airedale team has been buoyed by early results based on more than 20 nursing and residential care homes that started taking the telemedicine service in 2012-13. They showed a 35 per cent reduction in hospital admissions on the previous year, a 53 per cent fall in accident and emergency department attendances and a 58 per cent reduction in “bed days”.

Another example of technology being used to empower patients is taking place hundreds of miles from Yorkshire, in Somerset, in England’s west country.

Aware of the demands being made by a growing elderly population in an area popular with retirees, Yeovil District Hospital worked out which patients were imposing the biggest strains on the local health system.

They concluded that just 4 per cent of local people were consuming up to 50 per cent of the health and social care budget. As in Airedale, equipment has been installed in the homes of the people who use the system most, allowing them quickly to contact a medical professional with any concerns, and contributing to a 42 per cent reduction in emergency hospital admissions in the past year.

Patients are also encouraged to monitor key indicators such as blood pressure, reporting any deviation from the norm to health staff.

Paul Mears, the hospital’s chief executive, whose achievements at Yeovil have impressed ministers and health service leaders, is candid, however, about the distance the NHS still has to travel.

“You look at other industries nowadays, how they use technology to integrate and interface with their customers: we’re still quite a long way behind that in the NHS in terms of the way we operate and the way we interact with patients.”

While the Airedale and Yeovil examples are helping patients to get more out of the NHS, doctors, too, are finding technological solutions are helping to provide safer — and cheaper — care.

A number of English hospitals have given medics access to an app called UpToDate. Based on information that has been peer-reviewed and collated by more than 5,000 doctors and clinicians, it allows medics to come up with treatment recommendations on more than 10,500 conditions across 23 specialities.

According to its makers, Wolters Kluwer Health, researchers at Harvard have calculated that its use can reduce length of stay by 0.167 of a bed day per inpatient, saving a typical large teaching hospital £2.2m annually or 9,000 bed days.

Are doctors happy to have diagnostic decisions automated in this way? Rajith De Silva, a neurologist at Barking, Havering and Redbridge hospitals NHS Trust, in east London, which has embraced the technology, says he and his colleagues, far from resenting it, appreciate the trust’s “remarkably far-sighted” decision to invest in it.

The tool can never replace hard-learnt medical expertise but can provide valuable reassurance to doctors that they are aware of all the relevant research, he argues.

“What matters is our ability to interpret the information that is available with the knowledge and expertise [we have] accumulated over the years,” Dr de Silva adds.

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