Reasonably strong evidence supports the premise that, if appropriately deployed and used, digital health care is safer and of higher quality than care delivered through paper-based systems. Another tranche of government funding (not yet allocated) will likely be needed to support a second stage (phase 2, 2020 to 2023) of the strategy, as described under recommendation 6: While some trusts may need time to prepare to go digital, all trusts should be largely digitised by 2023. The seminar itself was the result of a meeting between the Prime Minister and then CEO of Microsoft, Bill Gates, after which the Prime Minister is said to have become ‘hooked’ on the technological possibilities for improvement in the NHS. ↩, Sir David Dalton, CEO of Salford Royal NHS Foundation Trust, participated in early deliberations but left the committee in April 2016 due to other obligations. NHS England should announce a detailed plan for how it will allocate the £4.2 billion devoted to digitisation, with specific attention to how much will go to trusts to support purchase of software and IT implementation, how much will be allocated to infrastructure improvement, how much will support workforce development, and so on. Possession Status. We also recommend that this staged approach be bundled with an independent evaluation plan to ensure that lessons learnt at each stage help inform subsequent stages. Of course, computerisation is not new to the NHS and its associated primary care practices. Don was exceptionally generous with his time and insights, and we modeled much of our process on the one he used for the Berwick Report. In The Digital Doctor, a case is described in which the lack of user-centered design, along with alert fatigue and overreliance on technology, resulted in a 39-fold overdose of a common antibiotic (33). The solution: one healthcare worker signed in early in each shift and simply left his or her card in the machine, thus thwarting the very purpose of the security system. Despite large investments, these efforts mostly failed, in part because they were unable to solve the interoperability and ease-of-use issues. While a single individual and his/her office can do only so much, we found it both practically and symbolically meaningful that we could not identify any individuals who have ever cared for patients among those who have overall strategic authority for health IT in the NHS. The system, standards, and interfaces should enable a mixed ecosystem of IT system providers to flourish, with the goal of promoting innovation and avoiding having any one vendor dominate the market. The key components of NPfIT are listed in Table 2: Key components of NPfIT (10). Training (in areas like computer use, ergonomics, and doctor-patient communication) may play an important role, but its provision is not centrally funded and therefore varies. To put the CUH’s achievement in perspective, it is worth noting that prior to 2013, the trust had been given a rating of Stage 1 (‘minimal digital adoption’) on the Electronic Medical Record Adoption Model (EMRAM), whose stages range from 0 to 7. Although none of the HITECH money went directly to these companies, the entire Silicon Valley ‘ecosystem’ was waiting for a signal that healthcare was now a digital business. It is important to think broadly about interoperability, and to do so from the start. Electronically capturing health information in a standardised format. Once a trust has chosen a supplier, in addition to general help with contracting, implementation and optimisation, it may need advice on how to work with that supplier and its product. The US has seen massive failures following efforts to digitise the Federal Bureau of Investigation (FBI), the Air Traffic Control system, the Internal Revenue Service, and, most famously, the Healthcare.gov website established to implement the Affordable Care Act. The dearth of professional, well-supported CCIOs with appropriate authority and resources is an enormous obstacle to successful deployment and benefits realisation of health IT at the trust level. The review will inform the English health and care system’s approach to the further implementation of IT in healthcare, in particular the use of electronic health records and other digital systems in the acute sector, to achieve the ambition of a paper free health and care system by 2020. While few trusts will be able to afford such systems[footnote 14], it will be important to allocate appropriate resources for purchase, upkeep, and workforce training, and to provide the funds needed to support innovation and the integration of IT into improvement work. Health IT systems need to evolve and mature, and the workforce and leadership must be appropriate for this task. In England, there is considerable variation between regions – in both the care delivery system and the needs of the population. In fact, it is one of the most complex adaptive changes in the history of healthcare, and perhaps of any industry. From triple to quadruple aim: care of the patient requires care of the provider. 62000. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. We believe that the creation of several slots each year for individuals with an interest in clinical informatics – embedded in trusts, in national IT-related organisations, or even with commercial IT suppliers) would be an excellent investment. 62000. Why is it important to focus on clinical aims when it comes to digitisation? This assessment will be repeated over time to track progress across the country against national goals for digitisation (see. My organisation feels a CCIO is a ‘nice to have’, not a mandatory role that requires time, resource and investment. On the other hand, over 70% of acute trusts now share discharges electronically, progress that can be built upon. However, the limited digitisation of the secondary care system means that GPs often rely on paper correspondence or electronic discharge summaries to find out about the care of their patients in other settings. There has been vigorous debate about whether such a target-driven approach improves holistic outcomes, but – given the targets – all sides appreciate the role of IT systems in reducing the administrative burden of data collection. This, along with the well-known hazards of centralisation, argues for a more regional approach. While EHRs are generally popular among GPs, a number of drawbacks have been reported. Currently at Stage 6 in EMRAM ratings – among the nation’s highest – CUH is now aiming for Stage 7 status. We believe that a strong push to comprehensively digitise every trust over the next few years would be an error. While there is great enthusiasm for using ‘big data’ to develop personalised approaches for individual patients (‘precision medicine’), provide customised decision support to both clinicians and patients, and create ‘learning healthcare systems’, today all these goals are more promise than reality. We anticipate that relatively few trusts will be in this category. The electronic radiology system (PACS) was also delivered smoothly and on time. Ann Fam Med. This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. Moreover, we favour forging national ‘framework’ contracts with leading EHR suppliers to give small trusts the option of using a pre-negotiated contract, instead of having to negotiate individual EHR contracts themselves. Institute of Medicine of the National Academies. Of particular concern is the need for a cadre of CCIOs and others with both clinical and informatics training. Not holding any budget or having anyone report to me leaves me somewhat as an advisor rather than leader. Shortliffe EH, Biomedical informatics in the education of physicians. The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. Maintaining the sense of local ownership of the process by trusts and their clinicians is crucial – particularly on the heels of NPfIT, a failed programme of externally imposed contracts (13). Communications of the ACM 1998; 41:49–55. BMJ 2002;325:1086-9. 62000. Communications of the ACM 1993; 36:66–77. So I respect their correct decisions on some of those moves. The evaluations should be both formative (conducted and reported as the strategy is progressing) and summative (reporting at the ends of both Phase 1, in 2019, and Phase 2, in 2023). This consensus was articulated in a 2014 framework created by the National Information Board and bolstered by the allocation, in 2016, of £4.2 billion to support this work (6). Consider creation of a consortium of members of this group to promote shared learning. Jones SS, Rudin RS, Perry T, Shekelle PG. We believe that the NHS is ready to implement a successful national strategy to digitise the secondary care sector, and to create a digital and interoperable healthcare system. These individuals should have at least 25% of their time allocated to their IT and related work. Several members of the MedStar Health Human Factors Research Team (Natalie Benda, Raj Ratwani, Zach Hettinger, and Erica Savage) contributed to the section on usability. Like I said, everyone's got a job in F1. ↩, Some important work in this area has already been done by NHS, which has divided England into 73 ‘local digital footprints’. Lead for social care information and technology at Department of Health, North West Care and Health Improvement Advisor (social care adviser) at Local Government Association, Information and Technology lead (for social care) at Local Government Association, Professor of Primary Care Health Science and practising, Health and Social Care Information Centre, NIHR clinical lecturer in surgery, Imperial College, London, with particular interest in digital health, Social Care Account Manager at the Health and Social Care Information Centre (now, Clinical Director of Pharmacy and Medicines Optimisation, Newcastle upon Tyne, Professor of Human-Computer Interaction & Director of UCL Institute of Digital Health, Director General of Innovation, Growth and Technology, Department of Health, Chief Executive Officer, Health Education England, Director of Informatics Delivery, Department of Health. Since 2015, GPSoC-accredited systems have been required to allow patients to view their electronic records, although some practices have not actively promoted this feature (27). Professor Wachter and the advisory board will: In making recommendations, the board will consider the following points: Evidence will be gathered through a combination of available written evidence, meetings with senior figures in the health and care system, and site visits to Trusts with varied experience of implementing IT systems. Failure to appreciate this leads to many of the other problems: underestimation of the cost, complexity, and time needed for implementation; failure to ensure the engagement and involvement of front-line workers; and inadequate skill mix. It would be reasonable to expect all trusts to have achieved a high degree of digital maturity by 2023. Even our language was different,’ she said. Gardner RM, et al. The LSPs invested heavily in development of new products for the NHS and were tied into contracts with NHS CfH, which included steep financial penalties for non-delivery. “I'm definitely not worried because I have huge belief and trust to see the amazing work that Ferrari and Haas are able to put together both from the engine and the car side,” Mazepin said. Employers N, BMA, England N. 2015/16 General Medical Services (GMS) contract, 2015. These individuals are crucial in promoting the adaptive changes that are needed when an organisation switches from one way of doing work to another. By using national incentives strategically, balancing limited centralisation with an emphasis on local and regional control, building and empowering the appropriate workforce, creating a timeline that stages implementation based on organisational readiness, and learning from past successes and failures as well as from real-time experience, this effort will create the infrastructure and culture to allow the NHS to provide healthcare that is of high quality, safe, satisfying, accessible, and affordable. He or she needs to be optimally positioned to leverage the informatics capabilities and resources in, amongst others, DH, NHS England, NHS Improvement, NHS Digital, and the Care Quality Commission (CQC). The odds of failure will be increased by focusing only on buying and installing IT systems without attending to issues like hardware, network stability and speed, workforce training and development, programme evaluation, and iterative improvements. It is important to allow for the inclusion of large EHR suppliers, of course, but also of smaller firms with products orientated to solving more specific problems, including patient-facing ones. This is one of the greatest challenges in health IT policymaking: leaders need to generate enthusiasm for spending public money to implement digital systems, and yet the ultimate benefits may take years to emerge. Before we do, however, it is worth ending this section on an optimistic note. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk. In addition to the CCIOs, the workforce of both clinician and non-clinician informaticians, researchers with expertise in clinical informatics, programme evaluators, and system optimisers (data processers, analysts, quality and safety leads) needs to be increased and nurtured. The managed care movement in the mid-1990s sought to shift the system toward capitation (fixed payments to cover a population of patients, putting the delivery system at risk for the cost of care). is an illustration of how important it is to build in interoperability from the start. Impressively, the past few years have seen the emergence of a new consensus that, while NPfIT had been unsuccessful, its goals were, and remain, essential.