NHS not making enough use of technology

24 Oct 2008

The NHS is failing to make use of everyday technology such as e-mail to deliver reponsive and convenient patient services.

A new report by the King’s Fund health think tank says the health service must be more innovative in its use of everyday technology to improve care for patients.

It says there is an absence of strong leadership and direction, with “little evidence of real impetus and drive for the adoption of technology”. In addition, the heavy reliance placed on centrally driven and funded projects like the NHS National Programme for IT (NPfIT), “might, not in fact, work in practice”.

The report, Technology in the NHS, says the NHS is also lagging behind other sectors such as banking and travel, in its use of technologies such as video-conferencing or webchats to improve patient care.

It says even well-established technologies, such as e-mail and the internet, are not being used routinely in the NHS. More widespread use could enable patients with booking GP appointments, receiving routine test results, view their medical records or have online consultations says the report.

By embedding everday technology into its services and introducing more advanced technologies, the NHS could improve the patient experience, deliver better clinical outcomes and save money.

However, the report says that top-down, policy-led technology adoption of the kind embodied by NPfIT, may only be part of the solution and may inadvertently create problems. The report notes the NPfIT programme is late, has seen costs escalate and run into signfiicant problems.

Alistair Liddell co-author of the report said: “Consumers are accustomed to using technology in their daily lives – 17 million people bank online and 55 per cent of internet users book their holidays online. Yet new technologies, and even basic ones, are not embedded in the health service.”

Liddell added that leading technology companies were beginning to respond to this demand: “Consumers are increasingly expecting to use technology in their health care, and technology companies such as Google and Intel are responding to this demand.”

The King's Fund suggests the NHS could send tests results out via e-mail or allow patients to have webchats with doctors - both of which would improve the patient experience.

It also advocates using video conferencing between senior hospital doctors and a patient's family. It says improving the use of technology would be particularly helpful to people with long-term conditions such as diabetes.

Diagnosing why the NHS is failing to make full use of available technology the King’s Fund report cites a lack of incentives, resources and leadership.

Liddell said for the NHS to improve its use of technology “will require an understanding of why useful technology is not being adopted and a determination to overcome these barriers.”

The report calls on the DH to “create a culture and climate that encourages innovation and technology adoption within the NHS.”

It suggests that NICE should carry out assessments of technology so they can be accelerated from trials to adoption. More informal mechanisms are required for assessing the costs, benefits and risks of new technologies.

The report also calls on the NHS to work more closely with industry to improve the technology procurement process. “This includes working with technology companies to help them build business cases for their products.”

Reader's Comments

How many banks do you converse with via email?

philipyoung@pcti.co.uk

24 Oct 08 15:19

I read this story on the BBC news web site this morning and couldnt help wondering how many times I've communicated with my bank via email .. err none!! Why would anyone let alone a review panel conclude it is sensible to share potentially sensitive information over a non-secure network - these people are deluded!

you dont say!?

24 Oct 08 16:04

" top-down, policy-led technology adoption of the kind embodied by NPfIT, may only be part of the solution and may inadvertently create problems"

...while we're on the subject of shocking revelations

"Bears may defecate in the woods"

Time would be nice

roseneath@ntlworld.com

25 Oct 08 09:22

It's all very well to talk about new ways of communicating with your Doctors, but we are currently drowning in a sea of electronic and paper communication. I have no idea when I would be able to respond to emails from patients let alone video conferencing. Many may say that it will be an alternative to an appointment or phone call but it will not be. Due to the ease of using email, it will be in addition to all the other methods and diagnosing and advising over remote systems is extremely hazardous. I suspect that the only advice our Defence organisations would support would be to advise patients to make an appointment.

Anything else and you are likely to be on your own.

re: communicating with banks

27 Oct 08 12:11

I do most of my communications with the bank online including applying for new loan products. I follow up on things via email because I don't want to wait in a queue at the bank nor on hold over the phone. It is a convenience thing to allow me to contact them in my own time and they can respond in their own time. I still prefer to go into the bank to sign documents rather than have them mailed out to me but that is about it.

It all comes down to how you define sensitive information and how paranoid you are. The likelihood of someone being able to intercept your communications and then do something malicious with it is incredibly small - you would be more likely to have your mail stolen or trash raided for people to gain access to sensitive information.

Similarly with the topic at hand, I would be more than happy to sign-up for email notification of test results. It is unlikely to be sent to the wrong person so that means that it would have to be maliciously intercepted. And at the end of the day, who would really care if I happened to have a low white blood cell count from a test? My wife probably would, but I'd tell her anyways. This does not mean you should send everything out via email but for convenience I think there would be value in considering it.

I think the real deluded people here are those who are too paranoid to trust email while using other communications mechanisms that are used are often less secure, usually with an argument along the lines of "I read on the internet that it was insecure, therefore it can never be trusted" accompanied with a statement similar to "it might possibly one-day potentially be used to send something sensitive".

re: communicating with banks

philipyoung@pcti.co.uk

27 Oct 08 15:12

OK, so the chances of email interception are small but they do exist. It only takes a single breach of confidentiality to occur to create mass hysteria.

The more important issue for GP's in particular is the unstructured nature of email. As the GP commented above, when would they deal with it?, in what timescale?, what information can/cant' be included?, where is the record of the communication made?, is it appropriate to attach every email out/in to the clinical record?. The list is long if you apply more than a seconds thought.

Don't misunderstand, I'm absolutely 100% behind the idea of using technology to improve the patient experience, but it can only be offered within a structured form i.e. a web based application with perhaps email notification rather than email on its own.

In fact many GP systems suppliers already offer web based GP appointment booking, appointment reminders and repeat script requesting. Some suppliers even offer access through the "red button" via freeview. Admittedly, this might not be available to every single practice but the facility is there, it's up to PCTs to deploy it.

Its far better that suppliers continue to focus on delivering interconnected systems that ultimately benefit the patient experience even if they dont have direct involvement in the process. This is happening right now and there haven been some big success stories e.g. GP2GP.

The extracts taken from this report simply attempt to stick the knife into the national programme (again) by making headline grabbing comments such as "well-established technologies, such as e-mail and the internet, are not being used routinely in the NHS".

This is nonsense and anyone involved in Healthcare IT knows it.

Re: communicating with banks

28 Oct 08 22:40

"I do most of my communications with the bank online" ... "I would be more than happy to sign-up for email notification of test results"

When was the last time your bank had to tell you you had a potentially terminal illness? I get heartily sick of people comparing clinical information with banking information and concluding that the NHS is populated with clinicians who are card-carrying Luddites. The NHS is riddled with practitioners who would love to be able to use IT to its undeniable advantage but who are simultaneously alert to the sensitivity of the information they routinely handle, day by day. Healthcare is a darned sight more complex and involved than banking (that's why I do it!) and to denigrate it by unqualified comparison with other sectors simply underestimates the dimensions and complexity of the clinician / patient relationship.

Internal Improvement

richardbak@lineone.net

29 Oct 08 10:52

as pointed out its easy to compare health processes with areas like banking and make ill informed comparisons. Theres no doubt more "routine" communications like being able to view free/book GP slots on-line before phoning or e-mailing/texting appointment reminders could help improve services.

But internally theres a widespread under utilisation of basic ICT infrastructure thats already being paid for. I have worked in organisations still making appointments for staff using only paper diaries when improvements to internal communications, logging and sharing info re meetings, leave, training, work/personal could be made without too much development work but its not.

I called a reception to book an appointment with a doctor and the admin staff couldnt tell me when she might be available because she had taken her paper diary with her! crazy.

Obvious low cost opportunities to improve internal comms which in turn improve external comms being missed.

banks vs healthcare

30 Oct 08 13:06

"I get heartily sick of people comparing clinical information with banking information and concluding that the NHS is populated with clinicians who are card-carrying Luddites."

The reference to banks was in response to the initial posters comments. Of course there are differences but there are some similarities too. For example, most people would consider their financial information as confidential as their medical information. I think you miss the point slightly when you compare healthcare to banking when a better comparison would be medical systems vs financial systems, since I would agree that healthcare as a whole would be more complex but disagree that this translates to systems being any more complex and lacking in similarities.

Also, I think that your comment: "When was the last time your bank had to tell you you had a potentially terminal illness?" illustrates the point I was trying to make at the end of my post. The focus is on the extreme case rather than the averages so options are often ruled out as a whole rather than adopted where appropriate. For example, as a proportion of test results that you get, how many of them would relate to a terminal illness compared to less sensitive results? No sane person would recommend sending terminal illness results via email but perhaps email can be used in a subset of cases.

And I agree with most of what was said in the other follow-up to my post.