After yesterday’s spleen-venting diatribe about the latest pronouncements from UK Government minister Matt Hancock on digitizing the British healthcare system, as a balance it’s worth noting where there have been successes that can be built upon, as well as some timely reminders that there are complex considerations that need to be taken into account around digital transformation.
As part of a debate on the subject hosted by Founders Forum HealthTech Summit for London Tech Week, four expert commentators with varying perspectives on the healthcare sector provided their insights on the topic of the shift to digital. What emerged made for a much more grounded vision of future potential - and pitfalls - than the headline-hungry political rhetoric from Hancock.
It’s important, warned Uday Bose, Managing Director of pharma giant Boehringer Ingelheim UK & Ireland, not to get too carried away by the ‘all move to digital’ hype that’s been generated by the COVID crisis:
It's dangerous to get swayed by the headlines on this one. It was inevitable that people would move towards the virtual platform. What we've noticed, what we've discovered, through the work that we do with the healthcare system, is that a lot of patients have been unable to access these platforms.
Healthcare in itself is a very sensitive topic. Many patients are reluctant to go to their GP [General Practitioner] anyway. To then have to consider doing that on a remote consultation, potentially on a platform that you don't have or you're not comfortable with, makes it very complicated. What we've noticed is there is a correlation - poverty, access to digital technology and access to better health outcomes, they're all related.
Definitely there's been a significant shift in that direction and that's great for many people, but we just need to be mindful that we don't leave many other patients behind.
Privacy is a important concern in the race to move online, he added. The public is awake to stories of data hacks and security problems in the private sector and this will have an impact on attitudes:
There's a lot of anxiety about what is happening with ‘my data’. We're one data breach away from people just ‘locking the doors’. People are afraid, so we really have to invest heavily in trust. I would suggest maybe we take time to make sure we address the inequalities that we've identified through policy, through proactive approaches, before jumping onto the next wave of fancy innovation that grabs the headlines.
That’s a message that might need to be sold to the ever-enthusiastic Hancock, himself never knowingly under-sold, but other politicians are perhaps more grounded. A focus on trust and inclusion is a critical pre-requisite, agreed Dean Russell MP, Chair of the Digital Health All Party Parliamentary Group in the UK Government:
Everything comes back to trust. Transparency around the data, around rules, around guidance, around all these things is absolutely key. Whenever anybody feels - in any walk of life, in any role or anything, especially when it's their health - that somehow something isn't necessarily as it seems, then that causes distrust. It's so important that that's covered…there's a need that people feel that there's trust there, not just when they're sharing data, but also what they're reading and that we're giving accurate information and that data has been looked at.
There’s also understandable public scepticism around how successful digitization can be, unsurprising given the number of headline-grabbing, budget-busting public sector IT problems seen over the decades. The UK health sector has never shaken off the failure of the multi-billion pound National Program for IT (NPfIT), for example. Russell cited his own earlier involvement with an initiative known as NHS HealthSpace to argue that times have moved on:
The premise of HealthSpace was how patients could access their patient records, their Summary Care Records. It was a really important initiative, but in a way it was ahead of its time…The ability to have servers big enough to hold gigabyte files, that just wasn't there. Now that is there. What's happened is that it's taken a long time for technology to catch up with society.
I think we need to look again at what technology is available now and in the future and see how we ensure that society can catch up with it. I think there's a lot of really great stuff going on, but there might be a bit of skepticism because, when we look at things like big IT infrastructure systems 10,15 years ago, it wasn't quite as successful as one might hope. I think that causes a bit of concern. So we need to sort of build that trust and continue and do it iteratively as well.
While Hancock insists that health sector staff are now enthusiastic technophiles, others may be more sceptical as to exactly how tech-savvy the wider audience is and how that impacts on a digital revolution. Andy Cachaldora, General Manager of Digital Service N. Europe for GE Healthcare, made the point that communicating tech benefits and how to tap into them will be crucial:
If you go to physician, a physician doesn't really know about IT. His experience of it is he can use his tablet, he can have access to his medical records, he can use Google etc, but can't quite understand why there's restrictions within the NHS or such. So there is a piece of bringing physicians and departments more closely together to get a better understanding, but also in terms of sharing medical records with patients. It's all very well sharing medical records, but unless you're a physician, you can't translate what it actually means to you as a patient. So we need to think about what information we provide to patients that's useful and that they can understand, in addition to the governance. That is what gives everybody the confidence to move forward.
It is essential to factor in the attitudes of patients and the public in general, agreed Dr Indra Joshi, Director of AI at NHSX, the UK Government unit responsible for setting national policy and developing best practice for NHS technology, digital and data:
The pandemic has pushed us [to adopt digital health tech] and it's been across the world that we've seen that drive, but also a change in attitudes. So, yes, patients, and yes, the public are keen to do this, because they've obviously seen the benefits, especially when you can't go and do things face to face…Quite often people talk about involving patients or the public and so we have a [focus] group and it becomes sometimes more of a tick box exercise. What we're trying to encourage - and it's always a needle shift, and nothing changes overnight, but it is just shifting the needle - is to say, ‘Actively and deliberately involve people’ and ‘Don't make them participants, make them involved in the whole product lifecycle, from conception, all the way down to the end product’.
And while much of what’s discussed around digital transformation in healthcare may sound aspirational. It’s important to be practical, she urged:
Quite often people love talking, people love saying things, but actually, on the ground, having been a frontline clinician for over a decade, you're there on the coalface in A&E with a patient and this just needs to be seamless. This needs to work within your workflow. It shouldn't be digital or a tech; this has to be integrated into part of the care pathway. So what I would say is, really try and move that needle on a practical and tangible front and really say, ‘Yes, it's great to have discussions and really change and create awareness, but at the same time, just really move the needle for real problems, there on the frontline’.
None of this is to say that the wider ‘big vision’ should be put to one side, just that it’s important to build on strengths and achieve real successes, rather than chase vague notions of ‘modernity’, as was the publicly-stated driver when Prime Minister Tony Blair commissioned the NPfIT on the back of a one hour pitch.
Boehringer Ingelheim’s Bose made the point that the UK has a lot to be proud of in terms of healthcare and life sciences strategy:
I know people criticize and challenge the NHS. There's so much criticism, but for what we have and what we do, it's incredible - from birth to death, to be able to track a patient, all of their interventions. When I speak to my international colleagues, they recognize the power of what we have in terms of a healthcare system and the ability to use that data. What confuses them, is why aren't we doing more with it? That's the universal question I get.
COVID and the accompanying societal digital acceleration and loosening of bureaucratic barriers has made a difference to the ability to make decisions quicker and partner effectively, he argued:
What we've achieved with the vaccination [program in the UK], what we've achieved to get to this point, shows everybody around the world that actually when like-minded people come together and they trust each other and they collaborate with the patient at the heart [of things], we can achieve great things. So I'm actually very excited. I'm going into global meetings now in a very bullish way to say that we've proven it can be done - the data is there, the system is there and together we can really make an impact here. So fingers crossed, we build on this momentum.