Oracle co-founder and CTO Larry Ellison has made clear that the company’s multi-billion dollar acquisition of Cerner is to aggregate healthcare data at a national - or even global - level to improve patient care. The vendor also recently pointed to how the continuous collection of centralized healthcare data could help improve personal care and that by taking ownership of Cerner, Oracle can now more easily integrate its own backend healthcare systems (in areas such as HCM and finance) to improve healthcare operations at scale.
With this in mind, it was with interest that diginomica spoke to Craig York, Chief Information Officer at Milton Keynes University Hospital NHS Foundation Trust. The Trust has been a long-time Cerner user for its electronic patient records (EPRs) and considers itself digitally mature compared to some other NHS organizations in the UK.
The NHS - although often referred to holistically - is a very complex, fragmented organization. Political policy is directed by the government, which is then undertaken by the Department of Health and Social Care and directed towards NHS England. NHS England is now made up of a number of organizations that include Health Education England, NHS Improvement, NHSx and NHS Digital.
Beneath that there are 42 integrated care wards across the country, which have seven regional government structures that support them. And then there are 215 NHS Trusts - of which Milton Keynes is one - which make up an array of hospitals and healthcare providers, as well as 1,500 primary care networks.
York explained that his Trust has made it a priority to invest in digital and doesn’t wait for dedicated finances to be released from central government (although this is always of course welcome). He said:
We like to think of ourselves as an organization that really focuses on digital. To do digital well it takes investment over a sustained period of time. I think that there are examples of other NHS Trusts that wait for investment from national funding.
It's really important to make sure that you've got a reasonable level of investment every year; continuous placement programmes of infrastructure.
Some of the things that we're doing with our electronic patient record with Oracle Health, in terms of devices, it all relies on a reliable solid fast set of infrastructure. And if you leave that aging for too long, you don't update, you can have some problems.
Milton Keynes University Hospital NHS Foundation Trust, alongside Oracle Cerner, also makes use of Oracle’s Health Information Exchange, which allows for shared care records between different health organizations (a key vision for the Oracle strategy). This is enabled by a central government Information Governance Framework for Integrated Health and Care, as well as common information standards.
Using this allows patients of the Trust to view their GP record online, but also allows Milton Keynes to connect to other healthcare providers in the area and further afield. For instance, it is the first hospital outside of London to connect to the OneLondon programme, which connects health and care services across the capital. York said:
It’s important for our clinicians to see that information and it frustrates me sometimes that other organizations are not going at the pace I sometimes want.
It's hard sometimes when we're doing something and you have limited influence on NHS England - you're one voice in a group of peers. I'd like to see people invest more in their local organizations, their local teams.
Milton Keynes has gone as far as investing in a Chief Clinical Information Officer and a Chief Nursing Information Officer, both of which are embedded within the IT team, indicating that the Trust sees digital and clinical care as being closely linked. York added:
They're included in the roadmap. They're part of the conversation and decision making every week. They’re part of the change board, when we're putting in any changes to our EPR or other systems.
A consumer-grade experience
York looks after the technology organization at the Trust and has approximately 100 people on his team. A core part of this team is focused on the EPR, which includes a development team, as he sees it as critical to patient experience. He said:
If you want to keep at the pinnacle of use of that system, it's hard work. You've got to have a team that’s always focused on the next upgrade, the next improvement, the next module.
York said that patients and clinicians should expect a consumer-like experience when receiving their healthcare. He highlighted the long-running ‘joke’ in the press about clinicians having to wait 10 minutes or more for the computers to turn on in the morning, which makes digital-enabled care laughable for many Trusts. York said:
I was down in the emergency department to have a conversation with those clinicians and one of the junior doctors said well let's just do a test. Let's log out and log back in into the system and access a patient record. It happened all within under a minute, to get from start-up to an actual record of information.
If you're a consumer, if you're at home, and you turn on some piece of technology or use some piece of technology, you just expect it to work. You expect the information readily. And I don't think that we should expect anything different in healthcare or the NHS.
Milton Keynes is already mobile enabled - consultants can access the EPR system from home on their iPads to review any results, reports, vitals and relevant information. They can even have a conversation over the phone with a clinician in the hospital and the voice conversation is integrated back into the record, so there’s no confusion about what was said.
Commenting on Oracle’s plans for Cerner, York said that he had been a little worried after the acquisition, but that since attending Oracle’s recent event in Las Vegas, he’s very happy about the progression of the company. He said:
Oracle has now given us a clear roadmap for 12 months and 18 months of what they're going to do. And an example of that would be that access to data, access to their system and integration, is really important.
They've committed to their API's being completely open, and they're going to add to them over the next 12 months, where they're going to increase them by 300%.
They made a statement along the lines of that not only will Oracle internally be making use of these API's, but actually customers will have access to these, and rivals will have access to these. It became clear in meetings that this is a clear strategy from Oracle and that this was really important.
A not too distant future
As noted above, York’s Trust tries to take full advantage of electronic patient records. Patients at Milton Keynes University Hospital already have individual portals, where they can see results, view their record, and can confirm, cancel and reschedule appointments. York said:
We now also have a preoperative assessment questionnaire, which patients fill in. That doesn't go in as a PDF or some kind of RTF file - that's going in where we want it to, in discrete parts of the patient record.
Contributing to the patient record is the future. They can communicate with clinicians. Now when a doctor wants to ask a patient a question, they can put a message onto the portal and the patient can reply to it. I think that's really important as well, as it's recording direct communication with the clinician.
One of the key examples Oracle gave at its recent CloudWorld event is of how clinicians could in the near future interact with electronic patient records using their voice and taking advantage of generative AI. It showcased how a doctor could say ‘show me Derek’s patient record’ and they are then presented with the information they need, whilst AI could offer a summarized version of notes from the appointment and highlight key points or even offer recommendations.
I asked York if he saw this as a feasible scenario at an NHS Trust, such as Milton Keynes University Hospital. And he said:
Yes, I am excited about it. I don't think it's as far as you perhaps think.
He added the key focus should always be experience:
The next few years ahead, I look forward to delivering everything that I've seen here at the conference. I see us pushing the boundaries with Oracle and with others.
There's famous pictures of kids where they've got their interaction in a hospital, where it's the doctor just facing a computer. One of our key priorities as a hospital is patient experience. We don't want to walk out with a negative experience. You want the clinician to engage with you, to talk to you, that they are focused on your care.
Moving technology just to the side, but where it plays an important part and can help the clinician in the decision making, but is not interfering with the care they’re providing - that’s’ the goal.
I was also keen to get an understanding from York about what barriers exist to Trusts like Milton Keynes University Hospital achieving their digital ambitions. Predictably, he said that being a public sector organization can mean that finances are an issue. He added:
The economy in the UK is perhaps not as good as it's been in the last few years. There’s likely to be some investment in that technology. And that can sometimes be challenging. I am sure we can overcome it as a country, as an NHS, as a local organization.
He also said that it’s important to put in the groundwork and be ready for new technological advancements. York said you can’t jump from ‘zero to AI’ overnight and there needs to be modern infrastructure, networks and devices in place - all of which require investment. He explained:
You can't be three versions behind, you need to be on the latest and greatest, because there's going to be prerequisites. It's a challenge sometimes to always keep up to date. We pride ourselves on that in Milton Keynes. And we look forward to being a pilot and looking to exploit that kind of technology. I would hope within a couple of years that that technology is actually deployed in our hospital.
However, York also said that he’d like to see more done at the center, particularly by NHS England, which is effectively in charge of digital strategies for the NHS. He explained:
I'm sometimes frustrated. I think that they can do more. I would like to see a clear push on standardization. Why are they just not saying that any IT system that you buy must adhere to a set of standards? We've already got the data. We've already got the API's. Let's just turn on the functionality. I think sometimes citizens feel that the NHS should just know this information.
If a patient turns up at another care setting, and there's relevant information that is available somewhere else, that should be accessible to the location where they are. That's just interoperability and standards. I would like to see more push from NHS England and the government on those, pushing that adoption.