When you ask a doctor for his opinion, you might not always like what you hear. But it’s almost always in your best interests to listen.
That’s the experience of the UK health sector right now, as it recovers from the brutally honest assessment of the real state of IT competence in the world’s biggest individual employer, the NHS (1 million individuals).
The doctor in question is Dr Robert ‘Bob’ Wachter, now Professor and Interim Chairman, Department of Medicine,University of California, San Francisco, but previously chief of the medical service and chief of the Division of Hospital Medicine at UCSF Medical Center.
And the prognosis? Wachter’s found that the vast majority of the teams making up the NHS are digitally immature, that government plans for a ‘paperless’ NHS by 2020 are totally unrealistic by at least three years – and that IT people in the NHS are low in number and “low down in the org chart”. He says:
The NHS has a job title, ‘Chief Clinical Information Officer.’ But they are too thin on the ground, there’s no professionalisation or defined training path for the role, and they don’t have the status or internal credibility the role needs. And the people in the NHS who are good at IT – I must have met the top ten to twenty of them? I don’t think any of them had ever met a patient.
‘Dr Bob’ is a highly-respected expert in the application of technology to hospital administration systems. Among other things, Wachter coined the term ‘hospitalist’ and has deep familiarity with the Obama administration’s ‘Meaningful Use’ (2009 Health Information Technology for Economic and Clinical Health (HITECH) Act ) attempt to encourage more use of tech like EHRs (electronic health records) in the American health sector.
That expertise caught the eye of the UK Cabinet Minister in charge of the £100 billion NHS, Jeremy Hunt, who commissioned Wachter to probe why IT isn’t as popular in British medicine as in other advanced economies.
Wachter was helped arrive at his conclusions after six months of intensive scrutiny by an international team of health IT experts, including Julia Adler-Milstein, PhD, Associate Professor, Schools of Information and of Public Health, University of Michigan, and Rollin (Terry) Fairbanks, MD, MS, Director, National Center for Human Factors in Healthcare, as well as Danish and British illuminati.
So the prognosis is bad. But what’s the prescription, the way to cure? Wachter says that the British should essentially copy Meaningful Use, but learn from its mistakes:
One thing we need to get right from the start in the NHS is interoperability. In the US, we have fantastic levels of technology in hospitals now, but 95% of these systems can’t talk to each other. You need to ensure from the start that any systems you build can talk to not just other systems in your Trust, but also when necessary to other hospitals’, to GPs’ systems, and non-NHS social care organizations, too.
Secondly, the NHS needs to phase its rollout of new IT. As with all discussions of computerising the NHS, the context is always the imperfect one of the world post the disastrous National Programme for IT, which cost the UK taxpayer billions in pursuit of the then Prime Minister Tony Blair's vanity project commissioned on the back of a one hour meeting with civil servants. Wachter admits:
NPFIT knocked the confidence of both physicians and the NHS that tech can really work.
As a result, Wachter has poured cold water on Hunt’s rampant plan for an end to paper in the NHS inside four years, arguing that 2023 is more realistic (and at HETT, he said “five to ten years” out is a more credible milestone for real technology integration into British health and social care processes).
And thirdly, the NHS needs more savvy people. While the rest of the British state lost all its tech competence as a result of endless outsourcing, the NHS, it seems, never took it seriously enough to even know it was missing it. Hence his Review’s call for a swift upgrade to the CCIO role and better training and support for what the job title is supposed to define – a serious professional with clinical expertise who also knows what software can do.
But it’ll take time for this patient to heal, says Wachter:
Productivity comes from the eventual complete refiguring of the nature of work after technology is introduced – it’s never an overnight benefit, and can be the opposite. The tech has to be in place in the NHS first, then the redesign – and then the patient, and the clinician, will see the improvement.
Her Majesty’s Government has taken note of Dr Bob’s prescription, and says it’ll implement his ideas.
But anyone expecting this patient to mend their ways even by 2023 is possibly gambling with their mental health…