Hospitals need to get to grips with IT – Nuffield report

NHS hospital boards need to get to grips with the potential benefits and pitfalls of implementing information technology, a new report from the Nuffield Trust urges.

‘Delivering the Benefits of Digital Healthcare’ identifies seven areas in which the think-tank argues that there are systems available that could deliver “huge scope from major improvements in quality and productivity.”

But it also warns that “without careful implementation” such technologies can “create inefficiencies, staff frustration, and even threaten quality of care.”

To avoid this, the report identifies ‘seven conditions for success’ that start by noting that “you need a transformation programme supported by technology, not the other way around” and that clinical leadership is vital.

Candace Imison, the Nuffield Trust’s director of healthcare systems, hopes the report will do two things: “The first is that this is how healthcare is going to be delivered in the future.

"So if you are sitting in a hospital, this is a big and significant agenda and you need to get to grips with it,” she told Digital Health.

“The second thing is that there are lessons to take on board. Getting this right is really, really critical, and the most important thing is the alignment of technology and workflow.

“That is no mean feat, because you have really, really complex IT systems and a really, really complex healthcare system, and that makes this really, really hard.”

The Nuffield Trust kicked off its work on the report with a literature review. Imison said this showed that “the implementation of technology was not great” and that it was very hard to find evidence of benefits.

To address both points, its researchers carried out a series of interviews with healthcare IT experts, mostly from the US, but also from institutions in other countries, including India and Israel.

As such, the report does not deal in any detail with the UK experience; although it notes that new entrants into the nursing observation and vital signs monitoring market have delivered quick wins to some trusts.

Instead, it distils its experts’ views into ‘seven key areas of opportunity’. It lists these as; using clinical decision support “to deliver more systematic, high quality care”; using real-time patient monitoring to “reduce costs and improve outcomes”; and using IT to integrate and co-ordinate care across fragmented systems.

It also supports; using telehealth to reduce admissions and free up appointments; developing patient engagement and self-management tools; using resource management systems to “plan staff rosters and match capacity to demand”; and investment in analytics.

Its lessons for using these technologies effectively include; the importance of clinically led transformation programmes; the need to invest in leadership and change management; and the need to invest in system design, analytics, integration and interoperability, and in information governance and security.

The report also warns that there will need to be “multiple iterations and continuous learning.”

“Even with careful design, there may be a number of iterations in the design of systems,” it says. “There may be several cycles – some quite painful – before systems reach a tipping point where all of this investment starts to pay off.”

Because of the emphasis the report puts on board level engagement, the Nuffield Trust has devised its own maturity index that includes IT representation on the board and “board focus and attention” alongside more traditional IT maturity measures, such as the presence of different systems.

Imison told Digital Health News that this was a response to the National Information Board’s digital maturity index, which is “very focused on technology”; but it has no plans to map trusts against it.

The report says all boards now need to “deepen their understanding of the new capabilities that technology gives them and, most importantly, to align their technology and transformation programmes” and to invest in clinical IT leadership.

It also urges the government to continue its support for IT, as set out in the National Information Board’s ‘Personalised Health and Care 2020’ strategy and the more recent Carter review.

And it suggests that NHS Improvement, the body replacing Monitor and the Trust Development Authority, and the Care Quality Commission, could invest in IT capacity to support the trusts they are regulating and inspecting.

“The idea that this is important is key,” concluded Imison, who sits on the board of a trust herself. “But when you are looking at finances and CQC inspections, finding the headspace is a real issue.”