When May Healthcare systems worldwide are notoriously difficult environments in which to innovate. They are too big, too important, and too political to easily accommodate the freewheeling risk-taking that is core to a dynamic startup culture.
However, the rigours of the SARS-CoV-2 pandemic have revealed a remarkable ability in healthcare systems to transform fast and at enormous scale when confronted with a crisis.
The UK’s National Health Service (NHS) is a prime example. An employer of more than 1.3 million people, it leveraged technology to pivot how it operates while simultaneously using its unique structure to stand up capabilities in clinical trials and genomic sequencing that were – and continue to be – of enormous benefit to the rest of the world.
Fostering innovation in the NHS is a hot political topic, and advancing technology forms a central thread in the Long Term Plan for the NHS, unveiled just months before the global pandemic took hold. In particular it aims to improve data sharing to help divest more control to patients and their communities.
But while the coronavirus crisis has empowered backs-to-the-wall innovation in the NHS in the short term, how well placed is it now to maintain that momentum?
Tech For Good sought the views of healthcare leaders both within the NHS and in industry to find out.
THE INTEROPERABILITY DREAM
By Andrew Raynes, Chief Information Officer at the Royal Papworth Hospital NHS Foundation Trust
The health industry is playing catch-up when it comes to data sharing. For example, if you’re talking to an insurance company or an electricity supplier, you only have to give them your details once and you’re on record with them, and that data is easily shared between departments within the company. This, unfortunately, isn’t always the case in health and care.
But it is changing.
I’m the chair of the Cambridgeshire and Peterborough Integrated Care System (ICS) digital group, and the next chunky piece of work we’re undertaking concerns record-sharing, using an integration engine that has data moving in and out, safely and for the purposes of direct care, between public health organisations. The end goal is that a patient will only need to hand over their information once, and in doing so we can make sure everyone has the information they need to give that patient the best possible treatment, wherever and whenever they need it.
We hope that means there should no longer be a need for a patient to have to share their personal details multiple times, and this journey has already started for us with our neighbouring NHS hospital. Next, our job is to scale it.
Where you start with a shared care record at ICS level, that can then be shared at a regional level, and then onto data sharing on a national scale. This has been a long-time coming: I’ve been in the industry for more than 20 years, and we were talking about this when I started. But, finally, we’re on the cusp of achieving something great.
In that time we’ve moved on from believing all data has to be on one system, to realising that the answer actually lies in being able to efficiently share data for direct care across multiple systems and platforms. We achieve that by ensuring standards are the same across the board in the health and care service. So, even if my hospital uses a different system to another hospital, we can share data because it conforms to the same standards as all other hospitals.
But we’re not there yet.
Vendors aren’t all using the same standards, and true interoperability isn’t achievable until they do. So there must be a mindset shift for the apex of interoperability to suddenly become a reality; that’s when we complete what I call Maslow’s Hierarchy of Digital Needs.
In the Maslow triangle, the most fundamental and important layer is the one at the bottom, which supports the growth of everything above it. In healthcare, that bottom layer is infrastructure, which in our world means good data quality. Good data quality is when you’re using a standard messaging format, whether you’re using on-prem, cloud or hybrid. So if you’ve got that in place at the bottom of the triangle, you’re all good. You can improve patient care, and you can innovate at greater speed. But the key is ensuring our data quality is good, and easily shared. We’re much closer to that than we have ever been.
Another crucial factor in getting to an interoperability utopia is trust.
We absolutely have to move from a place where the public doesn’t trust data-sharing, to a place where the benefits of doing so are obvious to them every day. Their experience will be vastly improved once they are placed at the centre of a joined-up system where their health data is a single, secure source of truth that enables much more efficient patient care across all clinical touchpoints.
To achieve the necessary level of trust, we have to ensure the public understands their data will only ever be seen by the people who are treating or caring for them. It’s down to us, the professionals working on behalf of patients across the system – both technical and clinical – to work tirelessly towards that goal. It’s an undertaking we are absolutely committed to.
INNOVATION IS POSSIBLE, AND I CAN PROVE IT
By Dr Wieland Sommer, Professor in Radiology and CEO of Smart Reporting GmbH
Innovation in healthcare has always been challenging and in some ways that is perfectly understandable. Large, complicated systems like the NHS are naturally very risk averse, and they breed risk averversity in the people working under pressure within them.
The task facing innovators both inside and outside health systems has always been to overcome both systemic and often quite personal barriers to achieve the huge amount of benefits we all know sit just on the horizon, especially with digitalisation.
The good news is there are signs this is improving. We are seeing policy makers at a political level put their arms around innovation as an important strategic concept. They are providing more incentives, and introducing new innovation programmes all the time. We have seen during the pandemic how fast health systems can move when they need to, and there is certainly a desire to see that momentum maintained.
The barriers are still there: large incumbent vendors closing off their APIs and protecting their territory; a jigsaw of systems with poor interoperability; onerous tendering policies that exclude smaller, more dynamic companies; hard-working practitioners fearful that ‘new’ will also mean ‘more’.
But I can speak now from personal experience when I say it is possible for innovators to successfully overcome these challenges. The trick is to work hard every day to prove the value of innovative solutions to both the system and especially to the people in it.
I started my career training as a medical doctor and became a radiologist, before then becoming a professor of oncological imaging. Then I completed a Masters in Public Health at Harvard. I added research and academic perspectives to my clinical experience, and the combined viewpoints led me to realise there was a large challenge that needed to be met.
People have been talking about big data and medicine for the last 15 years, but if you look at projects in this area nearly all of them have failed at scale. The root problem is not the clever analytical technologies themselves, but in how the data that feeds them is being is acquired in hospitals. I helped create Smart Reporting in 2014 to help solve this problem.
Diagnostic imaging and how analysis is reported is a critical component of the patient pathway. How this data is managed directly impacts how well clinicians and administrators can do their jobs, and then of course it impacts patient outcomes. Right now, almost everywhere, this reporting is digitised without being ‘data’. Clinical reporting may use speech recognition for inputs and computers for outputs, but those outputs can remain as varied as the radiologists or pathologists themselves. We make PDFs, but we don’t make useful data.
Smart Reporting’s tools standardise reports so they are simpler to write and read, less error prone, and more efficient to produce. This makes the clinician’s time go further but, because the output is clean and structured data, it becomes far more actionable. With it processes can be automated, saving even more time for both practitioners and patients, and be used to
unlock the opportunities of advanced analytics to improve treatments and train AI for medical imaging.
Structured data like this also helps bridge the gaps between the data silos that exist even within individual hospitals, but especially beyond them as the NHS seeks ways to improve data sharing between locations. Our SmartWorX interoperability system acts to bridge these silos.
By addressing a problem at the source, and working every day to prove the real-world value of innovation to the technical and medical community that is using it, we have managed to overcome the usual barriers to positive change. After just seven years we are now serving more than 10,000 physicians in over 90 countries.
While I know it is always difficult, our experience at Smart Reporting tells us that the innovation agenda is always worth pursuing, and I’m optimistic that the momentum can only increase further in the NHS with the right mix of policy and leadership.
SWAPPING BUREAUCRACY FOR TRUST
By Dr Rizwan Malik, Consultant Radiologist and Divisional Medical Director of the Bolton NHS Foundation Trust
A perceived failure to innovate is one of the sticks with which the NHS is most regularly beaten. How many times have we seen, heard or read stories and opinions to that end?
One of the biggest paradoxes here, though, is that the NHS harbours some of the most innovative thinkers in the medical profession. There are huge numbers of very capable people with great ideas across the service, whether that be in research, healthcare, technology, administration or anywhere else. The key to NHS innovation is trusting and tapping into that talent.
For too long the link between NHS decision-makers and its people on the ground simply hasn’t been there. There have been too many “gatekeepers” who have tinkered around the edges for too long in the name of transformation. They have ignored the vast experiences of the individuals and teams that use NHS systems every day and who can see where change could make a genuine difference for both staff and patients.
I have been a Consultant Radiologist in the NHS for nearly 15 years. I am also Managing Director of South Manchester Radiology, a company which provides innovation and transformation services to both the public and private sector. These roles have given me a helicopter view of the issues we have and, in my opinion, building trust across the healthcare spectrum is the only way to drive true innovation.
COVID-19 has given us a taste of what could be achieved, and I can share a really simple example of this. Radiologists such as myself, in collaboration with innovative CTOs and technologists, have spent the last decade proposing platforms and systems to allow radiology to be performed remotely if required. It was generally rejected.
When lockdown happened, however, those proposals were rapidly dusted off and it was quickly decided it was something we should do. Then suddenly the problem became time – you had hospitals who had staff everywhere needing expensive monitors, and we were held up with a supply chain issue. But within three months we went from the first discussions to having kits in place for radiologists to work from different locations.
That is just one example, but learning lessons from the pandemic will be essential going forward. Change is possible if all stakeholders are determined and focused on the same thing – too often any improvements have been ‘Heath Robinson’ fixes not sustainable for the future, or more ambitious change is rejected completely because other things haven’t been fixed or updated. On that point, one shouldn’t predicate the other. We shouldn’t stop progress because the stuff that we’ve got could be replaced.
In radiology specifically, talk of digital and data transformation is rife, including in the area of imaging and reporting. There is a shift towards adopting tools which facilitate more guidelines and structure around how a clinician reports, and I am generally in favour of standardised imaging and reporting.
What’s crucial, though, is that these tools benefit clinicians and patients, not just data scientists. As a radiologist, this approach needs to make me more efficient, while it also needs to be advanced enough to gather the right information and not revert to templated inputs. Again, it’s all about collaborating and taking the lead from those in the field.
In that example, if we can get to a point where reporting outputs are in a standard format then we can be more robust about how cases are followed up and patients get the best service. Ultimately I yearn for the day where we have better connected systems across the board, both domestically and globally, and – even though there are pockets of excellence today – the data we collect and generate is used to radically improve healthcare provision at scale.
While there is that constant and very real battle between the now and the future in the NHS, we can be at the forefront of that change. The vital thing is to work closer with those who link strategy to patient care, and in the end replace bureaucracy with trust.
EMBRACING THE FORCES OF CHANGE
By Jane Rendall, Managing Director at Sectra
There’s a real desire within the NHS to improve patient outcomes, and yet it struggles with creating change.
As an organisation, the NHS is full of potential and people wanting to make a difference. However, it needs an overarching strategy; a vision of what the future will look like – no matter how unachievable it might seem – that will bring all of its stakeholders together.
In my experience, the NHS seems to undergo periods of dramatic change followed by long phases of stagnation. When I first began working as a radiographer for the NHS, making structural changes seemed almost impossible. Years later, when I returned to the organisation in a different capacity, there had been some dramatic innovation around digitisation. It was night and day, but that quickly slowed to business-as-usual for a long time.
In that case, as so often, the motivator for change was an external force. That force can be in the form of new funding, the innovative influence of the private sector, legislative actions, or a crisis.
A crisis like COVID-19 proved that when there’s motivation, change happens swiftly within the NHS. Over the past year, I have seen projects that would have otherwise taken months and even years to implement being approved almost instantaneously to address the pandemic’s challenges. The IT efforts around the Florence Nightingale hospitals, in which we were involved in a small way, is a perfect example. But it also begs the question: Why doesn’t change happen more swiftly in the business-as-usual scenario?
In the private sector, businesses are always looking at their own workforce and thinking about how to best utilise the talent they have to drive growth. In contrast, the NHS’ lack of adaptability can often become a very limiting factor.
One fundamental learning from the pandemic has been the importance of failing fast. In order to drive innovation, people have to feel they can take risks, make mistakes, and learn from them. Instead of hiding mistakes or placing blame, implementing the learnings that come from them can be incredibly powerful to the overall growth of an organisation.
The vaccination campaign has shown that the NHS is capable of moving fast and making healthcare accessible to all. Once the pandemic is over, that impetus shouldn’t be allowed to wane. Instead, it should be used to create connections with patients, to progress the establishment of shared data and systems, and to encourage patients to take control of their own health.
The NHS has historically prioritised treatment over prevention. If you have a heart attack or a major illness, the care you’ll receive will be fantastic. But the question now being asked is could this be accurately predicted? Could the patient’s underlying condition have been treated and other measures put in place to avoid the acute situation? Prevention and wellness initiatives address health issues before they happen, reducing costs and saving lives.
Our vision is to use technology to help the NHS deliver care where it’s needed and at the best time, as opposed to it being solely available in acute settings.
In the future, I would love to see a technically unified NHS working collaboratively with industry as an external motivating source of innovation, and doing so in constant contact with the communities they serve. I would love to see diagnostic centres where people could go to get X-rays and other diagnostic tests on their way to work and strategies that focus on wellness and illness prevention so that citizens become actively responsible for their own health.
By empowering citizens to take control of their care, and using technologies to improve its provision, the NHS will be able to alleviate suffering for the individual and the whole healthcare ecosystem.
