Several issues have to be considered in applying digital, data and technology for the integration of care, writes Martin Dean, digital transformation officer of SCC Healthcare
The integration of health and social care is high on the public service agenda, and there is a consensus that the application of digital, data and technology (DDaT) is going to be crucial to the chances of success.
It is going to be a key enabler of the change, especially through more sophisticated uses of data to target and co-ordinate care. But it has to be applied in a highly complex landscape and with a series of stiff challenges, and there are big questions about how best to make it work.
This formed the basis of a recent UKA Live discussion involving myself, Malcolm Whitehouse, chief digital information officer at NHS Greater Manchester Integrated Care, Owen Powell, chief information officer at Central and North West London NHS Foundation Trust, Geoff Connell, director of digital at Norfolk County Council, and Helen Olsen Beford, publisher of UKAuthority.
It brought out a number of important points, including that the creation of integrated care systems (ICSs) has provided a foundation for more holistic approach and to implement new ways of working.
One of the big opportunities is to draw on the wealth of data from existing line of business systems run by organisations working within an ICS, but this will have to be done in a way that allays fears about the visibility of sensitive information.
There is a possible solution in adopting a federated model, in which the data remains on those systems but from which key pieces of information, relevant to a specific professional’s role, could be viewed at the point of care. This could be complemented by an ICS level data lake of anonymised data, available to researchers for population health analytics and insights.
Both of these would require careful design, but cloud service providers are offering platforms and tools with increasing flexibility, and the scope to add new elements such as machine learning and AI to the mix. Some early adopters are already using solutions, and while mainstream is still in the distance the technology is evolving quickly.
There is a core requirement to make all of the solutions as easy to use as possible, while ensuring they fit the purpose. Technology can often be a barrier not because of intrinsic difficulties but because of the way it is implemented and that processes have not been effectively mapped out.
The discussion brought up important points on how to approach the implementation of new solutions, including that systems should not all be changed in one go. There was a suggestion to initially focus on small initiatives to produce measurable benefits, which could provide a basis for scaling up prove the value for other efforts.
Change and outcomes
It was also advised that projects should be approached by bringing technology and business teams together, reflecting that they are about business change and wanting better outcomes for patients.
There was also agreement that there is currently a significant constraint on the ambition in the level of digital literacy, which can hold up the successful use of DDaT solutions in many care organisations. There are people who have learned quickly and are eager to do more, but others who are struggling, and this is standing in the way of efforts to get the best from existing solutions.
In response, there is a need to raise the overall level of skills – recognising that they will differ for clinical and administrative roles – and one suggestion was that ICSs would benefit from an early analysis of their relevant needs.
Equally important are the difficulties around procurement. One big factor is the traditional public sector reliance on capital expenditure for large DDaT investments, while the increasing use of cloud services often depends on a revenue model more suited to operational expenditure, for which funds are continually tight.
There is also a pattern in which funding is often made available from central government with conditions that it is spent quickly, which makes it difficult to plan strategically.
Finding a balance
The establishment of ICSs has raised hopes that new approaches to funding can be developed, and that they can set medium to long term strategies to shape procurement for their areas, with an intent to find the right balance between capex and opex. This could also involve a minimum digital investment standard across all the bodies involved in an ICS.
But the way the UK public sector manages its funding is currently inadequate for the task at hand, and fixing this will not be easy. There is a need for better methods to allow people to lay plans for DDaT and operate as effectively as possible. The integrated care boards that oversee ICSs have to find intelligent ways of working with the industry, and suppliers can develop practical ways of supporting them.
One possibility – which we have made to work successfully at SCC Healthcare – is to aggregate various services so they can be paid for from capex, and doing so in a way that meets regulatory requirements and will satisfy the auditors. It calls for some imaginative thinking in how to structure the commercial relationships but it can produce fruitful results.
Underlying all this is the fact that, while DDaT is crucial to the future of integrated care, the big challenge is in making it work is around people and communications as much as technology. Before making the big decisions on DDaT there is a need to engage with stakeholders, including frontline staff and patients, to understand exactly what will make their lives better, then make choices on technology platforms and solutions as part of a wider strategy.
If you would like to get in touch with a SCC specialist to learn more or to book a meeting with us at our Digital Innovation Hub please, email [email protected]
You can catch up with the UKA Live discussion below: