COVID-19 Sparked Digital Transformation – but What Next?
In July 2020, a panel of participants from UKCloud Health, Intel, and the NHS came together in this webinar to discuss what happens to healthcare IT after the first phase of the COVID-19 pandemic.
How do we use NHS capital funding to encourage long-term transformation?
This has to become part of the new thinking, innovation can not be on-off items but embedded into the way we work. It’s got to be about being able to articulate the benefits and the total cost of ownership (TCO) and move to a revenue model v capital expenditure. Business Cases need to modernise to the new way of operating in real world such as “pay as you consume” and away from pay up front and sit on the shelf whether it’s used or not. This is a significant benefit of using cloud.
Cleveland Henry, UKCloud Health
We will only ever solve this challenge if we change the model that underpins innovation funding, otherwise we never get past pilots. When any NHS organisation gets innovation funding that modifies a pathway it needs to be a requirement to specify how the innovation becomes BAU and held to account in achieving this. It isn’t just a problem at the centre, it’s at the implementation end [as well].
Adrian Smith, NHS Arden
As we move more services into the cloud, we need to get our organisations used to revenue rather than capital funding, and also for the expectation that change and iteration will never stop. In terms of Capital commitment, at Kettering we’ve been comfortable with approving business cases for our digital programme that run over a couple of years.
Andy Callow, Kettering General Hospital
What can patients do to nudge primary care to adopt digital tools?
Acceptance of change and/or doing things differently is a bigger obstacle to digital tools adoption than the tools themselves. Patient nudge based on expectation is a good pull model, but there also needs to be a push method that is delivered through the centre as part of standards that are measured. Look at QOF, items are undertaken religiously that should deliver benefits to all, the use of digital should be no different, as there should be real benefit to both patients and HCP’s in many instances.
Cleveland Henry, UKCloud Health
You have said it in the question – patients need to say/demand virtual consultation from the GP. [We’ve] always been able to ask GP to ‘ring me back’ so it now needs to be ‘video me back’ and up front keep asking for a video appointment!
Adrian Smith, NHS Arden
Taking Tom Loosemore’s definition of digital – what you’re describing is exactly is our collective “increased expectations”. I think the first thing to do is to make the GP aware that you’re comfortable with this. There’s a lot of good Healthwatch reports around where patients have expressed their fear and then delight at being able to use virtual consultations. At a national level there’s been no shortage of funding for virtual consultations and triage (circa £42M if I remember correctly), so I’m disappointed to see it has had little impact in some areas.
Andy Callow, Kettering General Hospital
Can healthcare professionals truly empathise with patient conditions through virtual technology?
I’m not sure this issue is specific to virtual consultations, I also believe as a patient myself who has a LTC that elements of my LTC can & is managed more efficiently with technology, I also accept that this is not always the case – it should never be one size fits all anyway.
Cleveland Henry, UKCloud Health
This is my personal perspective as a patient on the topic of telehealth & virtual appointments, having experienced this in a minor way during the lockdown. I understand and agree with the sentiments expressed that virtual appointments don’t fit all needs, and I can believe that during the pandemic virtual appointments may have been used in situations where under normal circumstances this might not be the first choice. As a patient though, I found it extremely liberating to have such prompt and frictionless access to healthcare – in my specific case, a prescription. I would like to see this capability being an option as part of the new normal, but of course when deemed appropriate by healthcare providers. There are certainly times when I would still want the reassurance of a traditional (and FTF) bedside manner!
Chris Feltham, Intel
This links to the excellent stuff Adrian said about diagnostics. The virtual consultation should not be a sticking plaster or holding move, it should be a genuine interaction that has parity to face to face, but obviously used where appropriate. Some of that is about building confidence and sharing the art of the possible.
Andy Callow, Kettering General Hospital
Do videoconferencing hinder healthcare professionals from making the right diagnosis?
I think it should be going forward personal choice (I reckon over the last 5 years, 80% of my interaction with could have been done via videoconferencing) but more importantly circumstance dependent – it needs to be what is right for the patient, the HCP and the specific situation – it should never be one size fits all.
Cleveland Henry, UKCloud Health
This takes the comparison the wrong way round – a videoconference has to be at least as good as a telephone call, provided the GP doesn’t try to infer from inadequate data. VC needs to be enhanced with high quality diagnostics at the patient end where needed – e.g. through HCA led home visits or self-administration through Amazon delivered and returned stations.
Adrian Smith, NHS Arden
The origin is a forced approach, but has been a direction of travel for a number of years. Obviously it has to be used appropriately and with patient choice. But we can see on a number of areas of society that many people who previously had fears about joining video conferencing calls are now comfortable – across all demographics. At Kettering we have seen strong clinician willingness to try it, and positive reactions from patients, as we gradually being to restart some of our services. I’m optimistic that will continue.
Andy Callow, Kettering General Hospital
What does the panel think about the statement that, ‘video conferencing or remote diagnostics only scratch the surface of meaningful diagnostics’?
In all walks of our lives we have preferences to how we transact, not everyone will like some methods and others will like others, my personal view is that just because some “like” or “dislike” say a remote consultation, should not be the determining factor for them to be offered or not wholesale. Patients should have a choice and if they prefer it, then should be welcomed to use that.
Cleveland Henry, UKCloud Health
[I] Disagree – data shows it’s not a minority and this is partly because the quality of imagery through remote diagnostic kit, displayed on a large screen, recorded and re-played, can be better than a F2F consultation with inferior kit. Plenty of evidence patients like it when it is done properly.
Adrian Smith, NHS Arden
I think this will come down to using these methods when appropriate, but getting to the right outcome for the patient is always the aim. At Kettering looking to track how many interactions it takes to get to the patient outcome to determine if you need more virtual consultations compared to face to face, including the cumulative time taken.
Chris Feltham, Intel
Does video patient consultation damage the patient’s confidence in making a rapid recovery?
Again this is about choice, but also seeing evidence. Personally, as a patient I think I have a better, not worse relationship with my doctor’s surgery in managing my LTC through video consultations, unfortunately we are still awaiting the ability to get my quarterly injections virtually 😉
Cleveland Henry, UKCloud Health
Triage – it isn’t right for all conditions and all patients. GP skill is in deciding when another route is essential.
Adrian Smith, NHS Arden
I think we have to look to the evidence to see impact on patient [outcomes].
Andy Callow, Kettering General Hospital
How can we improve productivity for people who work at home?
This is a key point across many industries not just health. We have to be conscious that not everyone has the facilities to work from home and that needs to be respected and understood. There also needs to be assessment/understanding of what tasks can be done well remotely and tools to support/facilitate and those that are not conducive to working from home. I like some of the thinking of “hub” type locations where say different public sector or (say across a ICS or a city) can operate from local “hubs” as opposed to may organisations office, this relies on connectivity, security, etc …. however what working from home does enable is a much more flexible working – i.e. working around family commitments, etc.
Cleveland Henry, UKCloud Health
Tricky one – everyone’s home circumstances are different – from the physical environment to the noise disruption to other distractions. Surely long-term we have to get to a point where the home worker and the worker who wants/needs to be in the office are treated equally and no one is disadvantaged. Many employers, including the NHS, are doing all they can to help improve home working environments.
Adrian Smith, NHS Arden
Not everyone is fortunate enough to have space for working from home. At Kettering we asked everyone to do a Display Screen Equipment (DSE) assessment to check their environment was ok, and we have routes in place to purchase equipment to support staff. During this time, we have to acknowledge that some people are trying to balance looking after children and working, and we have to take that into account and make allowances. The benefit of working from home, using the tools we have in place, allows people to operate in different working patterns that fit around those circumstances, and I’m totally not bothered when someone’s dog barks and I’ve personally enjoyed it when someone else’s child crashed a meeting to show everyone their favourite unicorn toy!
Andy Callow, Kettering General Hospital
Data integrity and safety is top priority in health care. With remote working practice hurried during Covid-19 due to the compelling circumstances, underlying fear always exists in everyone’s mind. How does technology ensure the safe data handling?
Data Security & Integrity have to be foremost in both think & practice and should not be diluted due to emergency circumstances. Technology however does provide an opportunity to drive improved data security and integrity over ‘normal’ manual & paper based practice. Cloud Services are built with security at the core and are therefore a real enabler to ensuring data security as we transform to more use of technology in healthcare.
Cleveland Henry, UKCloud Health
It’s an unfortunate truth that cyber-attack methods are becoming more sophisticated, and as the attack surface grows with the explosion of connected devices of all shapes and sizes, the legacy model of software protecting software can no longer keep up – even under non-pandemic conditions. Intel’s approach is to build hardware-enabled security capabilities into our silicon, the protection from which can then extend up the stack all the way from core hardware, to operating systems, applications, networks, and the cloud. Some examples include: 1. Intel Threat Detection Technology improves detection of cyber threats using a combination of CPU data and machine-learning. 2. Intel Trusted Execution Technology establishes platform trust and boundaries in the cloud, identifying if server hardware is trusted or has been compromised, and controlling where sensitive workloads/data can be hosted – which country, which data center, which server 3. Intel Software Guard Extensions enables placement of sensitive data into “secure enclaves” – encrypted areas of memory that can isolate that data from other parts of the platform. The short answer is that there are a wide range of technology capabilities to enhance data security and data control. Challenge your infrastructure provider – whether internal or external – about how they are making use of these capabilities to secure your data.
Chris Feltham, Intel
As was mentioned by Andy, let’s make a comparison with the paper-driven world we are leaving behind. Wherever we work technology gives us the tools to add layers of security – am I more worried about accessing my bank account from home than I would be in an office environment? We can and will put the right process and controls in place.
Adrian Smith, NHS Arden
As a Trust we have 1000s of paper records – access to those have no audit trail or integrity checks. As we move to a wholly paperless hospital, we increase our ability to audit and monitor access. We provided guidance to our staff on home working, which included how to keep data safe in this changed environment.
Andy Callow, Kettering General Hospital
“Extended” access to patient data to assess risk / improve patient management using AI/ ML has been a feature of the recent situation. This brings in questions of data access security, ownership, commercialisation etc. What do the panel consider will be “better / the future” in relation to this?
I’ve talked about security and data protection in a previous answer, but when it comes to the topics of privacy with respect to AI we’ve published a paper that makes recommendations in this area. You can view the paper here but the high-level recommendations include: 1. Legislation/Regulatory initiatives should be technology neutral and support the free flow of data 2. Organisations should embrace risk-based accountability 3. Automated decision making should be augmented with safeguards to protect individuals 4. Governments should promote access to data 5. Funding research in security is essential to protect privacy 6. It takes data to protect data (to detect bias or threats)
Chris Feltham, Intel
Access questions is similar to above. Ownership and commercialisation is different. We need to support the Life Sciences Industry in devising new commercial models that makes use of available data and I suspect we will be pushing an open door with patients in terms of data usage for benefit. The challenge generally comes from the clinician not the patient so some reverse education needed here!
Adrian Smith, NHS Arden
The guidance on ethical use of AI from NHSX is sensible framework for us to work in and keeps the patient outcome and the fore. I agree with the recent Topol review in that we need to put more investment into growing our capability and knowledge in this area, rather relying on the usual companies, so we’re informed consumers of this emerging technology.
Andy Callow, Kettering General Hospital
You mentioned the rapidity of procurement, are there any barriers to sustaining this?
Procurement IMO needs to become much more intelligent, less of ticking the box but to ensure what’s being procured in what is really required and not just conforming to answering the question in the box. Having the end user fully included in the procurement process is key and working with suppliers as partners, not as arms length product providers will also ensure procurement is effective and gets the right product & service delivered.
Cleveland Henry, UKCloud Health
Hope so! For far too long we have looked at digital therapeutics in the same way as chemical ones for no good reason and we have constrained real progress on the back of this. Take diabetes structured education – some great digital tools out there to support behavioural nudging and no real reason for clinical trials when real world evidence shows the benefit (I’m sure Ben Goldacre would disagree!). We want the NHS to be ‘clinically-led’ but let’s not make that mean clinically constrained.
Adrian Smith, NHS Arden
We’ve demonstrated that procurement can be done at pace, but this was to achieve a very clear single objective. We don’t normally have this heightened focus, so sensible governance to ensure we’re spending money on things that will deliver the most value is appropriate. I’m going to offend some people by saying this, but at lot of the time people complain about procurement taking so long, is down to failing to plan and therefore being pushed into a buying decision. That’s not the fault of the procurement process.
Andy Callow, Kettering General Hospital
Is clinical attitude to the adoption of digital technology going to fundamentally change (for example, are we likely to relax the need for full clinical trials for digital solutions?)
Technology needs to demonstrate benefits and that is what the CV19 has enabled with some forced adoption of digital technology, attitudes will change through seeing, using, rather than just being told what it could do.
Cleveland Henry, UKCloud Health
Yes – offer funding from the centre for initiatives that the applicant can demonstrate how and when they will sustain which generally will mean abandoning something else to fund it after pump-prime from the centre.
Adrian Smith, NHS Arden
I think the tools available have the potential to give results earlier, easier and with greater segmentation than ever before, so I can see some things being relaxed based on more nuanced balance of risk and benefit.
Andy Callow, Kettering General Hospital
If central funding helped drive changes like video-conferencing, do we need to change where funding sits and how it is accessed?
There a place for central funding but there has to be choice at a local level of what specific product/service is used – competition drives improvement and innovation so we should not drive monopolies through one chosen solution, but set the standards that solutions need to meet to be funded. Video conferencing is a great example – yes [have a] central fund, but local choice should be in place so that the right solution for an organisation can be chosen (to a standard).
Cleveland Henry, UKCloud Health
Yes, there are excellent, proven behavioural change digital solutions available now to support both physical and mental wellbeing
Adrian Smith, NHS Arden
There’s clearly a case where central funding or contracts levers economies of scale. The recent O365 deal completed by NHS Digital is a good example – individual organisations would not have had the clout to get such a good deal. There still has to be local decisions to respond to local need, but I would welcome nationally negotiated deals on cloud hosting, single sign on, laptops, etc.
Andy Callow, Kettering General Hospital
Is the preventative behavioural change you have mentioned a digital initiative?
It needs to be!
Cleveland Henry, UKCloud Health
Probably but if it isn’t, the beauty is that utilising digital channels should save sufficient money to provide non-digital support to those who aren’t able to access.
Adrian Smith, NHS Arden
Given the almost ubiquitous uptake of smartphones in the UK, and adoptions of services accelerated through covid-19, is the digital divide now a thing of the past?
It presents options but we can’t neglect those that are not privileged to have smartphones – the digital divide is real and we have to be careful not to widen it, but it does present many positive opportunities as has been seen across many industries with the adoption on smartphone in everyday life transactions.
Cleveland Henry, UKCloud Health
What technical preparation do you wish you’d done ahead of the crisis?
The adherence to the behavioural changes the government has asked for largely in the name of ‘saving the NHS’. Just wish we could get people to change more generally.
Adrian Smith, NHS Arden
What change has most surprised you through the crisis?
Video consultations adopted at mass, it’s been talked about for year but resisted by the majority.
Cleveland Henry, UKCloud Health
Accelerating digital change by doing and saying the same things I did in the past ten years but with the assistance of Covid!
Adrian Smith, NHS Arden
What shifts and trends have you seen in the use of technology since the appearance of COVID-19?
Remote Desktop, Virtual Clinics as a Service (scanned and accessible historical MR at pace), Real focus on DR and resilience and tech capacity (growth).
Cleveland Henry, UKCloud Health
What advice would you give to the audience about what they should expect from their vendors in times like this? What should they be asking for?
Partnership, solutions through understanding; not just a menu of products.
Cleveland Henry, UKCloud Health