The UK Health Secretary, Jeremy Hunt, has announced that the NHS will be getting over £4Billion to improve IT with the hopes that clinical staff will gain valuable time to spend with patients instead of with paperwork.
This sounds really positive doesn’t it?
Technically, it is, since certainly it will cost a lot of money to buy new hardware and software. But it will also cost a lot of time and effort, and this is where I have serious doubts that this money will do anywhere near enough to improve IT in the NHS.
I still remember when the then Labour Government led by Tony Blair started the National Program for IT (NPfIT) back in 2002. What was meant to be a £6 billion investment is now costing an estimated £20 billion in ongoing development and deployment costs despite the Conservative-Liberal Democrat government ending it in 2011. It has been one of the greatest financial failures the UK has ever suffered.
Some products from the program were rather successful, such as NHSmail, an only email service for all NHS staff, and the N3 network which is the NHSs own high speed internet connection. However, hundreds of hospitals where to use a new Electronic Patient Record system, Lorenzo, developed by Cerner which in the end went to only a couple of dozen.
To put things in to perspective, this means that on average the annual cost of running approximately major teaching hospitals was has been gobbled up each year for a decade.
So what went wrong? Three main issues are at play here in my opinion, and are in order of what went wrong first.
1) TOP DOWN MANAGEMENT
Design decisions were heavily influenced by people who weren’t going to use the systems and solutions being proposed. The decision had more political motivations than practical ones to improve healthcare. Instead of IT solutions being tools for staff, they were to be tools for central Government to control how clinical services are given.
2) LACK OF USER ENGAGEMENT
With such a poor understanding of what the end users, including but not limited to doctors, nurses and all other health care professional involved in patient care, I was impossible to satisfy all the needs. It is true that you can’t keep everyone happy all of the time. But in the very least, any digital products being made must be used by all. It’s not like you get a few people saying Microsoft Word is impossible to use. Some may grumble about new iterations, but they all use it. This was not the case with products such as Lorenzo. If a system is not functional, it will not be used. Simple.
3) POOR IMPLEMENTATION
It has been a terrible mess trying to get hospitals to adopt all of the solutions. For example, The Royal Free Hospital was given Cerner’s Millennium back in June 2008 for free. Despite this, due to a number of issues such as lost outpatient appointments, delays in treatment, cost of extra staff and extra software needed, the roll out has cost well over £7 million.
An increasing number of doctors, and many other healthcare professionals for that matter, are thinking of leaving the NHS, if not their profession all together. Perhaps some of that money should be spent on trying to retain the highly trained staff that treat the sick before we get more machines and digital products which are meant to be tools for these highly trained staff to use. Grand innovations in digital health will reduce the need of staff, and in turn can reduce costs, but these innovations will never replace staff completely, and the cost benefits will take years, if not decades, to be realised.
We need to take a step back and fully appreciate what is going on rather than just look at problems. When we really know what we are doing now at a granular level and look at what we have as resources, we can then design new and improved ways of working where digital and technological innovations will be one of many answers.
In one of my previous articles, I highlight the benefits of having more doctors do healthcare UX. Beyond that, we need design thinking and user centred design to be integral to the planning and implantation of ideas to improve healthcare by allmembers of staff, not just the most senior one’s who have final say.
Feel free to get in touch if you want to hear more about improving digital health.
Dr Gyles Morrison is a Clinical UX Designer and Tech Guru for Medic Footprints.