NHS England’s board meeting this month included a focus on technology and innovation, with an overview of the “greatest opportunities for the NHS in the future”.
The paper acknowledges the three-year plan for the NHS to digitise, connect and transform, and splits key areas of opportunities according to these categories.
Here, NHSE highlights that the overall ambition is to ensure “foundational technical infrastructure everywhere” through electronic patient records, digital social care records and shared care records. This technical infrastructure is to support digitally recorded information in flowing “seamlessly and safely”, with improved access to information for citizens and staff and more opportunities for people to take an active role in their own health. NHSE notes that it is on track to meet its target of 90 percent coverage by December 2023, with shared care records in place across all integrated care systems and digital social care records in at least 52 percent of adult social care settings.
One of the key opportunities listed in this area is enabling people to have more choice and better engage with their own health through accelerating the roll-out and adoption of patient engagement portals. The paper states that there are currently 72 acute non-specialist trusts live with patient engagement portals, with 28 of them integrated to the NHS App via Wayfinder. The ambition is for up to 80 percent of acute non-specialist trusts to have a portal and Wayfinder in place, by September 2023.
Another key opportunity is to improve inpatient flow through hospitals by implementing electronic bed and capacity management systems, in combination with care coordination centres. These could provide a trust and cross-ICS view that would support real-time management of a patient’s journey through the hospital, enabling staff to use data to reduce variation in clinical and operational management processes and improving patient and system flow. Other suggested benefits include improved flow from emergency departments to inpatient bed an discharge, with more efficient use of capacity, fewer breaches of the maximum four-hour waiting time, released nursing time, improved patient experience, and better operational decision-making.
“The vision is a system where all the information the health and social care system holds about a person is seamlessly connected and easy to navigate,” the paper says. “Where clinicians and care givers in any care setting have a complete picture of a person’s health history, and where data can effectively be used to help manage the health of the population.”
In this area, key opportunities include connecting the existing 14 shared care records so that clinical information can be accessed by clinicians nationwide, and continuing to improve the GP practice phone line capacity through widespread adoption of voice over IP (VOIP) technology, which aims to support better management of inbound calls.
In addition, NHSE highlights the planned federated data platform, so that every trust and ICS has “their own platform that can connect and collaborate with other data platforms, making it easier for health and care organisations to work together to achieve better improvements in care and outcomes for patients than they could each achieve individually.” On this note, NHSE shares that local trials have enabled trusts to remove up to 16 percent of their waiting list through error identification, with a discharge pilot supporting one trust to reduce the number of patients staying 21 days or more to 12 percent, versus the national average of 20 percent. NHSE is actively working on this, and has entered into the procurement process.
Transforming through cross-cutting tech
The vision shared by the board is for “national, connected infrastructure to be used to drive step changes in the ways in which people receive and experience health and care, in order to enable us to move towards a more preventative, personalised model of care.”
Key opportunities include making the NHS App the first port of call for people choosing to engage digitally; to support wider adoption of virtual wards to reduce pressure on the system and support better outcomes and experience; and to transform the way in which data for research and development is made available, through networks of secure data environments, to enable research and more rapid innovation as a result.
In addition, NHSE calls for changes to the ways in which health conditions are prevented, treated and managed through the use of digital therapeutics (DTX). “We are in the early stages of working on transformation and delivery of DTX for mental health and [musculoskeletal conditions], while also developing a policy framework to shape regulation, access and adoption of DTX in the NHS,” the board states. “The framework will make clear which DTX the NHS should commission and pay for, including regulatory approvals, evidence standards and the role of NICE in appraising and recommending products.”
The board also suggest exploring the potential of delivering “a step-change in the way in which clinical notes are recorded through the use of ambient documentation”, which could reduce the amount of time clinicians spend entering notes into a system and thus release time for caring.
Transforming through pathway-specific tech
The board acknowledges that along with system-wide opportunities for transformation, there are “huge opportunities for technology to improve the way specific care pathways work, and the ways in which conditions are screened, diagnosed, treated and managed”.
The paper highlights how patient pathways in audiology could be shortened through use of remote digital ontology technology, noting that an all-in-one hearing assessment tool has been built which can be used to share images and information remotely with surgeons.
Another opportunity lies in using artificial intelligence assessment for suspicious skin lesions, to shorten time to discharge and avoid the need for face-to-face appointments.
The paper highlights how digital stethoscopes can be used alongside a smartphone app for remote diagnosis and monitoring of heart conditions, enabling people to check their heart rhythm at home without need for any additional medical equipment.
In the stoke area, NHSE says that use of Brainomix AI technology has resulted in improved outcomes, with the number of people recovering and able to perform daily activities rising from 16 percent to 48 percent.
Lastly, the board states that there are several AI tools that can be used to support chest x-rays, with several “starting to demonstrate real-world value”.
Read the board paper in full here.