NHS and tech: Using digital transformation to rethink healthcare

Digital transformation can help the NHS make better use of scarce resources. That means rethinking some of the assumptions around healthcare.

When David Walliker is asked whether he believes technology can help save the NHS, he has a simple, one-word answer: "Absolutely."

Walliker splits his working week between being CIO at Liverpool Women's NHS Foundation Trust and CIO at the Royal Liverpool and Broadgreen University Hospital NHS Trust. While this dual role gives Walliker an unusually broad remit for change, the challenges he faces in both are familiar to all healthcare CIOs — doing more with less. 

"We've got a chronic shortfall in funding and we can argue all day long about the politics of that, but the reality is — even with the new NHS funding that was announced last year — it's underfunded. Digital alone won't completely close the funding gap, but it gives us a fighting chance," he says.

Walliker's approach is to try and reduce the number of people going to hospital by using digital technology and information to boost operational efficiency and improve patient care.

"Our digital strategy at the Royal in effect says we want to avoid people coming into hospital where possible by supporting them at home; when they're in hospital, we want to get them out as quickly as possible; and we want to make sure they don't deteriorate while they're under our care. Doing that will help us to drive efficiency and save money," says Walliker.

The positive effects of digitisation are already clear. The Royal was selected as one of NHS England's Global Digital Exemplars (GDEs), which are examples of organisations that are delivering exceptional care through digital technology. Exemplars share their experiences to enable other hospitals to follow in their footsteps as quickly and effectively as possible.

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The level of success is such that the Royal is identified as a best-practice case study in the recently published NHS Long Term Plan, which presents a strategy for improving the quality of patient care and health outcomes.

Walliker has plans for further healthcare innovation. Importantly, he believes Health and Social Care Secretary Matt Hancock's vision for the future of healthcare will help him and his healthcare CIO peers to deliver digital change. Walliker is particularly pleased that the new health strategy states that interoperability and openness are guiding principles.

"It's smart because if the GDEs do become the blueprints for a digital NHS, then the hospitals will be purchasing systems from the providers connected to those organisations. It's in the suppliers' interests to start playing ball now and to open up their systems. And so far, it looks like they are," says Walliker.

"I think, finally, we've got a Health Secretary who understands IT. We now have a technology vision that is clear and its concise. And fundamentally, if you boil it right down to its basics, what that vision is saying is that we need to empower the patient so they have access to their information."

Walliker has already made significant progress towards digital transformation at both hospital trusts. At the Women's Hospital, he has implemented Alfresco Process Services, an open business process management platform, to develop user-friendly tools that aid the creation of custom electronic forms (e-forms) by hospital staff.

Work on e-forms at the Royal has been led by a small team of in-house developers using a document management platform, known as Patient Electronic Note System. Digitisation at the Royal is supporting pioneering work, such as using patient record data to help reduce the risk of sepsis and developing electronic risk assessment processes for patient care.

Walliker says further progress in his own organisation will rely on open standards and the effective use of application programming interfaces (APIs). He expects work with key partners, such as Alfresco at the Women's Hospital, to help his trusts make further headway when it comes to boosting patient care.

"The stuff we've done so far is great but I need to make it completely open, using APIs, and to be in-line with the national strategy," says Walliker. "The Alfresco system will allow us to do that. I think that's the key point, because we want patients to be able to interact with our records."

UK patients can already do that to some extent — Walliker points to the ability, for example, for patients to book or cancel appointments via the NHS. However, Walliker also has a bigger vision — and he is keen to open up APIs and take advantage of the upsurge of interest in wearable health-monitoring devices.

"That's where we want to take the patient record to — so, actually you're contributing to it with what you're doing, because what you're doing may infer how you're feeling that day. Then we can start to disrupt the concept of outpatient appointments," he says.

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Walliker recognises outpatient appointments still play a crucial role in healthcare. But at the moment, the standard approach is that every individual gets an outpatient appointment for their condition — and that can be an ineffective use of the patient's and the doctor's time.

"If we only bring people in when there's something wrong, what you avoid doing is getting everyone through the door and collecting the information you don't need to collect," he says. "From a patient perspective, even when it is a valid outpatient appointment, does it have to take place in a clinic, or can it take place remotely?"

Walliker gives the example of check-ups for pregnant women. While a hospital wouldn't want to remove the direct contact associated to first and final scans, there's no reason why trusts couldn't take a different approach to routine assessments during pregnancy.

"Rather than taking time off work, it might be that some women might prefer to be assessed remotely — you might just need a conversation with a consultant that provides reassurance," says Walliker.

"If patients can inform the data themselves, you've can potentially start remotely monitoring the patient and calling them in when you see abnormal results. But to do that, you need to open the APIs up — and we're trying to use Alfresco to help us do that."

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