Citizen centric Digital services at the frontline in health

Government has identified that promotion of Digital channels and services has significant potential benefits. Digital services improve engagement with citizens and the quality of service delivery. Citizens use many commercial Digital services (for retail, insurance and travel) and increasingly expect to use Digital as their default interaction with a service provider. Digital can also reduce costs of service delivery, streamlining existing models, and diverting more transactions to automated and “self-service” channels.

Within the NHS in England, Digital is driven by a mix of national initiatives and standards and local (and largely autonomous) activity. The central Health and Social Care Information Centre (HSCIC) and NHS England (NHSE) have stimulated the exploitation of Digital services for Primary Care through a number of initiatives. They have developed an overarching 5-year Digital and paperless NHS strategy for all health service providers. They have provided funding to upgrade and refresh GP IT systems and communications infrastructure (e.g. high speed broadband) and have funded a number of pilot programmes. Their national specification for Primary Care IT includes requirements for Cloud-hosted patient records, basic Digital service capabilities and interfaces to enable easy, secure and paperless sharing of patient records across the NHS. And GP contracts require general practices to provide basic online services for patients, such as the ability to book appointments and order repeat prescriptions online, by April 2015.

GPs in turn provide Digital services to their patients within the overall local Health strategy developed by their local Clinical Commissioning Group (CCG).  The CCGs look at the provision of services in a locality. They develop and promote a locally tailored IT Strategy with GPs and other providers (including hospitals and Out of Hours care).

The current position Primary Care Digital services in England is varied.  Some GP practices have been offering online appointment booking for many years, while others are only just starting. Some have high quality web sites with information on local services that support patient self-help and reduce unnecessary face-to-face or A&E use. A number of GPs use Skype to provide more convenient services. But other practices are struggling with insufficient internet bandwidth to operate Cloud based IT systems. While some local health networks are fully digitised, with all patient information captured and communicated electronically, others print letters, then scan them to maintain the semblance of a Digital record. And while many GP practices share basic patient records on the national NHS “spine” service, to allow hospitals to access critical information on medication and allergies, this is far from universal.  Some patients calling NHS Direct or visiting A&E still have to provide their basic medical information themselves to the health professionals dealing with them.

In practice, the adoption of Digital across local health providers is a learning process, with some successes and some teething problems.

GPs have learned that marketing Digital services is challenging. Digital take-up cannot be assured by leaflets and posters. Local administrators and health professionals have to market online services directly in engagements with patients. However, Digital service benefits are not fully realised unless future patients are made aware of them before they need help.  How to communicate and signpost Digital services for local citizens (including both current and potential service users) is a new challenge that GPs, CCGs and Local Authorities are grappling with.  Unlike commercial Digital services, with tangible monetary or convenience value, the benefits of health Digital services are not always clear to patients. So communication and engagement has to be thought through carefully.

Sharing patient records across organisations is a complex business.  Most patients expect NHS professionals to share Digital information for effective clinical care. Indeed, they do not necessarily distinguish between different NHS components and see the NHS as one organisation.  But the reality is that the health and social care system is a complex network of public bodies and commercial entities.  For Digital services to be effective and drive out end-to-end efficiencies, all local health and social care organisations will need to collaborate and share information. For this, they must have common standards of connectivity, service infrastructure and information standards.  

Furthermore, however relaxed patients appear to be about information sharing, they need to be informed about it, so they can understand any implications and how sharing affects their rights.  Unfortunately, there is confusion about the rules that govern data sharing and what consent is needed from patients, confusion inevitably compounded by a multi-provider, public/private environment.  The deployment of the paperless NHS and citizen Digital services will be hindered unless there is greater clarity here.  All health practitioners and commissioners need better information, as well as education and training.

Further, for Digital services to be successful, more “control” for their design and operation needs to sit with service users.  This means IT professionals must reinvent themselves and acquire skills in facilitation and empowerment. This is a major shift and one that needs to be instigated and promoted by CCG commissioners and Clinical leads within the major health providers, including hospitals.

Health service managers are trying to achieve all this against a backdrop of relentless Digital change. Most people under 20 expect to manage their affairs Digitally. New technologies come onto the market constantly. Indeed Digital is not just destroying analogue. New Digital is already replacing old Digital. This impacts health. Commercial IT providers are developing new products and services to respond to the NHS Digital Strategy. They see public and preventative health, as well as community care, as areas ripe for Digital exploitation, especially through the adaptation of technologies already in use commercially to support citizens’ personal fitness regimes.  In this fluid world, all health service managers need long term strategic focus. But they also need the tactical agility to make course corrections to avoid technology pitfalls and exploit emergent opportunities.  Again, these are new skills and capabilities needing development.   

The reality is that many health providers cannot rise to these challenges unaided and without real openness to and awareness of what is going on in other sectors. In the course of our work, we provide support to many health providers who are at different levels of Digital maturity. One way in which we can help them is by giving an overview of what is going on elsewhere in the health sector. We also try to cross-fertilise their thinking with the best Digital ideas from the other sectors in which we work, such as local and central government. 

Written by Bhagiyash Shah, Director at Prederi, as part of the MCA Year of Digital.