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NHS chiefs need to “deepen” their understanding of digital, says Nuffield Trust

NHS trusts need to focus not only on opportunities, but on how to escape the pitfalls that come with introducing digital technologies, according to a report by the Nuffield Trust

A report, published by think tank The Nuffield Trust, has called on NHS organisations to invest as much in culture change as in technology to ensure it is adopted successfully.

The report Delivering the Benefits of Digital Healthcare said that the “ingredients” are in place for technology to deliver better care, but that there is still “huge scope” for major improvements by using the systems better.

It said that too often, “strategic decisions about clinical transformation” and the investment in technology is “only a footnote” to NHS board discussions when it should take “centre stage”.

“Digital technologies will not deliver improvements in productivity on their own. Without careful implementation, they can create inefficiencies and staff frustration and even threaten the quality of care,” the report said.

It sets out seven opportunities to drive improvements across the health service, including using clinical information decision support tools to deliver systematic high-quality care, and using real-time patient monitoring and analytics to provide targeted and proactive care.

It also highlights the use of telehealth and self-management tools for patients as opportunities to improve care, something that has had slow uptake in the NHS to date.

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Although positive about the effect digital technologies can have on the NHS, the report is also careful to point out that how the technology is implemented is key to its success.

“A transformation programme supported by technology is needed, not the other way round. This is the fundamental lesson that underpins everything else,” the report said.

The repot underlines the culture change as a key factor in a successful implementation, and adds that many of the problems faced while going digital are “people problems”.

“Leaders need to build a culture that is receptive to change and a strong change management process,” it said, adding that the right training for staff is crucial to the success of a project.

It also calls for organisations to invest “at least as much” in the organisational transformation as on the technology, and that systems need to be designed with the user in mind.

Staff training ‘inadequate and incomplete’

Although not mentioned in the report, the importance of training became apparent at Cambridge University Hospitals NHS Foundation Trust when it went live with its £200m eHospital programme, which aimed to revolutionise the trust’s IT.

Carole Proctor, assistant secretary for Unison’s Cambridge acute hospital branch, and who also works at the hospital, previously told Computer Weekly that the training to use the Epic EPR had been inadequate and incomplete, and that staff had repeatedly said the implementation period was too short.

Whether due to lack of training or functionality, the result was that three months after go-live, only 9% of correspondence was fully produced through the system. The trust also found itself in financial difficulties and in the midst of an investigation by trust regulator Monitor (now NHS Improvement).

NHS data sharing is a priority

In line with NHS England’s mandate that all NHS IT systems must be interoperable by 2020, the Nuffield Trust report also said that organisations need to have data-sharing capabilities as a priority when procuring systems.

NHS England has a goal that by 2020, the NHS will be fully paperless at the point of care and able to share information across health and social care seamlessly.

This report added that this requires strong data governance and called on organisations to get help on local and national level to share data safely.

It also calls for regulators such as NHS Improvement to develop its own digital capabilities to better support NHS organisations.

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