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Information and Communications Technology in the NHS
Transforming the Patient’s Experience of Care
European Commission
Alasdair Liddell – King’s Fund20th July 2010
Two studies
• Fathom Partners for OfCom (March 08):
– What will the health sector’s requirement for wireless spectrum be in 20 years’ time?
– Scenario planning project
– ofcom.org.uk/research/technology/research/sectorstudies/health/
• ?What If! Innovation for the King’s Fund (Nov 08):
– What are the barriers to delivering the ‘best’ scenario from the OfCom report, and how might they be overcome?
– kingsfund.org.uk/research/publications/technology_in_the.html
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Definitions
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• My focus today is consumer-facing technology
• Technology enables, but the real issue is innovation
• Innovation = invention, incubation, adoption, adaptation and diffusion
• The NHS is very good at invention but very poor at diffusion
• To realise the full benefits of technology, there almost always have to be fundamental changes in ways of working, roles and service models
• Healthcare is lagging behind other sectors in its use of consumer-facing technology
• There are significant economic, clinical and quality benefits from greater use of technology
• But there are also significant barriers to technology uptake in healthcare
• What needs to be done? Some ideas…
• But it’s difficult. What do you think?
Key Points
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Other sectors’ use of technology
• Shopping
• Banking
• Holidays, travel
• Entertainment
• Information
• Social networking
• iPod apps
• etc10 April 2023 Alasdair Liddell Page 5
Individual – anywhere Home
Ambulance
Hospital / GP surgery
1. Healthcare technology applications
Settings for ICT applications
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1. Healthcare technology applications
Individual – Anywhere Applications
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Theinterfacing
ofa patient’s
record and /or Body
AreaNetwork toequipmentassociated
with theambulanceor onwardsto a distant
location (e.g.
hospital)
1. Healthcare technology applications
Ambulance Setting Applications
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Videoconferencing
1. Healthcare technology applications
Home Setting Applications
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1. Healthcare technology applications
Hospital, Polyclinic, GP Surgery
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Better clinical outcomes
Achieved through:
Increased patient engagement
Better continuity of care
Reduction in medical errors
Emphasis on prevention and healthy living
Health information web sites and devices (e.g. nutritional scanners) help consumers make better decisions about living healthily
Telecare and telehealth prevent unnecessary interventions
Improved patient experience
Improved access to information
Administrative and transaction tasks are easier
Monitoring and alarm devices can help people sustain an independent life at home
3. Key benefits
Benefits of technology adoption
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Benefits to society
Improved health in society = more economically productive society
More efficient use of resources – benefits health service, patients and society
Enables care closer to home
Effective use of information and technology brings peace of mind to patients, family and carers
Meet challenges faced by the health sector
More demand for health services – changing demographics
Technology enables more efficient use of resources
Clinicians can treat a larger number of patients (e.g. videoconferencing, telecare)
3. Key benefits
Benefits of technology adoption
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Product development
and marketing
Implement-ation
Use by consumers
Decision to purchase
Idea
Decision to develop
Decision to use
SuppliersCommissioners and consumers
4. Technology adoption process
Decision pathway for technology adoption
Clinicians and consumers
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4 models for technology adoption
Consumer awareness and understanding
Consumer concerns
Consumer activism and empowerment
Demographic changes
Internal factors
Policy
Structures to encourage adoption
Procurement and decision making
Information sharing
Leadership
Resources: funding and
people
Trials and assessment
Decision to develop
Demand
4. Technology adoption process
Factors affecting technology adoption
External factors
Technology standardisation
Engagement between suppliers and NHS
Investment case
Funding
Supply
Decision to buy
Decision to use
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5. Barriers to adoption
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The barriers to adoption
• Lack of (the right kind of) national leadership
• Few incentives for clinicians and commissioners to adopt technology
• The NHS is difficult to sell to
• Costs and benefits fall in different places
• Procurement is often least cost, not best value
• The change management consequences are disruptive
5. Barriers to adoption
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Case study - Warfarin
• 1m people on long-term anticoagulation therapy
• Control of this therapy requires 4-6 weekly blood tests, and adjustments to dosage, requiring visits to hospitals or clinics
• A self-monitoring device has been on the market in the UK for 16 years, but only 18,000 are in use
• This means that 98% of the anti-coag population are submitting to hospital/clinic tests
• Self-monitoring is clinically more effective, more convenient, and probably cheaper
5. Barriers to adoption
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Why?
• Not enough focus on the total patient experience?
• Misguided reliance on ‘push’ strategies
– web-sites and other information sources aren’t sufficient to ensure diffusion
– There is no incentive for inventors to disseminate and sell-in their innovations
• “Pull’ strategies require system incentives to be in place
Our recommendations
• Leadership from the centre, and locally– Actively to encourage, support, enable and reward
– Technology needs to be integral to policy development
– Procurement procedures need to be changed
– More coordination between national agencies and budgets
• Convenience is an outcome – measure it!• Links with and advice to industry to help them make
the compelling case• Create consumer demand• Target the ‘most likely’ consumers first
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NHS Financial Context
• The financial challenges facing the NHS may provide a stimulus for a more entrepreneurial approach to innovation
• Will the financial pressure be enough to motivate commissioners and clinicians to ‘pull’ innovations into their own care setting?
• Will the ‘system’ allow the necessary tolerance of failure that is an inevitable part of innovation?
• The key interfaces for maximum benefit are hospital/community, health/social care and patient/system
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What do you think?
Alasdair Liddell
alasdair@aliddell.com
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