Why legacy systems are halting connected healthcare

The story of National Health Service (NHS) IT is almost the tale of two cities. It was best of times, it was the worst of times. The new world, the third world. This world and another world.

In a world where most of us take for granted the management of our lives by the use of information technology (banking and the mighty ‘have-it-by-lunchtime’ Amazon are two examples), NHS staff step out of their cars, full of sensors and engine management systems, and into hospitals where the management of care is delivered in much the same way it was in the seventies.

The clinical end of the business is dripping with operating technologies and systems that are at the high-end of what is available: life-support, monitoring, robotics, minimally invasive techniques that are jaw-dropping.

Back on the wards, nurse rounds, checking temperature, blood pressure and oxygen saturations are still largely recorded by hand; with all the possibilities for error that presents… despite the fact reliable, tried and tested technologies are available to take the measurement and feed it, seamlessly, into the patient’s hospital records.

In most accident and emergency departments brimming with life-saving kit, the equipment is left standing to one side when elderly frail patients arrive whilst doctors are left to guess and test to discover what medications their patient’s multiple morbidity has stored up in their systems.

A quick look at the patient’s primary care record could easily solve the problem at a keystroke with connected healthcare.

At times of discharge, without gargantuan efforts, it is impossible for NHS to look at a social care record because of governance and data protection palaver.

Buy a pair of sun glasses from Amazon and not only will it remember you forever, it will offer you sun cream, beach towels, and swimming trunks. Be admitted to a hospital and every department, every nurse, every doctor will ask you to repeat who you are and your date of birth.  Next time you see them they’ll ask you again. They never remember you.

Why is connected healthcare such a challenge?

Like most conundrums the answer is buried in history.

NHS patient administration systems were first imported from the US. The technology designed to service the needs of a payer-system, not a care system. Early iterations of the systems were clunky, the user interface difficult to master and were skewed to the needs of the bean counters. They often failed, were inaccurate and the user communities lost the will to live.

They improved over time but in the silo of the finance department. More latterly it has become possible to interface third party technologies to feed into the patient records but, unfortunately, interoperability remains a huge stumbling block.

I think there is also a general assumption, among patients, carers, users and relatives, that everyone involved in their care can and will speak to each other. They are unaware we have invented an electronic “Tower of Babel” and it is near impossible to do so.

There are exceptions. Liverpool’s care program knits together all the services across primary, secondary and social care but not after 3,000 separate data governance agreements had been completed.

What to do with a healthcare system that is largely unplugged?

There are two problems; confidence and money.

The NHS and social care have lost their confidence in procuring healthcare technology systems. Recent initiatives from NHS Data to assess the state of NHS tech have revealed a patchwork of un-readiness. With no specific leadership from NHS authorities, no clear priorities, difficulty in identifying suitable systems to invest in and a very confused future, NHS managers see procurement as a risk.

The common law of business logic might tell you that an organization the size of the NHS, with its buying clout, would make its mind up, buy a lorry load of good stuff and have it delivered to every hospital for someone to plug-in and make connected healthcare work. Instead there is a labyrinth of business case duplication, hesitation and few real high-end skills. A convoluted tangle is putting it mildly.

Ultimately, buying IT has become too risky; just ask Cambridge FT. They installed a new patient administration system. It was years in the planning, months in rehearsal and weeks of support and back up for staff. Minor glitches were seized-on by the press and regulators, culminating in one of the best NHS chief executives throwing in the towel.

And that brings us to the money problem. Why take the risk especially at a time when the best of all possible excuses is known to the entire nation? ‘There’s no money for this’. Perhaps the NHS should be responsible for finding the money. Moreover, suppliers have to make it easier to buy.

Companies like IMS Maxims have pioneered open source software. The NHS should be forming a queue at their door but unfounded suspicion and caution about ongoing commitments means progress has been slow.

Alternative funding ideas are also needed. Why not just install systems for free and every time a user presses F10, or whatever the key, 0.001p is spent? Pay to use could be a revenue solution to a capital problem. The prospect of the hardware and software licenses staying on the vendors books and the attraction of capital and corporation tax relief seems to pass them by.

Even should this happen, it may be redundant. New technologies are overtaking us. Cloud storage will make servers redundant, Apps replace screens and terminals. Staff will bring their own device to work and use it for all purposes using simple software that connects them, confidentially to records and data, and wipes the information as they leave the building. RDF technologies tracking nurse-patient facing time, all interfaces blue-toothed to the record system and WiFi ubiquitous throughout the estate. Performance dashboards on the Chief Exec’s desk and displayed in real-time on the website… and then the alarm rang and I woke up!


Roy Lilley

About the author

Roy Lilley

Roy Lilley is an established, independent health policy analyst, writer, broadcaster and commentator on health and social issues. Previously, a Visiting Fellow at the Management School, Imperial College London and formerly at the Centre for Health Services Management at the University of Nottingham. Lilley also provides consultancy to NHS organisations and the companies that have services and products for the health service. Roy has, twice, been voted top UK speaker on NHS topics.


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  • April 5th 2017 08:30

    […] Africa, like mobile money, these countries have ‘leapfrogged’ others dealing with older legacy systems. In China, to take an example, 61 per cent of patients have devices, software, or apps to monitor […]


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