The Department of Health and Social Care (DHSC) has published a policy paper outlining the Department’s digital vision. Digital healthcare is a priority of the Secretary of State, Matt Hancock, and this document sets out the ambitions he expressed back in September.
The report covers a range of topics, including integration between systems, and ambitions for the use of artificial intelligence for diagnosis and robotics to assist in social care. The report also sets out an aim to use big data to collect real-world evidence in order to speed up approvals for the latest technology from the UK science industry.
The key focus of the report is setting out plans to establish a digital infrastructure which promotes competitive development of information systems. Rather than the top-down approach which has characterised previous NHS IT projects, such as the ill-fated National Programme for IT in the NHS, the intent is to establish conditions for suitable systems to develop competitively via standards of security and interoperability. By mandating common standards, the aim to bring existing and new systems to the point where information can be shared across them easily. In addition, by adopting a modular structure, it is hoped that not only will innovators be able to build new technologies on top of core systems, but that there will be the possibility of core software being replaced in a competitive fashion, spurring competitive improvement.
Such a system is to involve the mandated use of modern operating systems and browsers to promote security, along with guidelines and common standards to promote compatibility. In addition software will be expected to take a “mobile-first” approach to ensure real-world practicality on the platforms many will be using them on. Finally there is an expectation that NHS systems are not only online-based, but that data is stored using a cloud model rather than on-site servers.
These proposals offer a range of strategic advantages to the NHS through interoperability and better data use. However there are a number of key challenges not addressed by this paper:
- Firstly, as a policy document this paper is naturally light on implementation detail. There are therefore a number of unanswered questions about how in practice common standards will be made to translate into software products which are truly compatible, and how long it will take before suppliers converge towards a predominant approach.
- Secondly, a shift to all data being cloud-hosted would result in a profound shift in the NHS’s cyber-security needs. At present, cyber-security issues in the NHS (such as the large-scale WannaCry incident in May 2017) are primarily as a result of outdated computer systems, or those which have not had important security patches. A shift of this kind would eliminate many of these legacy problems, but placing so much sensitive personal information in cloud systems will also increase the importance of cyber-security systems to avoid personal medical information and associated loss of public trust.
- Finally, the digital vision as set out is dependent on extensive databases of information from across the NHS. The utility of these is dependent on these all being reliable and up-to-date. The report recognises that this is dependent on staff being set aside to maintain the information on these, but there is no indication as to whether resources will be made available to invest in the creation of these teams, or whether trusts and GP practices will be expected to find this money out of already stretched budgets. If support for these new systems is not provided centrally, there is a risk that resourcing will be variable, which may result in an effect on data reliability, undermining the ultimate integration objectives of the project.