Has UK healthcare had its online banking moment?
I was recently approached by a journalist who wanted to talk about the NHS’ deployment of technology during the coronavirus outbreak. The question they wanted to explore was “has healthcare had its online banking moment?”
The more I thought about this question, the more I thought that answer was “no.” I don’t think UK healthcare has had its online banking moment. What it might have done is have its telephone banking moment.
The telephone banking moment
The idea of an online banking moment is an odd one. A lot of the banking developments that we now take for granted took many years to gain widespread acceptance and they overlapped.
People continued to cash cheques in banks after cash machines arrived, to use cash machines to check their bank balance after call centres were set up, and to phone call centres when online banking was available on a PC.
Before the coronavirus outbreak, most UK healthcare was at the High Street banking stage. All General Practitioners and a majority of hospitals had more or less extensive electronic patient records, but staff had to be onsite to use them, so patients had to go to them.
GPs had also implemented some patient-facing services such as repeat prescriptions (the cashpoint, in my analogy) and some hospitals were experimenting with digital triage and follow-up (early stage online banking), but use was extremely limited.
During the COVID-19 emergency, we saw a rapid shift to remote working and a big increase in digital clinics and consultations (hence: the telephone banking moment). But if the “online banking moment” is the moment at which individuals can do everything online, it’s clear that healthcare still has a long way to go.
Change has been fast, significant
That’s not to downplay the significance of the changes that we have seen. That shift to remote working and to virtual consultations is real. And we have seen some UK customers moving quickly to implement projects that were in the pipeline.
The main reason that the pace of change has picked up is that barriers have come down. People are looking for a broad consensus on which to move forward, instead of looking for agreement on every point of detail. People have also been willing to deploy solutions that meet a need, or that are 95% per cent there, and iterate in an agile way.
We have seen that work well for our client, Gloucestershire Hospitals NHS Foundation Trust. Instead of spending a year getting ready for a big-bang go-live with SunriseTM Acute Care, it has taken a pragmatic approach.
It went ahead with a planned implementation of nursing documentation and e-observations in the first few weeks of the crisis and has seen huge benefits in tracking COVID status of patients and being able to identify and respond to patients who may be deteriorating.
We have also seen it work for The Dudley Group of Hospitals NHS Foundation Trust, which has been piloting an information-sharing project with its local healthcare community, using dbMotionTM Solution. It has pushed ahead with additional feeds during the outbreak with very little fanfare but with significant benefit to clinicians.
The information sharing argument has shifted
The Dudley Group’s experience also illustrates another important shift that we have seen during the crisis, which is towards more information sharing. The big reason for that is that people have taken a pragmatic approach to information governance and patients have gone with them.
It’s been clear to everybody that if a patient from somewhere like Dudley contracts COVID-19 and ends up being treated in a Nightingale hospital or a tertiary centre in a city like Birmingham, its clinicians will need access to their medical records and their local doctors will want to know what is happening to them. It has made the abstract argument for information sharing concrete.
What do we need to maintain progress?
We will need some structural changes to the NHS, so the integrated care systems that have been emerging over the past couple of years can manage the kind of information sharing that we have seen around the Nightingale hospitals.
At a national level, I think it would be useful to have a structured review of what worked and what didn’t, of the enablers and the obstacles, and of what got missed. That will undoubtedly include some big picture issues such as data architecture, standards and security.
We also need to keep the money flowing. The shift to remote working and virtual consultations has been supported by national licences for Microsoft Teams and a platform called Attend Anywhere, but these will not be available forever.
At some point, trusts will have to decide whether to continue with these platforms or to look for other solutions, but investment will be needed so people know they will continue to be available. Then, we will need to work out how to integrate these platforms with other tools.
Don’t stop at online banking, let’s go for open healthcare
The priority must be clinicians having the information they need to work with patients at their fingertips. While we are doing that, we need to push on towards an online banking moment, by enabling information systems to share information with each other, using a platform like dbMotion Solution, so clinical teams can start working with each other and with patients in new ways.
But, at the same time, we need to remember that banking has moved beyond online banking. The open banking standard, which enables data to be securely shared and openly published through application programming interfaces, has created a whole new world of fintech apps. That’s why, if I open my phone, I can select an app and let it use my contacts to send money to someone instantly.
It’s open banking that we need in healthcare, a world in which patients can open an app, book an appointment, attend it, and have everything logged digitally, so the information can flow on into treatment or monitoring services.
Allscripts has always been committed to the open platforms. We’ll achieve real value when we have an open banking moment in healthcare.