Clinical Technology: Short-Termism or the Golden Thread?
17 November 2023
Numerous strategies and plans have referenced the imperative of embedding technology in healthcare. The NHS Long Term Plan committed all NHS trusts to meet a core level of digitisation, including having an EPR in place by March 2026. The What Good Looks Like framework describes seven elements to ensure all health and care providers have a strong foundation in digital practice, and in the Department of Health’s policy document A Plan For Health & Social Care, it explains how it will provide multi-year funding to ICSs based on need, starting with those without an EPR.
Digital Clinicians are Core to Change
In line with this agenda, there’s been a drive to professionalise the role of clinicians with a digital portfolio. The Wachter Review had five key recommendations, three of which related to the professional development of digital clinicians as a cornerstone to the digital transformation of the NHS. In his review, Topol highlighted the importance of training clinicians in preparation for the digital future of the NHS. The Phillips Ives Nursing & Midwifery Review focused on the digital readiness of nurses and midwives and make sure the workforce was equipped for the future.
Unfortunately it has taken time to get the ball rolling. Despite the papers, reviews, evidence and success stories many NHS organisations continue to look at digital as a project or short-term programme. It is often seen as separate to the clinical and nursing strategies of the organisation as a box to be ticked.
In the UK, the first national chief nursing information officer (CNIO) was appointed in early 2019, three years after the first national CCIO was appointed. Those crucial roles have only been identified in the UK within the last decade, which could go some way to explaining why many provider organisations are still to appoint CCIOs and CNIOs.
Thinking Beyond the Short Term
When we consider the scale of transformation required to move a hospital from paper records to an EPR, it’s remarkable to think that some senior, experienced NHS leaders expect to “go digital” within a defined, closed end, fixed cost programme. Often, the digital agenda sits within the portfolio of the chief information officer or perhaps chief finance officer and is therefore not seen as part of the clinical executive portfolios.
Digitisation completely changes the nature of the work, the tasks to be done and who does them – not appreciating that contributes to the failure of digitisation. As Wachter highlights, failure to engage end-users in the new systems is also a contributing factor, as is the failure to expand, train and nurture the digital workforce.
The digital workforce model, usually dictated by the monies available, varies widely in NHS trusts. Smaller provider organisations often don’t have the same financial resourcing to set up a clinical digital team and are more likely to rely on short-term funding from the centre. Consequently, doctors who are interested in digital get the title CCIO and a few PAs per week. A CNIO, CXIO or similar may be employed but the renumeration for the role can range from a Band 7 to a 9 and it may be in the form of a secondment or a fixed term contract. Other professionals are given titles such as ‘digital midwife’ or ‘digital physiotherapist’ and are given time during the week to support digital transformation.
However, the funding allocated to support digital progress is often limited in duration, often for just a one-year period. This tight timeline poses significant challenges to effectively integrating digital advancements into the clinical operations of an organisation. This includes extensive planning, active engagement of key stakeholders, development of a comprehensive training strategy, configuring and testing the EPR system, and successfully deploying it. Once the EPR system is live, there is a need to ensure the efficient use of the generated data to drive improvements in care delivery, patient outcomes, and operational efficiencies. Answering the critical question of ‘so what’ becomes paramount. Additionally, the organisation must also consider the future by evaluating new functionality and providing input into the clinical strategy of the trust, addressing the ‘what next’ question. Transforming the fundamental workings of an entire healthcare provider organisation within a set timeframe is a daunting task. Unfortunately, this often leads to missed milestones, the need for multiple extensions, replanning of activities, inefficiencies, staff burnout, frustration among clinicians, and an overall negative experience for everyone involved.
As Topol explains it is an exciting time for the NHS to benefit and capitalise on technological advances but we must learn from previous change projects. Successful implementation will require investment in people as well as technology.
Our first-hand experience has shown just how important digital clinician representation is across different professional groups, specialties and care settings when successfully deploying and adopting EPRs.
Deploying, optimising, and iterating healthcare software is not a finite project or programme; it is a golden thread that runs through healthcare. With the genesis of a modern professional clinical speciality that will continue to grow. It is a golden opportunity to fundamentally change the way the NHS works, making it safer, more efficient, for both patients and clinicians.
Jacqueline Davis is the Chief Nursing Informatics Officer at System C.