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Jeremy Hunt’s Dismissal Of A Paperless NHS Target Shouldn’t Detract Us From The Goal

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“I am quite relieved that most people seem to have forgotten that I made that promise.”

A lot of us working in NHS IT were quite surprised to hear that claim from the Health Secretary.

The promise Jeremy Hunt was referring to was nothing less than the directive from the Department of Health for us all to work to in order to become fully paperless by 2018.

To quote respected public sector ICT site diginomica’s write up of the Secretary’s appearance before the NHS Sustainability Committee, ‘The paperless NHS by 2018 challenge was announced by the Health Secretary back in 2013. Somewhere along the line this got pushed back to paperless by 2020. However, following a review by Professor Bob Wachter of the University of California, which stated that the 2020 target was also “likely to fail”, it is now thought we are looking at at least 2023 before the ambition is realised’.

Hunt told MPs that he “made big, bold statements about” going paperless, admitting he’d perhaps “rather bravely said I wanted the NHS to be paperless by 2018 in my first few months as Health Secretary”. (Hunt made the admission to the Committee in a closed December meet – the remarks were only made public last week.)

2018 might well be a realistic target for some ambitious Trusts

The problem for some us is that the sector took the plan to become fully digital very seriously.

After all a paper-free NHS was a route of travel that at one time featured its own special section on the DoH website, was regularly discussed by Jeremy Hunt and senior stakeholders in NHS England – and Trust IT managers had to find ways to deliver against it [https://www.gov.uk/government/news/jeremy-hunt-challenges-nhs-to-go-paperless-by-2018—2]. Only last year, Hunt announced that he had received an extra £4bn to help Trusts get there.

The good news is that the promise of going digital hasn’t being forgotten by Hunt or NHS England – it’s just been pushed out further, as we try and action some of the Digital Exemplar and other items that came out of last September’s Wachter Review.

Hunt did confirm all this in his Committee appearance and there’s lots of great progress being made. After all, it would be a false economy to scrap the target if it’s anything to do with saving money on IT as paper is far more expensive in the long term.

We know. We are seeing it every day with our NHS clients, who are achieving great things with content management in cutting down the paper chain and achieving the kind of benefits that the 2013 set of objectives called for.

That doesn’t mean there still isn’t work to do in terms of getting to paperless. Although a lot of digital format medical and patient data is starting to circulate between some parts of the local health system, even some of it as far as A&E, it’s not yet flowing as well as it could be inside the Trust as a whole.

We’re a bit disappointed with the Health Secretary for being a bit flippant about something we take very seriously.

But that hasn’t lessened the commitment we have as an NHS IT supplier to the goal of a digital, joined up NHS.

And some of us will get there in 2018.

Now that’s the kind of big, bold statement I like.

Gary Britnell
Head of the Healthcare Practice
SynApps Solutions UK

How Our Police Are Successfully Adapting To A Changing World

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I would like to discuss some of the interesting work we are doing in the law enforcement sector. Some recent trends highlight very well the kind of route of travel that British Policing is heading in, and which we are increasingly relevant to.

The first is the rise of the digital aspect of crime. The authorities report that cybercrime activity is both “growing fast” and “evolving”, with the threats from Distributed Denial of Service (DDoS) and ransomware attacks increasing significantly in 2015, for example. This danger is recognized at Cabinet level, with the government announcing a National Cybersecurity Strategy, which will see HMG investing no less than £1.9 billion in “defending our systems and infrastructure, deterring our adversaries, and developing a whole society capability”, to quote Chancellor Philip Hammond.

The setting up of the country’s National Crime Unit in 2013 is one sign of this, with the body actively engaged in providing a powerful and highly visible investigative response to the most serious incidents of cybercrime, pursuing cybercriminals at not just the national but the international level.

To single out one incident, the Agency said it broke a malware ring in November that may have carried out money laundering to the extent of more than £11m, through hundreds of accounts at various UK banks, using false identity documents and ‘money mules’ recruited and controlled by the crime group. The NCA suggests this kind of organized digital crime is on the rise.

Local, not just national

This work is being done at the individual Force level too. As a recent piece in The Telegraph from Boeing pointed out, “UK police forces must address these new threats and at the same time tackle age-old law-and-order offences, disputes and disturbances of the peace… [so] Forces are turning to cutting-edge technology to move the odds in their favour.”

A great example is body-worn cameras, a technology that will allow the Police to address community concerns about invasive techniques, potentially reallocate resources to more productive tasks, but also provide useful video evidence for trials. “Body-worn video will support our officers in the many challenging situations they have to deal with, at the same time as building the public’s confidence,” pointed out the Met when it launched its own major deployment of this technology to 22,000 uniformed officers last October.

Last but not least, the setting up of a national, unified Police ICT Company for the UK in March 2015 means that useful technology like body-worn cameras and other digital aids come much higher up the agenda for the sector than ever before. Under the governance and ownership of police and crime commissioners (PCCs), the Company is already producing useful overall strategy for Chief Constables around digital, as well as acting as a better procurement vehicle for the community, saving money and achieving economies of scale in dealing with suppliers.

I think you’ll agree that there’s a lot of positive change happening in the UK Police area, changes driven by the rise of hostile forces like cyber fraudsters but also by the willingness of society as a whole to accept a more digital aspect to traditional public safety and legal work.

This context of change is what’s driving some of the work we’re carrying out with multiple Forces.

To find out more about how SynApps can assist your Force in managing data, get in touch.

You can also read our most recent article on the new integrated SynApps-delivered digital interview solution, here

Mark Mark Winstone is SynApps Solutions’s joint Chief Executive Officer, as well as its Sales & Marketing Director

24 Hours In Tomorrow’s Digital Police Station

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Mark Winstone reveals another exciting solution for the public sector SynApps is working on with its customers – this time, in the Police sector

I want to briefly talk to you about some work we’re doing in one of our core markets, that of Police, which we’ve worked in for about seven or eight years now. I can’t go into as much detail as I’d like to, as some of the specifics are still being worked out. So what I can say is fairly ‘top level’ – but suggestive of the route of travel here.

It’s an interesting route of travel. Rather like the exciting work we’ve talked about in the NHS, it’s about us helping real-world organisations on the policing frontline solve real problems with our content management technology. And like that NHS work, it’s early days – but we think we’re on to something deeply practical.

What we’re trying to be practical about is the problem of time. The Police are always watching the clock when they get a suspect to the station, and it’s a clock that can’t be bargained with, either. If you’ve seen 24 Hours In Police Custody, this will be familiar to you.

The basic issue is that the Police have only so long to work with a suspect. Under the law, the Police can only hold someone for up to 24 hours before they have to charge them with a crime or release them (though they can apply to hold an individual for up to 36 or 96 hours if they’re suspected of a serious crime, e.g. murder, and you can be held without charge for up to 14 days If you’re arrested under the Terrorism Act (see here).

That sounds like a long time, but it isn’t; a case needs to be assembled, witnesses interviewed, as well as the suspect with their solicitor, and so on. Now, don’t think all anyone wants here is to press charges. Bringing cases to trial that can’t be won is a waste of time and resources; quickly having solid proof that this is the wrong line of enquiry gets the police back out on the beat quicker than finding the actual culprit; keeping someone in a cell for longer than they need is expensive and unhelpful. Accurate Policing is better for everyone – and quick and accurate is best of all.

Looking after digital evidence right is best for all of us, when you think about it

But what’s been really dogging many Forces is the added, needless complication of processing the digital evidence component of all this.

That matters, as digital evidence is becoming more and more central to modern law enforcement. As we move into an era of even more CCTV, body worn cameras on officers, evidence gathered by iPhone or digital camera, etc., then we’re going to have to find ways to properly manage, store and, crucially, search and properly label and timestamp, such digital evidence – for both the Police, the Courts and, critically, for all of us as digital citizens.

At the same time, in March the Home Office published a set of proposals for modern Police effectiveness that highlighted the growing importance of the electronic aspect of investigation and the need for “a comprehensive and joined up programme of digital transformation across policing” (see Modern Crime Prevention Strategy).

But if you have a system where you are trying to share files on DVD, manually, then this is time consuming and costly taking officers away from front line policing – which is not doing the best for the safety of the public or enabling officers to get better outcomes during an investigation. You’re also not doing the job the taxpayer really deserves if you aren’t efficiently storing or managing evidence, which may of course become crucial months, even years, down the line if there’s a break in a cold case or allegation of injustice. You want good chain of evidence, ideally from the first time the authorities get involved to historic file evidence, from a digital fingerprint to sound and video recordings of interviews, and so on: this is no less than we’re all entitled to expect in 2017, as it’s the most efficient way of delivering real 21st-century justice.

SynApps: the public sector partner

So better ways of working with digital evidence is something wanted by both Forces (as management of such evidence is their responsibility), the CPS and the government (in the shape of the Home Office and its agencies). And this is where modern content management comes in, in the shape of what SynApps and our tech partners can offer, as ECM is what is needed here to capture, move, search, store and systematically archive such important material.

I’m delighted to say that very soon just such a solution will be on the market. It’s a new integrated SynApps-delivered digital interview solution that we’ve developed for one Force that is being evolved into a full evidence management system in collaboration with some other technology partners.

Together with the great work we’re doing for the NHS around IDCR, the work SynApps is doing in digital Policing underlines how much we support the public sector, as well as how much our approach solves genuine problems here too.

Mark

Mark Winstone is Joint SynApps CEO and Sales & Marketing Director

 

2017: A Year The SynApps IDCR Moves From Blueprint To Proof Of Concept

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SynApps Solutions’s Joint CEO and Sales & Marketing Director Mark Winstone shares his thoughts about what he thinks 2017 will bring

For SynApps, 2016 has been very much about the NHS. But that doesn’t mean other markets haven’t been of huge interest to us. Our work in the Police market actually shares many of the same urgent business drivers as the health one, so there’s some useful commonality there.

However, the drive to interoperability in the NHS has dominated our work this year, as we’ve talked about [see here and here]. That’s to say that we very much agree and support the call from the very top of NHS England and NHS Digital, for a better way to use NHS IT to share information better.

That sharing has to be internally and externally, of course – which is why the CCGs, who are delivering not just a more interoperable NHS but also a more integrated and unified NHS and health and social care system, have been looking for ways to work toward the Integrated Digital Care Record, the IDCR, fast emerging as the most solid foundation for the next-generation NHS.

Think of it this way: you’re a CCG running a big city that’s got a chunk of countryside latched on. You could be talking about eight or nine Acute Trusts, maybe 80 or 85 GP surgeries. Throw in a couple of ambulance trusts, some mental health entities and local Social Services. It’s a complex network of people who want to partner better but don’t know how, and an awful lot of patients (many very vulnerable) who need to be looked after.

You will need technology to knit all this together, and patient information is the main ‘unit of currency’ that will make it work. This is so important and critical a problem for the NHS that we have spent the majority of 2016, led by my colleague Jason Scholes and his healthcare team, working on a framework for delivering the IDCR in a practicable way.

We know from all our experience with VNAs and data formats in hospitals that there are incredible disparities of technical knowledge and resource across the NHS. NHS England has been finding this out in its groundbreaking Digital Maturity Assessment work this year. We know there are different EPRs and different PACS systems and different IT systems in the NHS – even in the same hospital. So an IDCR is incredibly important, but also hard to deliver from scratch – which is what we have been putting our engineering and design resource into, in a bid to help the CCGs do this (our proposed IDCR blueprint work is here).

In 2017, this work will take a big step forward. Rest assured real proof of concept IDCR work is going on already at NHS customers, convinced by our vision and capability around clinical content and its safe management. IDCR will take a long time, but we will get there, and standards – always something we have lived or died by at SynApps – will be a key enabler, such as CDA, MESH and XDS.

We’re ready to make 2017 a really successful year!

Not all NHS organisations will get to any kind of IDCR finish line, of course. We anticipate that many won’t, and will want to instead benefit from the success of others, who may lease out IDCR capability through partners like us as cloud-delivered services.

This is something we see in our other big public sector ICT market, criminal justice. Individual Police Forces, the CPS and other stakeholders are also wondering if there might not be a more efficient, seamless way of sharing suspect information. Again, standards are being pushed and probed to see if they can help, and we are also working on demonstrators and PoCs to show what can be done.

The takeaway from all this is, I hope, clear: SynApps is working with its public sector and technology partners, doing important and interesting work – and 2017 looks set to be the year that these seeds bear fruit.

2016 – and 2017 and beyond – are about consolidating and building on the strong foundations that we think previous architectural work we did has laid down.

Can I now wish you all a great Christmas, hope you have a wonderful break, and see you in 2017 – when I hope you’ll join us and our partners and NHS IT customers in building more IDCR frameworks that will help patients, budget holders and the country as a whole.

Mark is SynApps Solutions joint Chief Executive Officer, as well as its Sales & Marketing Director

NHS Interoperability Is The Main Reason We Need IDCR

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“If I had any one piece of advice for the NHS around going digital, it’s to get interoperability right from the start… we have hospitals in the US that have great computers but where 95% of the systems can’t talk to any other system.”

For me, if there’s any one sentence that sums up why we’re working so hard at SynApps Solutions around interoperability at the NHS, that’s probably it.

And it’s from an absolutely impeccable source, someone who really knows what he’s talking about – Dr Bob Wachter, the US digital health guru the government brought in to advise the UK on how to better utilise digital technologies.

Wachter told the delegates at HETT recently that of his three main messages to the Department of Health, interoperability built on a solid foundation of standards was just as important as his other two.

The warning is incredibly timely for NHS leaders. That’s because we have designed a standards based architecture here at SynApps Solutions helping build a practical solution to help NHS leaders avoid that fatal lack of interoperability (1).

Let’s remind ourselves what the agenda is here. Hospitals want to share patient data internally, as the paper chase is killing off productivity and is increasingly recognised as archaic by smartphone-savvy users. They also know that soon, they’ll want to share that data with other providers in a more integrated health and social care chain.

A new way to exchange health information and data

To that end, NHS England and NHS Digital are promoting the IDCR as the ideal way to achieve that. The challenge: unlike in the days of NPfIT, there’s no central, top-down procurement process to get an IDCR. You’re going to need to build one.

The good news is that SynApps and our partners can help. But it’s still a significant undertaking. There are two big parts of the puzzle emerging – CDA and MESH. CDA is an HL7-controlled standard for working with Clinical Document Architecture (think things like discharge summaries and progress notes), so is a great way to put your output into a useful XML-based format, while MESH (message exchange service for health),which is replacing the older NHS DTS standard, is a new way to exchange health information and data (2).

So now there is a format for producing at least some documents and a great way to send them. However, there is also information that is falling between the gaps. Hospitals can generate a PDF for a discharge note, for example, but then end up printing it off and posting it to your GP. That’s not really the mission here, clearly.

The heart of the matter here is that not enough NHS stakeholders have got their heads around the difference between coded and non-coded documents. Put simply, non-coded documents are less useful than coded, though a lot more useful than paper. With coded documents, you can add in information that health systems at the other end can pick up automatically, which gives the recipient a lot more context and useful information about the patient and the case.

So what we want to do is to provide a way for NHS practitioners to a) more easily start using coded electronic documents that best exploit the power of the CDA standard and b) allow them to start using the power of MESH to safely route and share such digital assets. The key to this is realising that hospitals have lots of different types of documents and data, e.g. DICOM and non-DICOM. We have to work with all these data formats to get to the kind of interoperable future Dr Bob, Jeremy Hunt and NHS Digital wants us to be moving to.

A fantastic opportunity

What we want to offer is a way to check in all those different sorts of documents and formats into a safe place that means they can get routed out again in packages that conform to the CDA and MESH protocols. It will be able to work with coded documents – and we think non-coded is the stepping stone we have to work with to get there.

Once we have this basis in place, just think of the things smart documents could do in the NHS – route information without any need for re-keying or asking the patient the same questions 20 times, allow collation of data for better analysis of the bigger trends at the local, regional and national level, programmatic search, and so on.

We are convinced IDCR is a content problem. Our distinctive contribution to all this is content. We are a content management company; to us, CDA and coded documents are just more content forms to store, manipulate, access and share. We are also very experienced in hosting, and IDCR is a prime candidate for being delivered via a web-based solution to promote intra-stakeholder collaboration and partnership.

We can deliver on the Watcher Review’s aims and get interoperability bedded down as soon as possible here, as well as make IDCR a really fantastic way to share data tomorrow.

If that sounds like work that will help your organisation, then get in touch to discuss how to build the best IDCR to meet your team needs. Drop me an email today.

Gary Britnell

SynApps Solutions Healthcare Business

  1. We’ve also discussed this fascinating work here and you can check out the details of Wachter and his team’s recommendations in the full report, Making IT work: harnessing the power of health information technology to improve care in England, here
  2. see this NHS England guidance for more on that transition

Manchester Was The Countdown To A Huge Digital NHS Push – Are You Ready?

medic-563425_1920Anyone who is part of the UK health IT community gets used to big statements regularly being made about the digitisation of the NHS.

Last month, the Secretary of State for Health Jeremy Hunt spoke at the Health and Social Care Innovation Expo in Manchester, and finally set the seal on what the government expects the NHS to do next.

I probably don’t have to tell you about the context; the 2020 paperless NHS target, the NHS’s Five Year Forward View to ‘harness the information revolution,’ and the findings of the Wachter Review into what needs to be done (see here).

What matters now is what the Secretary specifically announced. (This is the main DoH press release)

The new website will also enable patients to download their personal health records to their phone securely

Hunt confirmed there are three broad themes in the current NHS IT plan, which are a renewed focus on interoperable electronic health records, a call for more use of patient-focused digital technology, and another go at care.data – data harvesting and exploitation of NHS information through secondary use of data, transparency and consent.

These themes matter, as they a) gave specifics on what the government expects the NHS to do with IT reform and b) reset some deadlines, most especially the 2020 paperless target, which has been pushed out to 2023 due to Wachter’s intervention.

Most germane for CCIOs is what NHS England, and more crucially NHS Digital (the old HSCIC), sees as its role in the post-Wachter regime. NHS England lists the following as the most important outcomes of Hunt’s September speech as the Exemplars, the opening up of official NHS apps and a major refresh of the main NHS website: “NHS Choices website will be relaunched as NHS.UK with a wider range of online patient services, including the ability to register with a GP, book appointments, and order and track prescriptions all in one place. The new website will also enable patients to download their personal health records to their phone securely, giving them instant access to important healthcare information, such as prescriptions and test results” (see here).

Now, a lot of this is outside what most Trusts will have to immediately worry about. But there were absolutely some things that will concern them. Consider this:

“Instant access to personal health records online – inspired by the ‘blue button’ app in the US, the new NHS.UK site will also enable patients to securely download their personal health records, giving them instant access to important healthcare information, such as prescriptions and test results.”

and this:

“More interactive, local information about the performance of health services – from today, the MyNHS website will give better data on how NHS services are performing across dementia, diabetes and learning disability services. Maternity, cancer and mental health data will follow later this year. In future, the revamped site will also include maps, graphs and tools so that patients can see how the performance of their local services has changed over time.”

The central role at local level of the IDCR to make this data-driven NHS work

The keyword for the NHS IT leader of today is data.

The Secretary says there is £4bn available now to digitize the NHS along these lines.

That data, however, is useless unless it is made interoperable and securely shareable.

Which is where our attention has been focused, with our work on helping draw up realistic roadmaps for helping health and social care organisations deploy Integrated Digital Care Records (see here).

So to sum up, this is the SynApps view:

Manchester was where the blue touch paper was lit for the next phase of IT innovation in the NHS.

Data is central.

And the IDCR is going to be a key way to deliver against all of this.

I encourage any NHS IT team to get in touch – and let’s see how we can help you make all of this a reality at your local and regional level.

Gary Britnell

SynApps Solutions Healthcare Business

Making Standards Deliver Great Health IT Outcomes: We Have Some Ideas

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Last time we spoke, I mentioned how we have started to work with Trusts to open up a practical pathway to the common goal of an easy way for health and social care stakeholders to share information – the IDCR, the Integrated Digital Care Record (see here).

Plainly, information is the pillar of the IDCR – it’s what will keep the structure up. But the foundation that makes IDCR happen is data interchange. We’re going to need a safe, reliable and functional way of moving data around.

That foundation is also going to have to be pretty data-format agnostic. A hospital Trust will be familiar and happy with DICOM data, while a GP’s surgery may have never heard of the term. We are going to have all sorts of data, from Excel to HTML to other formats to manage here.

NHS England is of course well aware of the need for a way to work with heterogeneous data formats as it helps CCGs move to the IDCR target, which is why it supports the MESH (Messaging Exchange for Social Care and Health) service, the successor to DTS (Data Transfer Service). MESH will have a big part to play in any IDCR project, but it will need to have the right elements to work with in order to push information around. This is where we think we can help. We’ve been doing a lot of design and testing at SynApps, as well as talking with both existing partners (especially Alfresco) and new ones, like the team at Enovation, on this topic.

Our MESH-IDCR thinking is influenced by NHS England’s own stated route of travel, which is predicated on the central role of CDA, the ANSI-certified Clinical Document Architecture (see here). This is a great way to define how information can be packaged up using the XML language and easily moved around by MESH.

A blueprint for a practical way forward?

I think you can see how the stars are aligning. To get to IDCR we need MESH and it looks like CDA is the best way of making MESH work. The problem is all the heterogeneity of computerised British medical data. There’s a great deal of complexity out there, complexity we think could keep IDCR coming on-stream for far too long.

That’s why we have been involved in so much back room work over the summer, trying to work out how to address this challenge. We have some proposals we think could help, instantiated in a blueprint for an IDCR architecture that can offer a way for many different data owners to securely and efficiently share data, checking it in and out of a rich central Repository. That Repository and an associated Registry is coming from us and Alfresco, while the Enovation team is underpinning it with messaging bus technology.

We are heavily engaged with CCGs who are looking at taking this blueprint and the first fruits of our ideas to the next level so you will hear more from us soon on this. In the meantime I’d be happy to respond to any questions you might have about the proposed architecture.

The last thing I will say is that we are very sensitive to the fact that getting to IDCR is a challenge. There are vast differences in the levels of digital maturity in the NHS and its partners in social care and the public sector. Even neighbouring hospitals can have very different scores. Technology generally is hard but especially in the NHS context.

However, whatever your organisation’s level of accomplishment here, we think we can help. Our standards-based, open, highly partner- and interoperable style approach is a realistic way to get to where we all want to be with patient data as soon as is practical.

So what’s to lose by dropping us a line and seeing if we have anything that may help you?

I encourage any NHS team to get in touch to discuss their own LDRM (Local Digital Roadmap) or individual strategies on how they’re going to deliver IDCR.

We will be at the UK’s Largest Digital Health Show – EHI LIVE – November 1, 2, Hall 1, NEC Birmingham, and at the NHS Clinical Commissioners Annual members event 2016, Amba Hotel, Marble Arch, November 3, 2016, so we hope to see you there.

Or just drop me an email.

Gary Britnell

SynApps Solutions Healthcare Business