FINAL GPSJ Summer edition 2024 ONLINE VERSION.2pdf - Flipbook - Page 22
GPSJ
NHS & HEALTHCARE
Is ‘smart health tech’ solving the right
problems for the NHS?
Dr Paul Deffley
We need to focus on solving the
right problems with technology,
and facilitate better conditions,
in order to improve smart
healthcare adoption at scale
in the NHS, writes Dr Paul
Deffley, chief medical officer for
Alcidion.
Where would you position the NHS
in relation to other countries, when it
comes to the adoption of innovative
technologies to support patient care?
Recent research from Newsweek
and Statista, which ranked the world’s
top ‘smart hospitals’, placed its first
NHS trust at position 72 on the list.
This finding caught the attention of
delegates at March’s Digital Health
Rewired 2024 conference, who
were surprised by the extent of
the seemingly faster pace of smart
technology on the other side of the
Atlantic.
Notably, led by the Mayo Clinic, the
Cleveland Clinic, and Massachusetts
General Hospital, more than 100
US healthcare organisations hold a
heavily dominant presence on the list
of 330 hospitals. So why have they
been successful, and should this
mean anything to the NHS?
An opportunity to reflect and
learn? Moving beyond pockets
of innovation
Newsweek’s global ranking is of
course only one piece of research,
unlikely to comprehensively represent
technological deployments at every
level of healthcare.
Although a further 21 UK sites
receive mentions further into the
ranking, I would suggest that
there are great examples of smart
healthcare in the UK, to which the
league table doesn’t do justice
Yet adoption of many innovative
technologies that can positively
impact patient care, still tends to
happen in pockets in the NHS, often
in the form of pilots that struggle
to scale and deliver impact more
broadly.
There has been much purported
22
around the role of smart healthcare
for decades – a promise that still
holds much excitement. But progress
at-scale often remains hindered.
As someone who has worked in
clinical leadership and CCIO roles
in NHS providers, commissioning
and system transformation, before
working directly in the health tech
industry, I remain passionate that
obstacles can be removed and
sizeable benefits consistently realised.
With that in mind, Newsweek’s
research offers a reflection point
on ways to boost effective use of
innovative technologies available
today to the NHS, by understanding
what has worked for peers around
the world.
What are the barriers we need
to overcome?
Heart failure is one clinical priority
that could be better served by smart
technology. Evidence, that has now
existed for many years, has shown
that remotely monitored heart failure
patients realise better outcomes.
In many cases patients on remote
monitoring pathways are less likely to
be admitted to hospital, more likely
to comply with medication, and can
be less likely to suffer complications
or death as a consequence of heart
failure.
Yet, many patients in the UK still
have no access to remote patient
monitoring, despite an urgent push
for such approaches during the
Covid-19 pandemic.
The problem in creating ubiquitous
access to such services is not the
technology itself, or evidence of
efficacy – both of which can be
surfaced. So, what is needed?
Back to our smart hospital
exemplars – whilst highlighting
AI, robotics, digital imaging, and
telemedicine as standout areas
hospitals have excelled in, the ranking
doesn’t detail recipes for success.
Speculatively though, a panel
discussion I was involved with at
the Rewired conference, suggested
possible answers, that might lend
lessons for better adoption in the
NHS.
Are we solving the right
problems?
Dr Lia Ali, a clinical advisor to NHS
England’s Transformation Directorate,
told the conference that for smart
health tech to be successful, it first
needs to solve a problem.
This might sound obvious.
However, technology vendors
often still build functionality without
understanding the problem they are
trying to solve.
In the US, many smart hospitals
are likely to have been successful
because they have used technology
to respond to a problem that has
GOVERNMENT AND PUBLIC SECTOR JOURNAL SUMMER 2024
both a patient and commercial
level benefit. These are in essence
commercial organisations that need
to manage profit and loss sustainably.
Failure to do so can have significant
impact, or worst-case scenario they
might cease to exist.
That is not to say they aren’t
driven by patient outcomes. But
this overt commercial driver means
that hospitals are often willing to
take organisational risk and invest to
achieve new models of care that can
and have unlocked benefits.
This is less inherent in NHS
behaviour. However, a different
version of the same driver facing NHS
organisations is productivity.
Karen Kirkham, chief medical officer
for Deloitte, told the conference
that demand continues to outstrip
capacity, and that investment in
traditional models of care will not
meet rising pressures. This is a global
phenomena, irrespective of funding
models.
A commercial message might not
land well within a social institution
like the NHS. But it ultimately has
the same need as US counterparts:
to effectively manage increasing
demand within a constrained
resource environment without
compromising patient safety.
Smart health tech needs to
deliver on productivity if we are to
see increased uptake in the UK.
That might mean enabling earlier
intervention, either within a hospital or
a healthcare system, to reduce risks
of complication, and prevent patients
presenting with more severe and
demanding conditions downstream.
It might mean investment in
patient flow – again within hospitals
and across settings. A recent flow
deployment in Australia saw a 13%
reduction in length of stay – solving
problems for busy clinicians, for
patients who want to be at home,
and for stretched healthcare systems
that can gain new intelligence on
where they need to deflect pressures
and improve support.
It might mean rethinking virtual
care and remote monitoring, and
remodelling pathways to improve
our ability to manage risk in the
community.
And it might also mean addressing
common causes of inefficiency
and patient safety concern. For
example, technology has recently
been launched to address a
widespread systemic problem of
volumes of patient results not being
acknowledged – with implications for
delayed care and ineffective use of
billions of pounds worth of tests.
Creating the environment for
smart healthcare
Creating the right conditions for
success also means recognising that
new approaches take time.
I’ve practised as a doctor for
more than 20 years. I understand
the tremendous value in just seeing
patients: pattern recognition,
observing them, witnessing
behaviours from the moment they
leave the waiting room.
In a new virtual care environment,
we don’t have face-to-face
collaborative conversations with
patients to guide judgement. If we ask
doctors to make decisions on remote
monitoring data and patient reported
surveys – that is significant change.
We design these approaches
for good reason, but we cannot
underestimate the transformation that
goes alongside it. We need to make
sure that we do not over focus on the
technology, and leave people behind:
both staff and citizens.
Expansion is more like
gardening than blueprinting
Advancing from a sea of pilots to
widespread mainstream adoption of
smart tech is also about more than
blueprinting.
Successful smart hospitals are not
just a process to be transferred: a
desire to cookie cut, to blueprint and
scale, will fail unless we observe the
true breadth of elements needed.
We need iterative approaches,
and clinical leadership to articulate
change and overcome bumps and
challenges.
Effective technology adoption
means listening to the problems of
patients and of clinical teams, who
might not be interested in the lofty
ideals of smart healthcare.
For successful adoption, there
is a need to observe, monitor
and treat smart healthcare as a
living programme. Just as different
approaches to gardening work in
one location but not another – in
healthcare we are dealing with
unique environments that must be
understood.