Digital technology falling (even) short(er) in NHS nursing: QNI report (UK)

February 9, 2023 | by | 2 Comments

When health tech ‘magic’–isn’t. Roy Lilley and his several times per week newsletter (NHSManagers.net, subscribe here) are really must reads for our UK readers dealing with the foibles of the NHS and NHS Digital. Billions have been poured into digitization of records and equipping district (community) nurses with laptops and access to apps that connect them to patient information. All of which is apparently, a flop for the money spent. 

The Queen’s Nursing Institute (QNI) has published a study, Nursing in the Digital Age 2023, via its data gathering and analytics area, the International Community Nursing Observatory (ICNO). It obviously should be microscope-read by NHS Digital, but also by US developers (and in other countries) with clinical users. (Oracle Cerner, Epic, and 00’s of EHRs and workflow apps–take notice).

Mr. Lilley outlines the level of failure here–from his article: 

  • 5 yrs ago; 32.7% reported problems with lack of compatibility between different computer systems… in 2022 the figure had risen to 43.1%.
  • 5 yrs ago; around 85% of respondents reported issues with mobile connectivity… in 2022 this figure was around 87%.
  • 5 yrs ago; 29.5% reported problems with device battery life… in 2022 the figure was almost 53%.

The overall take of the QNI study is that nurses are highly digitally literate and embrace technology at scale, but in practice, the apps and the hardware have become impediments as the workload increases. For non-UK readers, district nurses travel a lot, often working from home–akin to home care or rural nurses in the US. Points from their executive summary:

  • Hardware–battery life, weight of laptop, old laptops, ergonomics not only from weight but also when working in cars. Safety and confidentiality issues lead many nurses to take the work home, leading to delays.
  • Software–connectivity, authentication, multiple platforms, little integration, repetition of data entry, and poor connectivity and software design leading to interrupted workflows.
  • Some scheduling tools cause workload issues, such as over-allocation of work, unmanageable workloads and loss of personal autonomy.
  • Systems design–impersonal, designed to act as a barrier to interacting with patients.
  • Duplicative workload–repetition with dual entry on paper and into platforms because of poor connectivity and software design
  • The use of electronic health records (EHR) and similar platforms was mixed in terms of productivity gains and work capture. 

Another issue: “Moving technology-enabled care (remote monitoring) to the community appears to have shifted work from the hospital to the community”, meaning an increased workload on nurses where specialists or non-nursing staff could do this. 

Mr. Lilley summarizes as a service what both the hardware and software should be accomplishing:

Just ten simple things:

  1. Who is the patient,
  2. where have they come from.
  3. See their record, have they been sick before and…
  4. What we did we do?
  5. Anything in their history that’s a red flag?
  6. What do we do to fix them up this time and…
  7. Record how we did it.
  8. Figure out what worked,
  9. What did it cost and…
  10. Do we want to do it again.

Both Mr. Lilley’s newsletter and the study (PDF) are must reads wherever you live. Especially if you are a software designer.

No wonder nurses are single-day rolling striking!

(He also has an interesting take on ChatGPT, AI for copywriting and reporting, which we will take on next week….) Hat tip to Editor Emeritus Steve.

The Roy Lilley-Sir Simon Stevens ‘Health Chat’ interview

July 30, 2021 | by

Sir Simon Stevens, NHS England’s chief executive who leaves this post on 31 July after seven years, was interviewed by Roy Lilley (nhsManagers.net) for his recurring Institute of Health and Social Care Management Health Chat. This Editor has found a summary of the interview and it makes for interesting reading.

Sir Simon started with the NHS out of their graduate training program. Assigned to run a mental health facility in the North East, he introduced himself to some people on the drive by the facility and asked what they were doing. “Scattering the ashes of your predecessor” they said. From that macabre start, he went on to craft public policy under two very different Labor governments, the first ‘The NHS Plan’ in 2000 and then returning after stops at Downing Street and United Health to take over a ‘traumatized’ NHS in 2012. “The NHS was out of New Labour’s money, facing rising demand from an ageing and increasingly unequal society, and struggling to pick up the pieces from a broken social care system. It needed a new approach, and Sir Simon provided one with the ‘Five Year Forward View’ and its successor the ‘NHS Long Term Plan’” that controlled demand and improved efficiency by introducing population health management and integrated care. He was also able to secure funding, more than other agencies. Sir Simon was then expected to leave with the change of government, but then Covid-19 hit.

About halfway down, you’ll read some tart comments about the mix of digital health in the total picture of the NHS and whether digital first will stick.

With deputy Amanda Pritchard taking over, only weeks from the appointment of the new health secretary Sajid Javid replacing Matt ‘Man in a briefcase’ Hancock, the snapback in care demand, and apparently another round of a virus which should get the Henry VIII treatment (‘Will no one rid me of this meddlesome virus’?), it will surely be interesting times. Hat tip to Highland Marketing which is the strategic communications partner for the Institute of Health and Social Care Management and the Academy of Fab Stuff, and article writer Lyn Whitfield. 

NHS Digital GPDPR medical database plans criticized by Royal College of GPs, privacy advocates (updated 8 June)

June 2, 2021 | by | 2 Comments

What our UK Readers may have missed on the long bank holiday weekend. And why this matters outside the UK.  NHS Digital is being roundly criticized by privacy advocates, the Royal College of GPs (RCGP), the Doctors’ Association UK (DAUK), and individual GP surgeries on plans for creation of the General Practice Data for Planning and Research (GPDPR).

The GPDPR will compile information on 55 million patients–every patient in England registered with a GP surgery–into a database available to academic and commercial third parties for research and planning purposes. NHS has been collecting patient data on patients in a database, the General Practice Extraction Service (GPES), for the past decade. The GPDPR will replace it. Data collection on patients in England starts 1 July. What will be collected is at the end of this article as background.

The objections center on the sensitivity of the data, the short window of notification to patients, the lack of a clearly notified opt-out with sufficient time, and how it will be used.

  • The data apparently can include mental and sexual health data, criminal records (!), and other sensitive information. 
  • The short time–six weeks–between the announcement in late April (a low key affair with Matt Hancock-signed blog posts on the NHS Digital website, YouTube videos, and flyers at GP surgeries), and the start of data collection from the surgeries
  • How many patients are actually aware that this is happening and of their options is debatable. (See next two bullets)
    • If a patient didn’t pick up on it in the six-week window ending on 23 June (and go to the page with the Type 1 Opt-Out), a patient can opt out for data going forward, but cannot withdraw any data collected into the database prior to that date.
    • If a patient is in the National Data Opt-out program, their medical data will be collected anyway, since it applies to only identifiable and confidential patient information.
  • Many GPs are concerned about further erosion of the physician-patient relationship and the lack of communication to patients on how the data will be used, the ethical questions around the organizations to which it will be sold, and how patient privacy will be preserved.

The blackest mark here on NHS Digital is that the groups ostensibly involved in the development of the database–the RCGP and the British Medical Association (BMA)–are the ones sounding the alarm, along with the aforementioned DAUK and privacy groups such as MedConfidential and Foxglove. There is also a rebellion starting among London GPs. Reportedly, 36 doctors’ surgeries in Tower Hamlets, east London, will withhold data. An email is circulating to about 100 surgeries in north London questioning the legitimacy of the NHS data collection. This is despite penalties if they don’t submit.

Why does this matter if you’re not in England? Medical data–collecting, manipulating it, connecting it, finding insights, and selling it–is the Gold Rush of the 2020s. Pharma and payers as markets are just the start. Nearly every Roundup or deal this Editor covers has companies with a chunk of this gold rush. Why are telehealth companies worth their IPO/SPAC/funding prices? Why is McKesson ‘big banging’ four separate businesses into one division? Why do we follow ‘data warehouses’ like Sensyne [TTA 26 May],  Mayo Clinic’s big bet on a multi-line Remote Diagnostics and Management Platform [TTA 23 Apr], and virtual pharmacies like Capsule?  Why are insurtechs like Oscar and Bright Health hot? Why is it the #1 target of hackers?

It’s not altruistic. Services can be duplicated. Companies can be a hair away from failure. But ah, their data…the data has huge market value, even if its potential is not fully understood yet. Ask any data analytics person. Ask China, probably the most aggressive nation in collecting the health and personal data of its citizens, with Chinese capital for years now leading investment in global health tech companies.

In an article back in October 2015, this Editor described the many ways that deidentified patient data, in this case genomic data, can be identified by researchers through cross-checking via research database “beacons”, a network of servers. Referring to the 23andme and Ancestry.com collection of innocently given genomic data from consumers, this Editor proposed a Genomic Bill of Rights in 2018 and again in 2020. If this Editor, no data geek, can deduce it (hat tip to Toni Bunting back in 2015), this information has to be well known to researchers and to privacy advocates.

The controversy is just starting to ramp up. And it should. It’s about time there was a reckoning. The Guardian 30 May, 1 June

More background. According to the NHS Digital page on the GPDPR, patients will be anonymized by a process where de-identification software will replace their NHS Number, date of birth, and full postcode with unique codes produced by de-identification software. The data collected from GPs in England starting 1 July will be on: (more…)

Is the NHS ready to adopt telemedicine through and through–and is telemedicine ready?

August 27, 2020 | by

This analysis by Dominic Tyer in Pharmaphorum discusses the rapid adoption of telehealth during the COVID pandemic, both telephonic and online, to keep people in touch with their doctors. Health Secretary Matt Hancock quantified the changes wrought as “I’ve lost count of the number of times someone said to me: ‘what would have taken months took minutes’.” The article goes on to quote him as saying that COVID-19 has “catalysed deep structural shifts in healthcare that were already underway”, citing as examples data-driven decision-making, working as a system, and telemedicine. In fact, to Secretary Hancock, “From now on, all consultations should be teleconsultations unless there’s a clinical reason not to.”

For all the advances, Mr. Tyer points out flaws such as safeguarding sensitive health issues, particularly for young people, use by rare disease patients and those with a genetic condition, and reaching the 10 percent of the population who do not use the internet. All of these are significant. He concludes that “in the UK there’s clearly the political will and healthcare backing for wider use of telemedicine by the NHS, despite some, as-yet not entirely resolved, technological and safety issues.”

Will the UK revert to ‘underuse’, as the US has rolled back as well as practices have reopened? (What is ‘underuse’ defined as anyway?) Will these issues be resolved or ignored in a push forward for telehealth? And teleconsultations as a norm, with in-person an exception, is perhaps at this time, and in improving health outcomes, an overreach? Hat tips to Roy Lilley of the nhsManagers.net newsletter and Steve Hards

Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (Updated)

December 12, 2018 | by

Updated. Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

The Road to Perdition is Paved With Good Intentions. A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS and CMS in the US require some paper records. Confidentiality and hacking–especially when tied to computer networks–are problems with fax, but the same can be said for computer networks. Oh, and if your systems are attacked by ransomware, it’s awfully handy to refer back to printed records and to be able to communicate outside of computer networks.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

Other articles on this: Fortune, Forbes

Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?

February 17, 2018 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Here’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. (more…)

Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? Is Carillion’s collapse a spanner in the works?

January 16, 2018 | by

NHS England won’t be rolling out the Babylon Health ‘GP at hand’ service anytime soon, despite some success in their London test with five GP practices [TTA 12 Jan]. Digital Health cites an October study by Hammersmith and Fulham CCG (Fulham being one of the test practices) that to this Editor expresses both excitement at an innovative approach but with the same easy-to-see drawback:

The GP at Hand service model represents an innovative approach to general practice that poses a number of challenges to existing NHS policy and legislation. The approach to patient registration – where a potentially large volume of patients are encouraged to register at a physical site that could be a significant distance from both their home and work address, arguably represents a distortion of the original intentions of the Choice of GP policy. (Page 12)

There are also concerns about complex needs plus other special needs patients (inequality of service), controlled drug policy, and the capacity of Babylon Health to expand the service. Since the October report, a Babylon spokesperson told Digital Health that “Commissioners have comprehensively signed off our roll-out plan and we look forward to working with them to expand GP at Hand across the country.” 

Re capitation, why ‘GP at hand’ use is tied into a mandatory change of GP practices has left this Editor puzzled. In the US, telemedicine visits, especially the ‘I’ve got the flu and can’t move’ type or to specialists (dermatology) are often (not always) separate from whomever your primary care physician is. Yes, centralizing the records winds up being mostly in the hands of US patients unless the PCP is copied or it is part of a payer/corporate health program, but this may be the only way that virtual visits can be rolled out in any volume. In the UK, is there a workaround where the patient’s electronic record can be accessed by a separate telemedicine doctor?

Another tech head-shaker: 45 percent of GPs want technology-enabled remote working. 48 percent expressed that flexible working and working from home would enable doctors to provide more personalized care. Allowing remote working to support out-of-hours care could not only free up time for thousands of patient appointments but also level out doctor capacity disparities between regions. The survey here of 100 GPs was conducted by a cloud-communications provider, Sesui. Digital Health. This is a special need that isn’t present in the US except in closed systems like the VA, which is finally addressing the problem. The wide use of clinical connectivity apps enables US doctors to split time from hospital to multiple practices–so much so on multiple devices, that app security is a concern. 

Another head-shaker. 48 percent of missed NHS hospital appointments are due to letter-related problems, such as the letter arriving too late (17 percent), not being received (17 percent) or being lost (8 percent). 68 percent prefer to manage their appointments online or via smartphone. This preference has real financial impact as the NHS estimates that 8 million appointments were missed in 2016-2017, at a cost of £1bn. Now this survey of 2,000 adults was sponsored by Healthcare Communications, a provider to 100 NHS trusts with patient communications technology, so there’s a dog in the hunt. However, they developed for Barnsley Hospital NHS Foundation Trust a digital letter technology that is claimed to reduce outpatient postal letters by 40 percent. Considering my dentist sends me three emails plus separate text messages before my twice-yearly exam…. Release (PDF).

Roy Lilley’s daily newsletter today also engages the Tech Question and the “IT desert” present in much of the daily life of the NHS. Trusts are addressing it, junior doctors are WhatsApping, and generally, clinicians are hot-wiring the system in order to get anything done. It is much like the US about five to seven years ago where US HHS had huge HIPAA concerns (more…)

September-Autumn Events: The King’s Fund, Aging2.0 London, Health 2.0 NYC, RSM, ATA

August 29, 2017 | by

Summer is evaporating before our eyes. Fill your calendars to shake off the blues! Here are some events that depending on where you are, should go on it:

At The King’s Fund, London:

Monday 4 September, 5:30-8:30pm: HealthChat with Claire Murdoch and Roy Lilley. Ms. Murdoch is Chief Executive of Central & North West London NHS Trust and NHSE’s new National Mental Health Director. Tickets are £39.95 through Eventbrite here. (Note: this is a private event organized by UK HealthGateway, the publisher of the nhsManagers.net newsletter.)

We thank Roy Lilley for the top-of-the-letter mention of our recent article on telemedicine and retail healthcare. Until today, this Editor was not aware that the NHS was the largest purchaser in the UK of fax machines. Will Sarah Wilkinson’s appointment as the head of NHS Digital change that?)

Friday 6 October, 12.00pm-7.00pm: Ideas that change health care–a festival of ideas to inspire and challenge the future of health care. Free, but tickets are limited. Sponsorships available. More information here. #kfIdeas17

Wednesday 29 – Thursday 30 November, 8.30am – 5.15pm both days: The King’s Fund Annual Conference 2017. Day 1 concentrates on population health, Day 2 on modernizing the health and care system. More information here. #kfAnnual2017

Aging2.0 London at Innovation Warehouse

Thursday 7 September, 6-9pm: Aging2.0 London 2-Pint-0 presents Chris Sawyer from Innovate UK on the Digital Health Technology Catalyst 2017 – Round 1 [TTA 14 Aug]. More information here.

Health 2.0 NYC/MedStartr, midtown NYC

Wednesday 27 September, 6-9pm: Mental Health Innovations 2017. The rising need for and increased scarcity of mental health care calls for new approaches in technology and innovation. The usual lively panel of speakers, company presenters, and engaged audience. More information on their Meetup page here. (more…)

‘We carry on’ this Memorial Day

May 26, 2017 | by

As our Readers and Editors make our getaways for this holiday weekend (on Monday, in the UK the Spring Bank Holiday, in the US Memorial Day), it cannot help be on our minds the terrorist bombing this week killing concertgoers in Manchester and the extreme likelihood of further terror attacks. NHS trauma centers are already on highest alert specifically for this weekend, and there are reports that there may be another or even more devices in the hands of terrorists, ready for further slaughter, based on the remains of the home bomb factory. Here in New York, it is also Fleet Week, where many of our Navy’s and Coast Guard’s ships, along with sailors and Marines, visit the city. There are multiple, well-publicized events all over the metropolitan area. Evidence of increased security is everywhere.

On this US Memorial Day, where we remember and honor our fallen soldiers, sailors, airmen, Marines, Coast Guard, Merchant Marine and civilians in military service, we also include in our thoughts and prayers the innocent Manchester children and adults killed for simply enjoying themselves at a concert. We also remember that there are 18 adults and 14 children still in hospital, and that NHS emergency and trauma staff, under extreme pressure, performed magnificently.

Hundreds, perhaps thousands, of lives are forever changed. What really hits the heart, more so than at Bataclan, are that most of the dead and survivors, are children and adults waiting to take them home. Innocent lives snapped out in a few seconds. Holes in the heart that will never close.

What also hit the heart was Roy Lilley’s Friday newsletter, which says it better and more than this Editor can express. We carry on because we have to, until we can do better. We are pleased to link to it here.

TSA chair selection critiqued

October 23, 2014 | by

Today’s Must Read  Published today in Roy Lilley’s influential NHSManagers.net newsletter (by free subscription, click on link) is Paul Harper’s commentary on the appointment of TSA Chair Andrew Gardner. Mr Harper’s view is informed by considerable experience in the UK health services concentrating on telehealth and telemedicine. His key point is that an ‘independent chair’ should be exactly that. Moreover, standards of public governance should apply (the Nolan Principles of Public Life), as these private companies are largely doing public sector business. Your Editor will let Mr Harper state the rest; a PDF of his article is attached.

In the US, where your Editor is from, it is commonplace to have an association chair from ‘inside the industry’ whether healthcare or in other areas where I’ve worked, (more…)