The NHS recently turned 70. Or did it? In a modern digital sense, I’d argue the NHS is only 40.
It’s barely a year since the Wannacry hack left the NHS’s computer system on its knees, with staff locked out of critical patient data. The attack made headlines and put patient safety needlessly in jeopardy. That’s because while this particular ransomware attack did affect several large organisations globally, it could have been prevented by using modern computing systems and basic IT principles. This is the fundamental weakness of the NHS’s digital infrastructure: our approach has been archaic so far when it comes to storing, protecting and retrieving people’s data. You need only look at the electronic health records (EHRs) project – the most disastrous IT project in history – to see that this is the case. But as the NHS’s day-to-day service involves saving lives, the stakes are especially high here.
The answer to this crisis in infrastructure is to adopt a digital-first mind-set. For instance, if the NHS continues to accept handwritten records, it’s never going to truly embrace a ‘digital revolution’. Yes, this will entail changing how busy practitioners work, but adapting to change and harnessing technology brings massive benefits and efficiency gains with it, including improving knowledge sharing between practitioners and optimising research in the long-run. All of this helps patients.
What we need for our NHS is a digital transformation project on an unprecedented scale. But we can’t jump in and deliver high-level transformation from the beginning. If there’s one lesson I’ve learned working on digital transformation in the healthcare and pharmaceutical sector, it’s that the less appealing baby-steps are the most vital steps you need to develop so you can achieve Utopian levels of technological perfection.
The Americans provide a good example of how we could do this. The pharmaceutical industry in the US is next in line for massive disruption – retail behemoth Amazon’s recent acquisition of online pharmacy PillPack shows this. Similar deals – and the rise of direct-to-consumer start-ups like Hims – really shine a light on the juxtaposition in protocol for consumers getting hold of prescription drugs and where the NHS could sit.
The relationship between medical and pharma is a complex one, but there is no reason we couldn’t use technology to create this seamless prescription collection model. One Drop is a diabetes management platform that harnesses the power of mobile computing and data science to empower people with diabetes to live healthier lives. Imagine if every illness could be managed through an app that offered treatment suggestions to patients and informed doctors, all whilst keeping a tab on prescribed drugs?
At the 3rd Annual Patient Engagement and Experience Conference this year, chair Søren Skovlund highlighted that patients cannot make informed decisions about medicines due to a lack of value-based, real-world evidence. For me, this was telling. Knowledge is power, and UK consumers and patients should be able to Google the drugs they are prescribed.
If patients had the ability to find tailored information online, then this would help back up their doctor's opinion and create a closer bond of trust that could aid in the recovery process. It would be a valuable resource for GPs as well. I very much see this as a simple first step to digital success. The current NHS websites are passable, but information on pharmaceutical options is limited and many links on Google point to US specific microsites.
Another area that’s ripe for improvement would involve linking an individual’s drugs consumption to their NHS medical records. This would be a dream come true for patients and pharmacies alike. Imagine being able to view what drugs you took to fight an illness and which pharmacy you ordered them from. Due to how backwards the setup currently is, different hospitals and trusts run completely different systems to manage patient data – completely disconnected from pharmaceutical systems – so when a patient comes into a pharmacy, they need analogue prescriptions on a piece of paper.
However, a decentralised blockchain platform (for EHRs) could cryptographically verify every single patient medical record and prescription given to them. Every interaction on the patient file could then be accessed by GPs, the patients themselves, emergency services, and even shared with other relevant parties anonymously when needed. This would create closer alignment between healthcare providers, emergency services, pharmaceutical companies, and other bodies in the network. Patients could also control their EHRs and grant access to research bodies and other providers. They could view, export and even take their data with them when they travel or move overseas, although the success of such a pipe dream would be dependent on other countries adopting the same standards.
Some progress on digital transformation has already begun. One parliamentary whitepaper outlined a vision for making patients’ records ‘largely paperless’ by 2020, with EHRs containing information about patients’ histories, health and lifestyles. Despite being published in 2016, I cannot see how this will materialise in 18 months from now. But it isn’t for a lack of trying. Google’s DeepMind is exploring ‘a new technology to let hospitals, the NHS and eventually even patients track what happens to personal data in real-time’. However, with DeepMind’s commercial interests and agenda under review in this post-GDPR world, I am not convinced they will be the ones who will develop the exclusive solution that is needed.
The major obstacle to all of this is that the Wannacry attack and post-GDPR atmosphere means people are increasingly wary about how we use their data. The frustration from a digital perspective is that the advanced digitisation of data must come with improved security systems that would make future breaches less likely. As such, there needs to be a real education piece from the healthcare sector to inform and assure people that their data is safe (online and offline) and being used responsibly to benefit them. Picture the benefits we could derive from such an education programme. Following a shift in attitudes and greater data sharing, patients could reap boundless rewards. For instance, cardiologists could assess the probability of heart attacks in patients based on (anonymised) data insights around factors like diet and exercise routines as per their health records. Likewise, if there is an unusually high number of other people in the same area with similar health issues, the local council could use this information to improve local health by making informed policy decisions, such as building a leisure centre. Basic access to a range of data can facilitate scenarios like these, but people just aren’t aware that this is a possibility.
The challenges ahead of us are huge, but we can only build an advanced healthcare system by completely rebuilding the foundations of this sector’s digital infrastructure. It might be a tough pill to swallow, but it’s vital for making sure society and the healthcare industry are on board and that we rebuild trust. There is hope we can achieve this for our NHS and the pharmaceutical sector: Matt Hancock announced in July 2018 that £500 million is now going to be invested in the NHS’s digital transformation. But it’s up to us to convince government and practitioners alike that knowledge and data will empower everyone. Once people realise this, those long queues at the pharmacy could be a thing of the past. We'll start to see real change.
Danny Bluestone is founder and CEO of Cyber-Duck. Cyber-Duck is an award-winning digital transformation agency based in Hertfordshire and London. Our Ducks deliver user-centred digital transformation for clients like the Bank of England, Mitsubishi Electric and Cancer Research.