Encouraging Collaborative Progress in Healthcare Digitisation

NHS England, Integrated Care Systems (ICSs), and individual Trusts are making significant strides in digitisation and the use of resulting data which will deliver improved outcomes and efficiency in patient care. However, various challenges remain, hindering the speed and size of return on investment on digitisation and healthcare data management. In this newsletter, we aim to explore where increased collaboration and coordination and additional design recommendations can overcome these challenges.

Culture at the Core

NHS England's approach involves empowering Integrated Care Systems (ICSs) to make decisions on how data benefits their populations. Given the disparities in numbers and characteristics of ICS populations, it makes sense for ICSs to decide the weighting of services on offer and how and where they are offered via 'places'.  But should ICSs also be accountable for designing the infrastructure required to provide them the insight to make these decisions? 

We believe there are significant economies of scale in the centrally coordinated design of data mechanisms to capture, store and use data to provide the ICSs and their component organisations the valuable intelligence and digital capabilities. The data infrastructure needed to assess demand and supply across a region and to automate administrative tasks is common.  And there is a role for the national coordination of the designs for these data solutions to accelerate their rollout across a data workforce with different capacities and levels of skill.  We are certainly not suggesting that the only optimal architectural design or code is centrally designed; what we are saying is that there is a role to scour our ICS and Trust teams for best-in-class designs or solutions, catalogue and assess them and then communicate their existence or enhance and then share them for the benefit of all ICSs and Trusts.

Our reasoning is that, within the implementation of BI artefacts such as ETL scripts or data architectures, there is a significant cost to suboptimal design through time wasted for scripts to run, datasets which are not analyst ready causing the NHS analyst cadre to invest a lot of time writing unnecessarily complex or future excessive consumption of cloud processing resources.  Examples of the root causes of these, incorrect implementations of fact and dimension theory, inefficient coding structures, lack of engineering principles are present in almost every Trust and ICS because of the long acknowledged generally weak skills in data engineering.

Considering the current landscape

The cost of poor design is the greater given the fact that a significant number of NHS Trusts are expected to undergo the migration, archiving, and EPR implementation phase before March 2025. Each Trust, ICS and Trust and ICS relationship will be going through similar processes of maturing during this period.

In addition, based on recent surveys, whilst certain Trusts with seven different providers as well as those who have developed their own solutions have assessed themselves as achieving level 5 or higher on the HIMMS EMRAM scale, many Trusts using the same systems have not yet reached HIMMS EMRAM level 5. Whilst some of this difference will be down to implementation and culture, some will be attributable to a need to extend and optimise their EPRs; there is a lot of development needed at these Trusts as well.

These facts suggest that a more nuanced approach to design culture could potentially result in significant cost savings for NHS England, all the more welcome in the broader context of the recent reduction in the multi-year budget for the frontline digitisation program as reported by the Infrastructure and Projects Authority (IPA). Exploring strategies that optimise cost efficiency becomes crucial.

For instance, where there are many individual Trusts and ICSs currently writing business cases for system upgrades (in particular EPR), perhaps it is time to consider how this funding process can be more closely guided, encouraging and facilitating cross ICS/Trust collaboration and accelerating the completion of lower cost business cases. There are significant savings from supporting the provision of detailed plans for improvement required at all the above ICSs and Trusts.

Or where there are clearly differences in HIMMS EMRAM level where the same EPR system is being used, perhaps an analysis of differing sets of functionality, configurations or implementations would identify quick wins for improvement through the sharing of best practice, report formats, automation capabilities. In this way, the acknowledged variation in EPR maturity levels across Trusts could be closed with minimal duplication of effort.