The NHS at 70. How informed are we?

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The UK national health service has reached its 70th birthday. There is, in my view, no better national health care system when it comes to achieving its goal of providing universal healthcare irrespective of one’s ability to pay.

When the NHS started, our information system was the Lloyd George envelope. Today, in the NHS we make use of some of the latest modern technology, including latest information technology. We hear about how artificial intelligence is going to help us address the ever increasing challenge of meeting the needs of an ageing population. During a recent patient episode, And MRI scan was considered a routine part of my care at my local district Hospital.

So how are we to judge the use of technology to provide the best information to support the best clinical decisions in the modern NHS? The value of IT to the NHS, is not based on having the sexiest technology, but rather its impact on the quality of information provided, the decisions which can be made on that basis, and the quality of outcomes for patients.

In another recent patient episode I visited my GP, my local hospital, and a local urgent care centre. In each facility, I found computerised records. However, none of my clinicians routinely had access to each other’s contributions to what is after all my patient record. Whilst visiting the hospital, I was struck that even now we are still transmitting critical information around hospitals on paper in folders transported on trolleys which could do service in my local supermarket.

There is an irony for me that the current hottest topic in health informatics appears to be artificial intelligence. Back in the 1980s when I started my academic career, as part of my PhD, I evaluated the AI technologies of the time. It came as a great surprise to many that such systems could be trained as expert systems capable of apparently reproducing the expertise of human experts, whilst failing at tasks which most human being is would regard as elementary.

This appears to me to be a wonderful parable for the NHS in 2018. They apparently complex task of machine diagnosis or interpretation of complex digital images is well developed. The apparently simple task of sharing the most basic clinical record data between clinicians involved in the care of the same patient in different parts of the NHS remains one of our most significant challenges.

It has long been a principle of effective information management that the information systems of organisations reflect the strengths and weaknesses of the organisations they serve. In spite of the appropriate celebration of the achievements of the national health service that it 70th anniversary, it hides the truth that the most elementary episode of care is made up of interactions with several organisations that are not well integrated, and often those organisations are often subject to perverse incentives which discourage better joined up care.

In other words we need to ask the question, “Is care not joined up because we don’t have the systems to communicate effectively,or do the systems not communicate effectively because care is not joined up?” As always, the answer is not simple and the truth lies somewhere in between. However, I can’t help feeling that if the problem was an entirely technological one, we would have solved it by now.

One of the great achievements of Informatics in the NHS is the primary care electronic record. One of the major facilitators of this achievement was the principle that every patient was registered first with an individual doctor, and later with their practice. This apparently simple feature of the NHS is in my view the largest contributory factor to the successful development of electronic primary care records, which have always been clinically valuable, whilst not particularly technologically sophisticated.

Moving forward, I sincerely hope that information and Informatics can continue to make a valuable contribution to our national health service. I also hope that those making decisions about how our services are structured, managed and incentivised recognise that their decisions will play have a significant role in how much we can use better technology to improve patient care


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