Health secretary Jeremy Hunt has announced that a US “digital doctor” will undertake a review of the digital future of the NHS due to be published next summer.The review will focus on “the critical lessons we need to get right as we move to a digital future,” said Hunt in a speech at a Health Service Journal event on 29 October 2015.
The review will be done by Robert Wachter, who Hunt calls an “expert on the promise and pitfalls of new IT systems”. Wachter is the interim chairman of the Department of Medicine at the University of California, San Francisco, and the author of The Digital Doctor, which looks critically at the rise of healthcare IT systems in the US.
Hunt said the review will be similar to the Berwick review on clinical safety in the NHS, which was undertaken by Don Berwick in 2013.“[Wachter] will guide and inspire us as Don Berwick did on safety, and we look forward to receiving his report next summer,” said Hunt.
The idea for the review came as Hunt, together with NHS England officials – including director of patients and information Tim Kelsey – visited San Francisco in September 2015. Hunt said there has been a vast improvement in digitising records in the US, thanks to President Obama’s Health Information Technology for Economic and Clinical Health Act, but the change has “met huge resistance from doctors because of the extra burden that can reduce contact time with patients”. “For many doctors it feels like screen contact has replaced eye contact,” he said. In his speech, Hunt listed what he called four “elephant traps” the NHS needs to avoid, including bureaucracy.
He quoted a US study which filmed 100 patient visits and found that clinicians spent one-third of their time looking at the screen instead of the patient, and highlighted a US hospital that tried to attract applicants by using the fact that they “had no electronic medical records” as a selling point.
Hunt also said he was aware that “some think the IT system at Addenbrooke’s Hospital helped tip it into special measures”, referring to the action taken at Cambridge University Hospitals NHS Foundation Trust by foundation trust regulator Monitor in September 2015. Monitor is now investigating the trust’s finances and its £200m eHospital programme. “The lesson here must be to ensure that new IT systems improve rather than reduce clinician productivity – so that it helps rather than hinders them in their jobs,” Hunt said.
According to Hunt, the second trap is accountability. He highlighted the patient safety failings at University Hospitals of Morecambe Bay NHS Foundation Trust and the Mid Staffs scandal. “One of the best reasons for investing in digital records is to allow communication between multi-disciplinary teams in different organisations for patients with complex needs,” he said. “But by making cross-team and cross-agency working easier, there is also a risk that accountability to the patient is blurred.”
The third and fourth traps mentioned by Hunt were costs, where he mentioned Connecting for Health, which cost billions and “came to virtually nothing in our biggest ever IT disaster”, and data security. The Care Quality Commission is currently undertaking a review of standards of data security across the NHS, which will be completed by January 2016.
“We haven’t always got [IT implementations] right, especially when it has interfered with, rather than enhanced, the relationship between doctor and patient,” said Hunt.