Wachter NHS IT Review

Carry Out a Thoughtful Long-Term National Engagement Strategy. The Advisory Group believes that a long-term engagement strategy is needed to promote the case for healthcare IT, identify the likely challenges during implementation, educate stakeholders about the opportunities afforded by a digital NHS, and set the stage for long-term engagement of end users and leaders.

A Robust Independent Evaluation of the Programme Should be Supported and Acted Upon. In light of the likelihood of unanticipated consequences, the high cost of digitisation, and the chequered history of past efforts to digitise the secondary care sector, the NHS should commission and help fund independent evaluations of the new IT strategy. Such evaluations should be formative (conducted and reported as the strategy is progressing) and summative (reporting at the end of each of the two phases of deployment). In assessing the benefits and costs of health IT, evaluations should consider the impact of digitsation on the satisfaction of healthcare professionals.

Appoint and Give Appropriate Authority to a National CCIO. In reviewing today's NHS organisational chart and meeting with NHS leaders, we were unable to identify any high-level health IT policymakers who have both clinical training/experience and experience/training in health IT. We believe that such a person – a national CCIO – should be identified to oversee and coordinate NHS clinical digitisation efforts. This will signal that the NHS understands the adaptive nature of this effort to change, that it is serious about clinician engagement when it comes to health IT, and that it is putting a premium on clinical, not simply financial, outcomes. Such a person – who will need to have a background in clinical care, informatics, and leadership – should be given appropriate organisational and budgetary authority.

Develop a workforce of trained clinician-informaticists at the trusts, and give them appropriate resources and authority. We see the absence of professional, well-supported CCIOs with appropriate authority and resources as an enormous obstacle to successful deployment and benefits realisation of health IT at the trust level. Without the availability of high level CCIO jobs in trusts (reporting at the board or CEO level, significant budget and staff, highly respected in the organisation) and a sustainable career track, few talented individuals will choose to leave the full-time practice of clinical medicine, nursing or pharmacy to obtain additional training and certification in informatics.

Strengthen and Grow the CCIO Field, Others Trained in Clinical Care and Informatics, and Health IT Professionals More Generally. Given the importance of the workforce to the success of the overall strategy, we recommend an investment in workforce development of £42 million, one percent of the £4.2 billion currently allocated for health IT.

Allocate the New National Funding to Help Trusts Go Digital and Achieve Maximum Benefit from Digitisation. Given the upfront costs of switching from analog to digital (tens of millions of pounds for a mid-sized trust, still more for a large one), new investments are required to promote digitisation across the secondary care sector. We applaud the DH and the Treasury for making available £4.2 billion (approximately one-third of which is for IT system purchases and implementation support) to promote digitisation. Given the challenging financial state of many trusts, secondary care digitisation would have been impossible without new central resources.

While Some Trusts May Need Time to Prepare to Go Digital, All Trusts Should be Largely Digitised by 2023. It would be reasonable to expect all trusts to have achieved a high degree of digital maturity by 2023. After that year, no more government subsidies should be made available. The Care Quality Commission should implement a plan to assess the digital status of trusts (including digital maturity and use of digitisation to promote care improvement), and to deem those that are not sufficiently digitally mature as out of compliance on quality/safety grounds.

Link National Funding to a Viable Local Implementation/Improvement Plan. The availability of central money to support digitisation should be linked to a parallel investment from each trust, NHS approval of a plan that demonstrates that the trust is adequately prepared to succeed in both digitisation and in promoting regional interoperability, evaluation of progress, and ongoing accountability that the money was well spent.

Organise Local/Regional Learning Networks to Support Implementation and Improvement. To support purchasing, implementation, and ongoing improvements by trusts, digital learning networks should be created or supported. Such networks may vary, with some helping in the early stages (choice of EHR system, contracting, implementation) and others at later stages (optimisation, decision support, analytics). The latter category may include IT supplier-specific networks.

Ensure Interoperability as a Core Characteristic of the NHS Digital Ecosystem – to Promote Clinical Care, Innovation, and Research. The new effort to digitise the NHS should guarantee widespread interoperability. The goals of interoperability are to enable seamless care delivery across traditional organisational boundaries, and to ensure that patients can access all parts of their clinical record and, over time, import information into it. Widespread interoperability will require the development and enforcement of standards, along with penalties for suppliers, trusts, GPs, and others who stand in the way of appropriate data sharing. The system, standards, and interfaces should enable a mixed ecosystem of IT system providers to flourish, with the goal of promoting innovation and avoiding having any one vendor dominate the market. Plans for interoperability should be harmonised with other ongoing efforts to join up elements of the health and social care systems, such as those represented by the Sustainability and Transformation Plans (STPs).