Q
How is what you’re doing at AbedGraham contributing to your overall belief of how technology can foster substantial and everlasting change for the NHS?
One of the unique aspects of my work is I am fortunate to work closely with healthcare IT vendors as well as NHS organizations. Working with enterprise vendors and developing their understanding of the needs of the NHS at the policy, clinical, and operational levels is driving more effective engagements on the frontline. Technology deployments are streamlined, stakeholders engaged, and benefits realized as a consequence. This is mirrored by our strategic work with providers, ensuring they have robust approaches to their IT futures and are assessing which IT solutions they need to achieve success. By taking a long term rather than short term approach to our engagements at AbedGraham, I have become very confident about the role information technology can play to secure the quality of our healthcare system regardless of any reorganization it faces.
Q
As a physician, you understand the challenges for the NHS from a clinical perspective. Here in the US, physician buy-in has been a major hurdle for HIT adoption. Greater obligations and reductions in staffing, are putting strain on physicians. I imagine the same is true for the NHS, although the financial obligations are different. With that in mind, how is your company trying to shape and shift technology to meet those clinical demands?
At AbedGraham, we took the decision early to be an exclusively clinically based team, because we wanted to harness the skepticism and cynicism that clinicians often have regarding technology. We see it as a strength. As a consultancy, we work closely with vendors to make sure they have a granular understanding of the challenges clinicians’ face, especially in terms of workflow. We spend a lot of time in clinical settings observing process pain-points and workflow bottlenecks, as well as engaging clinical staff during IT projects. By bringing these insights to our clients, their sales, strategy, marketing and deployment teams all start to see the bigger picture, and instead of pitching products, we actually work more closely with providers to deliver solutions and outcomes.
Q
With its current financial flaws, it seems like the NHS is moving more towards privatization. Meanwhile the US is moving closer to the public model. If that’s the case, both the NHS and US healthcare system seem like two ships passing in the night; both searching refuge in the other’s flailing system. If we have failed with privatization and the NHS is struggling with its public model, what is the right answer? Can HIT play a part in solving these problems across the board? What other aspects need to remedy the situation?
I think it’s important to understand that the NHS and US healthcare model are wildly different. Privatization per se is not happening in the NHS in a manner that could be considered comparable to the US, as it’s primarily an outsourcing exercise where it does happen. The NHS is likely to always be free at the point of care. I think an important question to consider within both models though does relate to healthcare IT and innovations that stem from it. Who should pay for it? For example, telemedicine services could fundamentally change the way we think about service delivery. Should patients pay? Perhaps the government? Or in the case of the US, insurers. If anything, I think healthcare IT will accelerate the debates on both sides of the Atlantic as patient communities demand more from healthcare and how it’s delivered in the 21st century.
Q
So when it comes to HIT for the NHS, are the challenges largely the same as what we are facing in the US, such as interoperability and patient engagement? Or are there major differences there?
Interoperability is definitely a major theme here too, and a lack of it impacts patient and clinician engagement with IT. In fact, I would say it might even be a bigger challenge than the US because hospital systems here have hundreds of applications on the go at a time and have adopted best of breed IT strategies in most cases rather than committing to a single vendor. Add to that the fact that different parts of the NHS vary wildly in their digital maturity, and you can see why data silos exist. I think that is mirrored to an extent too in the US, but the NHS does not yet have a strict or enforced punitive policy system yet to drive digitization, although steps are being taken in that direction. Similarly to the US, we also need the vendor community to become more cooperative as a whole and with the government to develop and comply with interoperability standards in order to support the benefits of it at scale.
Q
In the US, the long-term goal is to diminish major financial spending with sophisticated models of population health management (PHM), largely facilitated by telemedicine, personal monitoring devices, etc. At least that’s the optimal directive. Is the NHS shooting for the same kind of optimal healthcare delivery environment? What’s the ideal healthcare delivery model look like for the NHS? What’s the consensus from the aging population in England buying into the technology that’s hit healthcare?
In the UK we are developing new models of care with a focus on integrated or joined up care extending from social care through to the acute setting. We have local healthcare economies working together as ‘vanguard’ sites to drive these through. I think technology like telemedicine absolutely has a place in this and will become more prevalent. Is there an ideal healthcare model though? I don’t think so. I think instead it’s about local health systems becoming more engaged with their communities and tailoring what suits them best. In terms of patients paying for technology, I think we’re still quite far away. There are very engaged patient communities such as diabetes patients, but for the vast majority, the lack of interoperability makes it very difficult to buy a true clinical IT device (as opposed to fitness and wellness products) and then derive any benefits from it when it can’t be validated or leveraged by their clinicians.
Q
With all of the challenges it faces, how is the NHS going to survive? Is it all bad news ahead, or do you think the developments in HIT can largely contribute to fostering meaningful change for the NHS?
I don’t think it is all bad news at all. We continue to deliver world-class, innovative care, and I think that will be the case moving forward. There are significant areas of improvement to be had too though, especially in care of the elderly and funding for mental health and the community. With the financial climate, I think spending on more manpower isn’t going to be practical and so we need to find new ways to deliver care. The increasingly digitized, and in the future, interoperable IT platforms should support the delivery of these new care models so we can continue to deliver excellent services for our patients.
Q
Good or bad, do you think the NHS and American healthcare system will closely reflect each other when it comes to how it functions and delivers healthcare to its future populations? Who do you think will come out on top? What will be its biggest hurdles? What could lead them to success?
I generally see little value in comparing healthcare systems in a way the pits them against each other. There isn’t really a ‘who’s best’ scenario as outcomes vary in a number areas. The real exercise is in what we can learn from each other? Both systems have their merits but both face very similar struggles too and particularly when it comes to healthcare IT. The single biggest challenge for both, I feel, will be securing clinical support for new models of care and the adoption of innovative solutions at scale. To do that we need to engage clinicians at the earliest stages of thinking, because they still continue to be the primary end-users of new processes and systems. If we can work hard to keep clinicians on our side, then they will be our champions and drive engagement through to patient communities, too. The end result? More efficient and effective healthcare services.
Q
Given all we have discussed here, what do you think is the most important message to leave our readers with when it comes to HIT and its role in NHS and American healthcare reform?
We’re all in this together. We have differences but many similarities and can learn a lot from each other. Above all, never forgot, it’s not about the technology. It’s really all about people. How we engage, inspire and align with each other will determine how successful we are as both our healthcare systems evolve, especially when it comes to using more healthcare IT solutions.
