At the eHealthWeek2016 event at Olympia yesterday, our Partner, Jonathan Edwards presented thinking on ways of getting Boards on board with digitally-enabled population health management and personalised care.
The IT Health Partnership can help you with all aspects of this challenge. Our people have had careers as CIOs, policymakers, clinicians, research leaders, and supplier executives. We provide consultancy services across the transformation lifecycle — with our portfolio of best practice tools we can help you define a vision and objectives, build a business case, set up a change programme, manage and deliver it, and achieve the benefits.
Read Jonathan’s presentation slides here:Edwards IT Health presentation 19 April 2016
Radical change in health systems around the world, including here in England. The Five Year Forward View identified 3 fundamental gaps in the NHS: care quality, finance and efficiency, and health and wellbeing. Population health management is seen as the most likely solution.
What is population health management? We can define it as the proactive and personalised care of patients in the setting that is the most clinically-appropriate and resource-appropriate. It will require a shift of focus from the treatment of sickness to the prevention of illness.
The 44 Sustainability and Transformation Plans are intended to move the NHS to population health management at a regional level. This won’t be easy because of perverse financial incentives in place today [for example, in an activity-based model, why should an acute trust want to reduce inpatient admissions?] For any real progress to be made, the perverse incentives will need to be fixed. Looking now at what’s happening in your worlds as IT leaders today.
The whole NHS has been asked to create Local Digital Roadmaps. 85 of them are being created across England by the end of June. By now, many of you will have made good progress with your Local Digital Roadmaps. As you finish them, there are two questions you will need to answer. Firstly, how will IT enable the achievement of your region’s STP in this new world of population health? Second, how can you use the work you’re doing on your Local Digital Roadmaps to engage board executives so they change their approach to IT?
How will IT enable STPs? – We have devised a simple model that identifies the main features of population health management, the new capabilities needed, and how IT can support this. (See slide deck). The elements in the right-hand column are things that you really should consider as part of your local digital roadmaps, and hopefully this model shows you how these elements fit into the bigger picture of population health.
How to engage boards? – Many NHS organisations are still not well equipped to gain full benefit from IT. This is so important because the Five Year Forward View cannot succeed without IT. You can’t do population health management on paper. What’s more, these days IT is all-pervasive. It has become core to everything we do in healthcare. And because every strategic initiative in healthcare is now dependent on IT, the stakes have got a lot higher and the impact of failure is far more severe than ever before.
But many boards haven’t yet grasped this new reality. Many still view IT as a back-office function. And even for those that do see IT as strategically important, they are often confused about how to get value from IT. For boards to feel confident about getting benefits from IT, you will need to give them a clear picture of the payback, whether it’s to do with financial savings or other metrics such as quality and patient satisfaction. And because you can’t get a benefit without a change in behaviour, you’ll need to educate the board members about what they need to personally do differently.
So this is why we would urge you to see the Local Digital Roadmaps as a great opportunity to push your boards in the right direction.
Key messages – IT Health Six pack: messages for boards
1.Turn IT into an enabler of NHS strategy
IT needs to gain a higher status. For this, you need three things. Strong IT governance, meaning that the people with appropriate authority and knowledge are taking the decisions that involve IT. You need an IT strategy that demonstrates a deep understanding of the organisation’s priorities and that explains clearly how IT addresses them. And you need an IT delivery team that is efficient, effective and adequately resourced. All these three things require the support of the board.
2.Advocate ongoing investment in IT infrastructure
Most NHS organisations have inadequate infrastructure, but with the increasing reliance we are placing on IT, what is merely inadequate today will rapidly become dangerous — a real threat to patient safety. Up-to-date hardware, networks, and operating systems need to be treated like essential utilities, and therefore having to make a business case for them makes about as much sense as making a business case for clean tap water. And what’s more, we need to move the way infrastructure is funded from our typical model of one-off capital purchases to a programme of continual ongoing investment.
3. Put benefits realisation at the heart of systems implementations
For years we’ve been hearing policymakers bang on about “going paperless”. Eliminating paper has no inherent value. In fact, it can be counterproductive if all you’re doing is automating bad processes. The true value of systems like the EPR is not to replace paper but to achieve benefits such as quality and efficiency. And you’re not going to get those benefits with a technically focused implementation. That’s because most EPR benefits come not from the system itself; they come from changes in behaviour that are enabled by the system. And it’s the CEO and the board that need to push for those behaviour changes.
4. Accelerate interoperability to support population health management
When you look at the technical side of interoperability, there has been great progress in getting systems to talk to each other. We’re seeing new approaches like FHIR, Mirth and openEHR, as well as some strong offerings from EPR suppliers and clinical portal suppliers. But there are some big stumbling blocks still, and they aren’t about technology. They are to do with 1. IG – sharing patient data — it seems that each regional group has to come up with its own data sharing agreement — why can’t we just agree on a standard one? and 2. utilisation — a clinical portal is only as good as the usage it gets. Clinicians really only want one system to enter and look up patient data. If they have to already work with an EPR, are they really going to want to consult a portal as well?
5. Build a culture of data-driven decision-making
To get benefits from clinical systems, you’ll need to use the data from the systems to generate insights that help your organisations provide better care. There is plenty of excitement about this, and a lot of the population health initiatives include predictive analytics tools. But before rushing to buy software, there are a few things that need fixing first, and this is where you need the CEO and the board to step in. Data quality in most of the NHS is pretty bad, because it’s never been prioritised. It’s going to take a while to fix this. The move to predictive analytics will require new skill sets, which won’t be easy or cheap to find. Above all, NHS organisations will need the cultural mindset to do data-driven decision-making, which means that you follow what the data says even when it tells you what you don’t want to hear. Other industries like retail and manufacturing have gone through this shift in mindset, and it requires leadership right from the top.
6. Support patient engagement with new ways of working
It’s great that the NHS is so excited about the one hitherto untapped resource that can make a huge difference to achieving the goals of the Five-Year Forward View — patients themselves. But many NHS organisations are in danger of running before they can walk – of rushing to deploy patient portals and apps without the ability to feed them with the right data, and without the infrastructure and policies to ensure that they work well and are used appropriately. It will be essential to get clinicians to commit to the new ways of working that will be required, which involves boring things that clinicians don’t like, such as training, policies, administrative support. Again, board leadership will be critical here.