Technology
Calls for a fresh take on digital transformation
IT system failures have been linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital Trusts in England. Gary Day discusses the way forward for the digitisation of patient data and warns that getting this right is essential to meet the NHS’s challenges, both now and in the future.
Documents and records may not be associated with cutting-edge technology, but they are at the core of digital transformation in the NHS. After faltering moves to digitise NHS medical records, the focus is very much on the challenges of legacy IT and the introduction of flexible approaches that deliver more advanced document management for a network of organisations employing 1.7 million people. Document management needs to transform itself in the short term while the NHS undergoes further reorganisation or adapts to new targets and priorities after a change in government. The task is daunting for any organisation, but especially for a loose confederation that treats more than a million people every day. Medical records number in their millions and have their own code of practice1
which
emphasises their centrality to care delivery. Records are governed by strict legal frameworks, and after the Caldicott Principles and inquiries such as Mid Staffs and Infected Blood, nobody should doubt their importance. Any widescale improvement in care delivery depends on the seamless transfer of data in documents, including the operation of England’s 42 integrated care systems. It is not just about medical records. The volume of documentation is vast just to keep NHS organisations running. Most of the many millions of patient-contacts in the NHS every week require communication in advance, data entry and communication of results. On a huge scale, NHS administration includes all the tasks of procurement, facilities management along with the organisation, remuneration and welfare of one of the world’s largest workforces.
Legacy IT is a significant barrier It’s no secret the NHS is struggling with demand and resources. With finances tight, IT often loses out to frontline care. Medical inflation is again outstripping the rate in the wider economy. The CPI UK health inflation rate was 6.2 per cent in May 2024,2
for example, compared with two
per cent in the broader economy.3
The Health
Foundation says NHS England’s £164bn budget for 2024-2025 is effectively one per cent lower than the previous year because of a growing and ageing population.4
It remains to be seen
what immediate impact the new government will have on budgets. Several challenges arise from this. The first is the reliance on legacy systems that have been in situ for a long time and that were often created for one purpose. This causes multiple pain points. Efficiency is inhibited, innovation in treatment and working patterns is capped, and patient data is at risk from inadvertent breaches by staff, and from the activities of cyber criminals. In addition, the reliance on legacy tech piles extra work on back-office staff and makes it difficult to retrieve information quickly when required. A freedom of information request by the BBC5 found IT system failures linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital Trusts in England. Approximately 200,000 medical letters were not sent by 21 Trusts because of widespread computer problems and nearly half of the hospitals with electronic patient systems reported problems that could affect patients. More than 400,000 letters were lost in computer
systems at hospitals in Nottingham. What’s more, the BBC highlights the case of a man with sickle cell disease and cerebral palsy died from pneumonia in hospital after his personal care plan was not easily visible. Cyber threats and data privacy are major concerns. The danger of patient information being deleted or encrypted by cyber-attackers, including ransomware gangs, is high on the list of concerns. This is particularly so in the aftermath of the attack on the Synnovis6 pathology services provider which caused widespread and lasting problems for care provision in South London. Many commentators, the former head of the National Cyber Security Centre among them, said the attack was more proof that the NHS has outdated IT.
Digitisation must not be a ‘nice to have’ Digitisation of patient data and workflows is essential to meet these challenges, enabling the NHS to do more with less while preparing the ground for advanced AI-driven applications and more highly integrated, patient-focused care. Swift and secure information exchange between clinicians, patients, pharmacists, pathologists and everyone legitimately involved in care
February 2025 I
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