Thursday, October 26, 2017

Going Digital



You know what…when I was in medical school, the word "digital" tended to be associated with "doing a digital examination"- so hope you excuse the Beavis/Butthead humour when i tend to have the urge to crack a smile whenever i hear the word the NHS is about to go…Digital. It never ceases to amuse me…sorry I know I am in my 40s…it shouldn't but it does. Anyway, beyond that, its all the fad nowadays, isn't it? We are all going digital- and that indeed is the next holy grail for us to chase.

But what does it actually mean? Does digital mean upgrading our fax referrals to emails or is it about using Artificial Intelligence, GoogleGlass etc to advance healthcare? Or is it a bit of both? I suspect this is where the NHS as ever comes unstuck. It has, suddenly- and quite rightly developed an urge to modernise with the times. It has all around it folks using Apps, WhatsApp, different communication strategies, use of cloud…heck, we all in our day to day lives have adapted technology as an ever present companion- yet come to work- and you wait..sipping your coffee, drumming your fingers…as the PC loads up- wakes up slowly but surely.
And this is where the struggle begins. On one end, we have the digital champions (No- I am NOT laughing) driving the uptake of innovation, trying to get the NHS up to the present century, while down in the basement, the fax machine whirrs into action yet another day. We have the most amazing dichotomy where any transfer of informatics have governance all over it like hawks- yet somehow sending letters through the post is ok. We have Skype frowned on as someone may hack the feed, yet its ok to discuss private matters on a ward with the curtain drawn- ah those amazing sound proof curtains. It feels as if the NHS is a vehicle let loose on a racing track- yet alas with still the engine of a Rover.

Amongst all that are 3 different levels of issues- firstly- the public and understandably an inherent sense of mistrust with continuous data flow and uptake. Care.Uk - and subsequently DeepMind have had their issues- and not unexpectedly, the public is not so keen to share their data with all- in some cloud. The conspiracy theories also don't help- but in the most, I suspect this one is a battle for hearts, minds and overall trust before we get informatics flowing seamlessly. The public has to trust the NHS to handle their data better- they seem to trust their banks more at the moment.
The second one is the myriad of providers, IT companies and their rules created. Let me cut through all the mumbo-jumbo and let me distill it down to simple english.
When I see a patient, why on earth, in 2017, can me and my GP colleague not share the same system to have notes? Not be able to entry our bits in the same system? I mean- thats just utterly bonkers, isn't it? Both professionals- caring for the same person- yet on different systems which don't talk to each other. What. The. Actual. Flip.
Finally, its that holy grail of "evidence". How on earth you do randomised controlled trials on digital technology -I have no idea. I mean, the pace at which technology moves, the NHS would have just completed RCTs on beta max by now- while we all were enjoying blue ray. The argument continues- let me give you one specific example. Structured education- ask any patient- they would welcome its presence. Do we have it yet? No. Why? Cos..evidence- or so says the professionals. Problem? As per national data- the uptake rate of the face to face ones- however amazing and evidence based it is? Well, its not very encouraging-lets just put it that way.

Fascinating, isn't it? The issue is whether the NHS can marry those 2 distant poles- one about faxing referrals, the other incorporating AI into insulin algorithms. I suspect the answer is yes- but it certainly needs both tackling, not just one. There is a need to modernise, there is also a need to keep pace.
Can we do it? Time will tell. The NHS has a blistering history with IT- of making a pigs ear of it. I could bore you with what we are up to in diabetes in NHS England- but won't for now- thats another story-for another day. But for now? Just let me and primary care be on one system- so that the patient in the middle isn't there wondering how amazingly amateurish we all are.

Convince me that's possible -seamlessly across the country- and who knows- we may boldly go where the NHS has never been before.




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