NHS leaders must re-evaluate their approach to digital transformation and address crumbling IT infrastructure and poor user experiences, say experts at Imperial College London.
Intensive Care Doctor & Data Scientist Joe Zhang and colleagues point to system outages at large NHS hospital trusts and warn increasing digital transformation “means such failures are no longer mere inconvenience but fundamentally affect our ability to deliver safe and effective care”.
Zhang - who also holds a Wellcome Trust research fellowship in informatics and artificial intelligence at Imperial College - argues investment in IT infrastructure, including computers, servers, and networks, is rarely prioritised and can be seen as a cost to keep down rather than an investment that increases productivity.
A recent survey of NHS clinicians commissioned by NHS England shows that user experiences of electronic health records are generally poor, a result of unreliable technology.
Guy’s and St Thomas’ NHS Foundation Trust experienced significant problems with its IT systems following the extreme temperatures earlier this year. The Trust’s Chief Executive, Professor Ian Abbs, apologised at the time.
“My executive colleagues and I want to extend a heartfelt apology to all those who have been affected by the extremely serious IT problems that we have been experiencing,” he said. “That apology is to our patients, their families and our local communities for the impact this incident may have had on their care; and also to our colleagues, for the significant impact that this has had on their ability to deliver the high-quality care to which we always aspire.”
Outdated tech infrastructure is a risk to data security
The British Medical Association (BMA) estimates 27 per cent of NHS clinicians lose over four hours a week through inefficient IT systems, say the Imperial College researchers. The BMA report also found deficiencies in investment and a lack of clinician engagement in procurement, say the researchers.
Outdated infrastructure is also a risk to data security, and it is unclear how many providers conform to national guidance by keeping multiple data back-ups, including those held ‘off site.’ There is also a growing disconnect between government messaging promoting a digital future for healthcare - including artificial intelligence - and the frontline experience of clinical staff coping with ongoing IT problems each day.
“This digital future will not materialise without closer attention to crumbling IT infrastructure and poor user experiences,” say Imperial College researchers.
The NHS can learn from approaches taken elsewhere, they say. In the United States, the effect of health technology on end users is an active area of research, particularly on how the functionality of IT systems affects clinician burnout and effectiveness. Oversight of healthcare IT infrastructure at the federal level can identify problems and coordinate a response, they suggest.
“We need to include systematic and transparent measurement of IT capabilities and functionality at the level of clinicians – the people actually using the systems,” researchers explain.
Quality improvement cycles must become routine in IT governance, as they are in clinical care, and government must provide the investment needed to identify and rectify poor performance but also demand accountability, with minimum standards for IT function and stability, they add.
“We must not tolerate problems with IT infrastructure as normal,” they conclude. “Poorly functioning IT systems are a clear and present threat to patient safety that also limit the potential for future transformative investment in healthcare. Urgent improvement is an NHS priority.”
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