Governance challenges for digital health – Digital has impacted massively on industries globally; bridging information gaps, improving services, and disrupting existing practises. Consumer expectations have accelerated rapidly, wanting more, newer, personalised – and faster. While the benefits of digital growth and rapid technological advancement have been wide and substantial – with much more to come – to have its associated challenges, especially in the health sector.
Public concerns and reaction from the Information Commissioner over the appropriate use of data by Deepmind Health and The Royal Free hospital during the development of an app that is already improving care and efficiency is just one example of how the past has not caught up with the future. The increasing growth in apps that connect patients directly to GPs – avoiding trips and time on the physical estate – is another.
In this article, we examine six key areas where digital factors impact on the healthcare sector:
- Digital literacy & skills
- Cultural change
- Public trust
- Mobile apps
Most NHS healthcare in the UK suffers from computer software becoming outdated and inefficient, with hundreds of different platforms being used. This vast scale and the complex interplay between people, process, organisational structure and geography, all make it particularly vulnerable. Closer working between the NHS and local authorities – the key to the delivery of Sustainability and Transformation Plans – and moves towards accountable care systems, also increase the importance of sharing data across multiple organisations and teams.
The hospital sector has been slow to computerise. Indeed, there are different levels of digital maturity throughout the sector, from cutting-edge apps delivering personalised service to their users, right through to smaller, more remote health service centres. Each requires up-to-date software to function and, most crucially, they must be integrated in such a way that necessary information flows can happen without interruption.
For example, e-prescriptions limit the need to take risk judgments on a patient’s dosages or types of medication, by enabling quick access to clear and complete data.
Collecting and connecting vital data and ensuring all interactional information is available across the system when needed are two key components that will improve outcomes and reduce the pressure on professionals who spend too much time trying to fill the gaps.
Agreeing on a common approach to the way different parts work together will drive service delivery improvement and innovation; the efficient electronic sharing of clinical information at the point of care across geographies is a crucial component of this. The trick will be to not compromise information security in the process.
The WannaCry virus that hit the NHS particularly hard earlier this year should serve as a wakeup call for security teams to quickly strengthen their security systems. The ransomware used for this attack was not sophisticated, yet the security in place was inadequate in too many places.
Cybersecurity is not just about systems, it’s about process and understanding. In healthcare, when dealing with confidential, patient-related data, there can be no compromise on the security of digital information. Proper risk management is lacking, and the essential direction from the government is missing. Whilst well intentioned, the NHS information Governance Toolkit is a collection of soundbites that highlight legal requirements without full consideration of the technical requirements needed.
Moreover, records management has broadened beyond risk and compliance towards information governance. Information governance is about protecting confidential and customer-related data. It can head off the bad publicity and loss of customer confidence that can result from a data leak.
Although the majority of healthcare organisations have some level of information governance policy in place, its effectiveness is too often hampered by poor training. Our research found that less than one-fifth of organisations regularly train all staff, while almost a third do no training at all.
Digital literacy & skills
Healthcare organisations are taking information governance more seriously. The provision of training to staff is becoming more widespread. But it does not yet go far enough.
If a hospital says that only staff trained in information governance will access confidential patient records, is that a good enough security measure? And what effect does this approach have on the speed of process? If, say, the practice manager must be notified every time a patient’s record is accessed, is this practical with so many patients?
Having said that, no staff member should be using the record sharing functionality without fully understanding it and notifying patients of the impact on their care. As the healthcare sector further embraces digital, the challenge is to ensure that staff skills keep pace with technological change requirements.
Success in transformation through technology has both technical and human components. Organisations must not underestimate the effort required to get the human part right.
The ability of the sector to overcome its challenges is largely dependent on its leaders and their willingness to change. To successfully navigate a digital transformation, there will be uncomfortable conversations to be had and some difficult decisions to be taken. It will require strong leadership.
Clinical engagement alterations can be jeopardised by clunky systems and cultural baggage in the NHS. NHS Digital has undertaken its third rebranding in as many years due to this. Cumbersome command chains and health and care system structures need simplifying and straightening out. But too much organisational restructuring is time-consuming, and hampers consistent leadership and decision making, particularly when the competing day to day operational challenges are so great.
The stickiest issue going forward is likely to revolve around the relinquishing of power to the patient. Healthcare professionals must accept that by design the patient should have a full record and, therefore, control of their care pathways. It is as much a mindset issue as anything else…
Healthcare professionals with clinical backgrounds understand that they are in the trust business more than the information business. The service provider must, therefore, deliver to the needs of the consumer – i.e. the patient.
The widespread use of social media, extensive knowledge of alternatives, and increasingly clear awareness of best practice places the conduct of staff and the organisations that they serve firmly in the public eye.
Whistleblowing is now more commonplace when organisations are not delivering correctly against their policies and procedures, or if appropriate policies and procedures are not in place. Digital providers must ensure that they adhere fully to best practice guidelines and that the mechanisms are in place for whistle-blowers to raise concerns.
Digital health apps that record patients’ data and reported outcomes straddle many different legal and governance obligations. Data privacy and protection is paramount both to build patient trust and function, and to ensure compliance with legislative benchmarks.
If you’re a developer or entrepreneur, and you create something in the health space, navigating the system is a key barrier. Aside from the difficulty of providing quality assurance on new mobile products, there is the challenge of processing personal data and moving such data safely and freely within the sector.
Each app can be an economy-wide data repository that anyone from primary, community, secondary or social care can access if they need to. But they must balance the ethical duty of sharing information for patients’ benefit against the risk of corruption or misapplication of patient data.
Greater connectivity allows for more expedient processes, thus unlocking the power of data within each organisational silo to shape a ‘learning health system’.
Mobile has very quickly caused a monumental shift in today’s digital health landscape, giving way to a new breed of patient who expects information and services to be – almost literally – at their fingertips. The onus is on the digital health sector to catch up, but not at the expense of governance standards.
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