Accelerate health information technology capacities across England’s National Health Service

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Unlike previously failed programs, such as the National Program for IT, England’s National Health Service (NHS) Global Digital Exemplar (GDE) program has made significant strides in building digital transformation capacity in some hospitals. These EDM provider organizations are now among the most digitally advanced sites in the world and have successfully exploited these capabilities during the COVID-19 pandemic.
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Beginning of a joint journey of transformation and digital learning within the English National Health Service. Full report of the independent evaluation of the Global Digital Exemplar (GDE) program.

Digital transformation, such as the implementation and optimization of electronic health records and electronic prescribing, has been achieved through organization-wide engagement and alignment of efforts around a vision turned towards the future, while leaving space for more organic development supported by knowledge-sharing initiatives orchestrated at the national level. However, there is a lack of clarity on how these success factors (those associated with successful digital transformation in the GDE program) are integrated into the national digitization strategy going forward.

The £ 9.8bn national computer program was launched in 2002 and attempted to digitize the NHS, but was dismantled in 2011 because frontline systems purchased centrally had failed to deliver the expected gains for the patient, system or efficiency.
2
  • Sheikh A
  • Cornford T
  • Barber N
  • et al.
National implementation and adoption of electronic health records in secondary care in England: final qualitative results of a prospective national evaluation in early adopter hospitals.

,

3
National Audit Office
Review of the final statement of benefits for programs previously managed under the National Program for Computing in the NHS.

As a result of the National Computing Program, hospitals were left on their own to procure and implement systems, with little guidance or central funding.

4
NHS information: revolution or evolution ?.

In 2016, a government review
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National Advisory Group on Health Information Technology in England
Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England. Report of the National Advisory Group on Health Information Technology in England.

of the NHS England Health Information Technology Strategy led by Professor Robert Wachter sought to learn from the disappointing results of the National Computing Program and the US $ 38 billion Health Technology Program. health information for economic and clinical health in the United States.

6
  • Sheikh A
  • Jha A
  • Cresswell K
  • Strikes F
  • Bates DW
Adoption of Electronic Health Records in British Hospitals: Lessons from the United States.

As the investment required to digitally transform all NHS hospitals far exceeded the resources available, the Wachter review proposed a phased approach, starting with the most digitally advanced hospitals, coupled with a national agenda. to strengthen leadership in digitization.

5
National Advisory Group on Health Information Technology in England
Making IT Work: Harnessing the Power of Health Information Technology to Improve Care in England. Report of the National Advisory Group on Health Information Technology in England.

The GDE program was therefore designed to create a selected cohort of digitally advanced GDE hospitals that would transmit their learnings to a second cohort of less mature hospitals, known as Fast Follower, and catalyze a large-scale digital transformation of the English NHS in the sense large. .

The GDE program has successfully advanced the digital transformation of services in 51 (18%) of 287 provider organizations by combining modest financial support (up to £ 10million per organization) with governance structures to provide leadership and clinical engagement focused on transformation outcomes linked to international benchmarks.
1
Beginning of a joint journey of transformation and digital learning within the English National Health Service. Full report of the independent evaluation of the Global Digital Exemplar (GDE) program.

The GDE program has also set up learning sharing mechanisms (in particular GDE-Fast Follower partnerships and the distribution of Blueprints [formal documents designed to capture implementation experience]) that fostered the informal networking needed to lay the foundations for a vibrant learning ecosystem.

7
  • Williams r
  • Sheikh A
  • Franklin BD
  • et al.
Using Blueprints to Promote Interorganizational Knowledge Transfer in Digital Health Initiatives – A Qualitative Exploration of a National Change Agenda in English Hospitals.

The success of the GDE program comes after a period in which many heavily funded national technology procurement programs, such as the National Computing Program and the Health Information Technology Law Program. for economic and clinical health, have failed to achieve digital transformation.
8
House of Commons Public Accounts Committee
Digital transformation in the NHS. Twenty-second report of the 2019-20 session.

,

9
  • Apathy NC
  • Holmgren AJ
  • Adler-Milstein J
A decade after HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions.

As the GDE program comes to an end, there is now a need to build on the momentum created and advance key lessons to promote digital transformation more broadly in the NHS. However, the strategy will have to be carefully considered. The transformational momentum resulting from the synergy of three key drivers – dedicated funding, a degree of local control over implementation routes and reputational benefits – could be weakened as the focus is on promotion digital transformation in less digitally mature organizations. This consideration is particularly relevant if the available resources are dispersed among organizations which might require higher levels of support.

This has two main implications. First of all, it is necessary to realize that digital transformation is a marathon, not a sprint, and, indeed, a journey without an end point.
ten
  • Krasuska M
  • Williams r
  • Sheikh A
  • et al.
Technological capabilities to assess digital excellence in hospitals in high performing health systems: international eDelphi exercise.

Second, it is not necessary or desirable for the followers to replicate the journey, involving many false turns, made by the current leaders. The upgrading strategy must now focus on creating leapfrogging opportunities through local partnerships, learning sharing and capacity building. Although it has been successful in promoting digital transformation in digitally advanced sites, the short lead time of the GDE program has encouraged proven solutions. Longer-term interventions are needed to promote innovation, including organizational, service, social and product innovation. Otherwise, there is a risk that the growing digital maturity gap between organizations will hamper both the provision of integrated digital environments for care pathways and the establishment of a dynamic learning ecosystem centered on people. innovation.

The authors received funding from NHS England for the independent assessment upon which this commentary is based. The views expressed in this commentary are those of the authors and not necessarily those of the NHS, NHSX, NHS England or NHS Digital. An independent academic advisory group provided clear advice and support throughout the duration of the GDE program. The academic advisory group included Anthony Avery (the chair), Gordon Schiff and Philip Scott. We would like to thank the individuals and service providers who participated in this research.

The references

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    Beginning of a joint journey of transformation and digital learning within the English National Health Service. Full report of the independent evaluation of the Global Digital Exemplar (GDE) program.

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    • Williams r
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    Digital transformation in the NHS. Twenty-second report of the 2019-20 session.

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    • Adler-Milstein J

    A decade after HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions.

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