There is a financial challenge; there will be a general election. Once the election is over, debate will start in earnest about the future shape of the NHS; and how IT can support the changes needed to improve efficiency and reduce demand by improving health.
That will throw up other controversies; such as where open source fits and whether confidentiality can be maintained. Great leaders will be needed; including new clinical leaders. Sam Sachdeva asks fifteen IT directors, suppliers, analysts and other observers of the healthcare IT scene for their predictions for 2015; and finds they are expecting another busy year.
Tim Kelsey, director of patients and information, NHS England:
On the day the probe landed on the comet, proposals for how the NHS should finally push itself into the digital age were published. A chorus of commentators refrained: “How can we safely land people on the moon – and robots on fragments of ice – while the NHS holds people's medical records together with bits of string?”
Our NHS has taken itself down some cul-de-sacs over the last decade, but ‘Personalised Health and Care 2020’, the National Information Board's framework for action, provides the first blueprint that all national bodies, clinical and civil society leaders have agreed.
It is ambitious: real-time digital records for all health and care services by 2020 at the latest; patient access to all their records online by 2018; a new kite marking service for health apps; giving all people at their end of their life the opportunity to have a mobile digital record recording their preferences for treatment.
Our ambition is to make the NHS a digital pioneer for our patients and citizens. We must embrace modern technology to help us lead healthier lives – and, if we want to take more control when are ill.
Natalie Bateman, head of health, social care and local government, Tech UK:
The Five Year Forward View [plan to meet the Nicholson Challenge to save £30 billion by 2020-21] and the National Information Board’s framework for action, ‘Personalised Health and Care 2020’, have set the scene for the industry.
One of the biggest changes will be the evolution of new care models that advance the move to integration and shared budgets. This will encourage a culture shift in how the NHS makes a decision about investing in technology; from the benefits to service delivery in an individual organisation/department to benefits to the patient and sector in a wider sense.
2015 will also see an increase use of wearables and with it a growing demand from consumers to utilise the data in their care. As public trust in the use of patient data is rebuilt, big data will become commonplace.
However, this could all change in May. [Health secretary Jeremy] Hunt is a technology evangelist, but will the new secretary of state (if it isn’t Hunt) understand the importance of technology to patient outcomes, safeguarding the NHS and contributing to UK Plc? It’s the responsibility of the industry to make sure that he/she does.
Charles Gutteridge, chief clinical information officer, Barts Health NHS Trust:
The NHS electoral debate will re-present the connected health framework developed over the past ten years as an opportunity to exploit the real possibilities of health IT – booking online, virtual health advice, and personalised health. Expect new use of old ideas claiming originality through political prestidigitation.
Whatever the overlying gloss, the reality will be application of national standards for messaging, health information exchange, use of SNOMED, and structured data; and a wider take up of a single systems approach to developing an electronic health record.
The prize for the end of the year will go to those who have established systems for aggregating data at local level for population health management. At the same time, 2015 will be the year that people really start to demand control and input of their personal health data.
We will see a lively debate nationally and through policy on the best ways to ensure safety and confidentiality; expect diverse and fiercely expressed opinion, tempered with personal health offerings from technology vendors.
Philippe Houssiau, vice president – healthcare, UK, CSC:
Interoperability will become genuinely important. With systems in place across all care settings, and drive from policy makers, there is no excuse for siloed information.
Integrated care will take off. With clinical commissioning groups looking to find ways to enable citizens to make the right health and care choices, we will see new models of technology-enabled coordinated care crossing the boundaries of the health economy.
Clinical relevance will become the benchmark, with health leadership looking to technology programmes to deliver end-to-end clinical pathways informed by predictive analytics.
We’re at a tipping point for digital patient engagement. With more than 50% of the adult population owning smart mobile technology and 50% of GP appointments for chronic conditions, the momentum is now unstoppable – with follow-up, monitoring and even diagnosis moving online.
More speculatively, 2015 will see the beginnings of CRM for health, with integrated care systems beginning to engage patients in increasingly ‘consumerised’ and social ways.
Markus Bolton, joint chief executive of System C:
Hospitals are going to be adapting to the new world of shared records and cross-organisational pathways; the way that end-of-life care is managed – and the IT systems that support it – are already showing the way.
We are going to see a proliferation of similar vertical applications that join up services across the care community in the coming year. The long-awaiting links between health and social care are finally going to happen.
Chris Spencer, chief executive of EMIS Group:
The ever increasing pressure on the NHS for lower-cost healthcare will drive an increase in personalised health budgets, making the citizen the customer rather than the patient.
Consumer health technology (including access to online services) will become an everyday commodity, enabling all of us to take greater part in managing our own health and our journey through healthcare services.
The shift to lower cost services will accelerate, and pharmacy will become increasingly important in chronic disease management, in partnership with general practice.
Consolidation of NHS organisations with increasingly common non-NHS organisations will see a further blurring of traditional primary, community and secondary care boundaries.
In all of this, health service providers (at all levels) will need integrated IT systems to join services together and provide patient focused, integrated care of the highest quality.
Rachel Dunscombe, chief information officer, Bolton NHS Foundation Trust:
2015 will be a dynamic year of political debate on the future of the NHS. Because of the systemic challenges, and the need to understand how to embed wellness, informatics will need to become a core strategic asset for all health organisations.
Trusts will also need to provide services in conjunction with the voluntary sector and will need to find solutions to provide integrated patient records spanning a wider group of organisations.
Personally, I am looking forward to working with our academic health science network and the Health and Social Care Information Centre / NHS England on Code4Health, on developing open source ventures, and supporting SME developers.
I am also looking forward to further strengthening the team of four substantive chief clinical information officers building the clinical intelligent client for the trust. And the 100,000 Genomes project, integration with wearable tech, and understanding the true power of population health management all excite me for the coming year.
Shane Tickell, chief executive of IMS Maxims:
In 2015 we will see the vision for transparency, open data and the move towards delivering safe and integrated care take shape. The focus on developing a sustainable healthcare system will drive new ways of working for chief information officers and IT directors to sweat their technology assets.
The popularity of sharing and promoting best practice amongst communities will grow through new, energised methods of collaboration between clinicians, developers and patient advocates, facilitated by open source products and people.
The accessibility of patient records in both primary and secondary care sectors will play an important role which will see the enhancement of mobile applications linking to EPRs become the norm.
The marketplace will continue to become more open and transparent underlined by new methods for comparing software solutions leading to faster product development. This will see greater use of best-of-breed solutions, as they begin to hold a more strategic role for healthcare organisations.
Adrian Byrne, director of IM&T at University Hospitals Southampton NHS Foundation Trust:
I was asked to do this last year, and looking back I notice that I said: “I predict that in 2014 open source health software will reach its peak of inflated expectations. I would like to think we will start to get some real traction in offering patients a true interactive experience with their healthcare providers.”
I wasn’t completely embarrassed, which was a surprise. I’m not sure if the hype cycle has yet moved on in terms of open source, but there’s been a lot of debate. For this year, I’m not sure I can offer you any more than platitudes. There’s an election. It feels gloomy. I hope users stay patient!
Bill Aylward, consultant ophthalmologist and developer of OpenEyes:
I predict that 2015 will become the year in which the NHS finally takes open source software seriously. Open source software has been successful in many other areas in the past, but UK healthcare should be a real 'shoo in' for it. The knowledge sharing environment, and need for cost-effectiveness means that the NHS is an ideal open source environment.
Phil Booth, co-ordinator, medConfidential:
Early in 2014, we warned that there were serious problems with the care.data programme. These proved to be so serious that the project had to be halted; and then rebooted in pilot form. The Health and Social Care Information Centre is now beginning to demonstrate that difficult, even painful, steps towards institutional change can be made.
However, the problems uncovered at the NHS Information Centre [which was proved to have had inadequate controls on access to and use of the Hospital Episode Statistics that underlie care.data in 2014] will prove to be the canary in the coal mine.
Other NHS data programmes will be shown to have inadequate information governance and consent – if they had any at all.We can only hope that a viable replacement programme for care.data will emerge from the wreckage.
This time, its core principles must include consensual data use, clear and complete patient information, data held and processed exclusively within a safe setting, and robust independent oversight. And it should be led by a registered medical professional; this has to be about medical ethics, not: “What can we get away with?
Andy Williams, chief executive of the Health and Social Care Information Centre:
In 2014, we successfully transformed the Spine. Bringing the service in-house, using open source software and innovative expertise from small technology companies, will save the health service millions.
The new Spine will also support the easier integration of systems that can transform information flows between professionals. The CP-IS application, is already flagging to medical staff when a child is on an at risk register; a simple but huge step-change for children’s safety.
In 2015, we will be doing more programme transformations like this. By the end of January, we will also have new service standards in place for our customers for data. Introducing more rigorous controls has had some difficult consequences for some customers, and we hope to resolve these so we can release data in a timely, responsible and transparent way.
Building public trust, which we have begun to do over the past year, is fundamental as we continue to collect, protect and share health and care information. We will endeavour to make sure there are no surprises for people, so they are able to make informed choices.
James Munro, chief executive and chief technology officer, PatientOpinion:
In 2015, the use of social media, both inside and outside the NHS, will continue to grow. Its use will accelerate the trend towards the primacy of networks over hierarchies, reducing the importance of organisational structures, and privileging reputation over formal authority.
We’ll see small but significant impacts in terms of both policy and culture change, around issues such as complaints, patient feedback and candour, as the NHS continues its glacial progress from producer-dominated to user-centred thinking.
Carrie Armitage, programme director, Cambridge University Hospital NHS Foundation Trust:
In 2015, the NHS will look more and more towards technology to bridge the gap in healthcare funding – but take note: technology does not come cheap and requires massive human investment in time and commitment from all staff, not just the IT department.
Those organisations that are serious about their electronic patient records will start to carve out protected time for their clinical staff to work with the technologists and look to influence medical and nursing training to deliver techno-savvy doctors and nurses for the future.
Joe McDonald, consultant psychiatrist and chair of the CCIO Leaders Network:
Towards the end of 2014, the National Information Board published its new framework for NHS IT. Personalised Health and Care 2020 says “the leaders of all health and care organisations [should] champion information and digital capability.”
It also says they should empower chief clinical information officers – drawn from medicine, nursing, the allied health professions and social care – “to lead transformation programmes that support the take-up of information and technology and lead improvement.”
We will be reminding all NHS organisations of their need to appoint CCIOs and supporting them to better use information to drive the efficiency the NHS needs. We will also remain focussed on improving the usability of systems and on developing the interoperability projects envisaged by the framework.
The need for clinical leadership in Health IT will not be diminished by the result of the general election, which may result in a Labour/Scottish Nationalist coalition with Alex Salmond as deputy prime minister!