Deprioritising equity, bolstering transparency, banishing indecision, and ditching incremental EPR-related digitisation were among the suggestions at a Rewired panel on advancing digital healthcare transformation.

At an animated and deliberately opinionated session, titled the Rewired Big Debate, four leaders shared the radical changes they felt would make the biggest difference to digital transformation.

Rishi Das-Gupta, chief executive of the Health Innovation Network, said tackling inequality was “really important” but suggested the way in which it is currently approached “is a real brake on innovation”.

“A lot of time is spent [trying to ensure that] anything we put in is as fair as possible. That is absolutely the right spirit to be coming from; we definitely shouldn’t do things that we think are going to deliberately broaden health inequality.

“But we could be saying, well, actually, we’ve got a new system that serves certain people, and that means freeing up resources that can then be used elsewhere. [We could avoid] getting too deeply into saying anything new has to be completely level across the board.”

The current approach is symptomatic of a broader risk-averseness that often stifles innovation, Das-Gupta said.

Indecision by default

“Unfortunately, despite all the enthusiasm and innovation at conferences like this, often indecision is the decision [on digital innovation],” added Nadine Hachach-Haram, consultant plastic surgeon and director of clinical innovation and strategic partnerships at Guy’s and St Thomas’ NHS Foundation Trust.

“What you find is the default is indecision,” said Hachach-Haram, who is also the founder of Proximie, a firm seeking to increase digitisation in operating theatres.

“No-one is going to get fired for not making a decision or for going to the standard big tech companies. But someone is worried that they could get fired if they bring in an amazing, innovative company that changes how care is delivered.”

Haris Shuaib, founder of Newton’s Tree – a startup focused on large scale AI transformation in health and care – said the NHS was “closed by nature and by default”. He urged “radical transparency”, not least to encourage the more reliable sharing of best practice.

“Forget about the EHR”

For Jacob Haddad, co-founder and chief executive of Accurx, that best practice would go far beyond a focus on the implementation of electronic records.

“We need to forget about the EHR,” said Haddad when asked for his radical ideas on how to advance transformation through digital. “They’re not going to answer all our problems, they’re not going to do the transformation. Most of the EHR implementation is taking what was done on paper and putting it on the screen.

“When the dust settles, and these EHRs are implemented, I think we’re starting to see trusts start realising that the productivity gains haven’t come through.

“Don’t get me wrong – you need an EHR. But that can’t be the holy grail of what we’re aiming for. It’s pure foundation.”