Leontina Postelnicu

Secondary care providers in England are expected to be “fully digitised” by 2024, according to the 10-year NHS plan released today. NHS leaders were asked to develop the blueprint following an announcement in the summer of 2018 that the NHS would receive increased funding of £20.5bn per year in real terms by 2023/24, which applies to NHS England’s budget and not the overall health budget. The new plan outlines a series of “practical priorities” to ensure that digital services become a “mainstream” part of the NHS, and the new secondary care digitisation “milestone” covers “clinical and operational processes across all settings, locations and departments". It includes a focus on ensuring that clinicians can access and interact with patient records and care plans “wherever they are”, protecting patients’ privacy and putting them in control of their records, while encouraging a “world leading health IT industry in England with a supportive environment for software developers and innovators”.  Technology standards will be mandated and enforced, as mentioned in the digital, data and technology strategy published by the Department of Health and Social Care towards the end of last year, to ensure that “data is interoperable and accessible”, and the plan also pledges investment in expanding the NHS Digital Academy programme and increasing the training of health and care staff in digital capabilities. Improvements to require "staged action" The NHS App will offer a “standard online way” for people to access services, with an open environment to be created for developers to “build enhancements”, and patients with long-term conditions will reportedly be able to access their Summary Care Record through the app by 2020. Separately, it is expected that 100,000 women will be able to digitally access their maternity records in 2019/20, with plans for the coverage to be extended to the whole country by 2023/24, while a new wave of Global Digital Exemplars (GDEs) is also reportedly on the way, along with seven other Fast Followers.  “The continued roll-out of GDE blueprints to more Fast Followers will ensure the NHS achieves maximum value by reducing duplication and sharing systems between organisations where possible based on open standards and interoperability. Central funding will be made available to trusts (subject to an upper limit) to help them meet mandated standards and technical requirements,” it is added. In a speech today marking the publication of the plan at Alder Hey Children’s Hospital in Liverpool, NHS England chief executive Simon Stevens said some improvements would require "staged action over the next 10 years", while others would "happen quite quickly".  "The ability to share and access high quality data driven insights - led by patients - is key to improving patient care in the NHS," said Dan Vahdat, CEO and founder of UK health tech company Medopad. "Helping patients understand their own conditions and sharing ongoing updates with their clinicians can enable clinical teams to drive earlier interventions and ultimately, use that data to predict issues before they arise." Commenting on the publication of the long-term plan, Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, added: “It’s good to have a plan which sets a clear direction for the NHS and tackles many of the issues the Academy has long been saying need to be addressed if we are to improve patient care. Our challenge now is to make sure it’s properly implemented and in this regard we, that is everyone who works in the NHS and patients who use the service, must all play our part if we are to make it a success.” Charles Alessi, Chief Clinical Officer for HIMSS, parent company of Healthcare IT News, said: “The announcements around the evolution of the health and care system in England are welcome and encouraging. The extra resources promise to accelerate the journey around digital transformation that is long overdue. They will assist England in improving outcomes for patients by ensuring that services are digitally enabled and patients get more involved in their care. "This approach will assist the NHS in its quest for quality, and enable it to be compared with its peers globally, not only in terms of financial efficiency, but also in terms of outcomes for patients.  We look forward to seeing the detail of these plans and working with the NHS around this transformation.” Editor's note, 10 January 2019: This article has been updated to include a statement from Dan Vahdat, CEO and founder of Medopad, and Charles Alessi, HIMSS Chief Clinical Officer. Healthcare IT News is a HIMSS Media publication. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Most maternity providers in England are making a "good start" in adopting digital technologies, according to a new report by NHS Digital. Published in November this year, the analysis looked at the progress made by all 135 providers, and the investment being made in software, equipment and infrastructure. The digital maturity assessment (DMA) found great variation across the country, with some trusts scoring zero (the lowest level) on some sections and others 100 (the highest level), although only a minority had “very low digital maturity”. “We now want to see greater collaboration across the NHS so those maternity services not using digital can be helped along the journey,” said Juliet Bauer, NHS England chief digital officer. The overall national average score was 51, and findings indicated that areas of high and low digital maturity were distributed across England. The highest scoring section was governance, which scored 77, while the lowest one was remote and assistive care, scoring 23. “It would appear the maternity providers are often doing well on the same elements but are also encountering challenges in the same areas. This allows a great opportunity for the national teams and networks to focus on solving those common issues,” the report reads. At the time the analysis was completed, NHS Digital identified 20 suppliers providing maternity systems to trusts across England, and “close to a quarter” of providers said they were considering re-procuring their IT system in the next 12 months. The DMA was commissioned after a national review outlined the potential role that technology could play in transforming England’s maternity services. It included more than 200 questions prepared by clinicians, spanning the acute and community setting, and responses were converted into scores to allow them to carry out comparative analysis and calculate an overall score. “The Maternity DMA is a ‘self-assessment’– this means that it is mainly based on the opinions of those who complete it, rather than pure fact. As a result of this, there may be inaccuracies or inconsistencies compared with what actually happens," according to the analysis. Digital midwife Julia Gudgeon, clinical advisor for the Digital Maternity Programme at NHS Digital, and one of the report’s authors, said: “We have listened to clinicians working in the field and women themselves, both of whom are key to developing the use of digital tools to improve the experience of service users. This insight helps us to understand what to do and what not to do. “Our hope is that the findings of this report will inspire further collaboration so that women, technology and maternity services can work together to provide better health, better care and better value." Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

The European Commission, EU member states, Norway and Switzerland have developed a plan to boost collaboration and further the development and use of AI in Europe, prioritising areas of public interest, including healthcare and transport. Initiatives will tackle the "low and fragmented" levels of investment in AI in the EU, compared to the US and China, according to the Commission, and the new plan focuses on four areas: fostering talent, making data more available, ensuring trust and increasing investment.  "We agreed to work together to pool data – the raw material for AI – in sectors such as healthcare to improve cancer diagnosis and treatment. We will coordinate investments: our aim is to reach at least €20 billion of private and public investments by the end of 2020. This is essential for growth and jobs," said Vice President for the Digital Single Market Andrus Ansip. The plan provides a “strategic framework for national AI strategies”, according to information released this month.  At this stage, five member states have adopted a national AI strategy, backed by a dedicated budget: the UK, France, Finland, Sweden and Germany. Through Horizon 2020, working with member states, the Commission will support the development of a common (anonymised) database of health images based on patients voluntarily donating their data, initially targeting the most common forms of cancer to help improve diagnosis by using AI. Meanwhile, common European "data spaces" will be created to enable seamless data sharing across borders, and advanced degrees in AI will be supported through initiatives such as offering dedicated scholarships. “These common European data spaces will aggregate data, both for the public sector and for business-to-business needs, across Europe and make it available to train AI on a scale that will enable the development of new products and services. “The rapid development and adoption of European rules such as interoperability requirements and standards is essential. The EU must also provide support to ensure that these data sets can be seamless accessed, exchanged and reused," the Commission said. Meanwhile, a group bringing together experts from academia, industry and civil society is working on developing ethics guidelines for the development and use of AI, with an initial version that will be open for consultation expected to be published shortly. The final document will be released in March next year. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Thousands of women in England were “warned unnecessarily” that they did not receive an invitation to a final routine breast screening in an incident believed to have been caused by an IT error, according to an independent review released this month. Back in May, then Secretary of State for Health and Social Care Jeremy Hunt told Parliament that around 450,000 women aged 68-71 missed their final screenings, from 2009 until the beginning of 2018, and that between 135 and 270 might have had their lives shortened. The incident was initially thought to have been the result of a failure in the introduction of an algorithm randomising women for the AgeX trial assessing the risks and benefits of extending the age limit for screening. A review chaired by Macmillan CEO Lynda Thomas, consultant oncologist at the Royal Marsden NHS Foundation Trust Martin Gore and Care Quality Commission Chairman Peter Wyman found that policy on the upper age bracket for breast screening had been “ambiguous” since the programme was introduced in late 1980s, and that the incident stemmed in fact from a specification issued in 2013 aiming to clarify how it should be defined.  The document, stating that women should be invited for screening "within 36 months of their previous screening, until they reach the age of 71", resulted in a "misalignment" with IT systems in use and the implementation carried out by breast screening units. Junior minister Steve Brine told Parliament earlier this month that “the impact of the change in policy was not fully understood at this time”. According to the report, ministers were “incorrectly advised” and the public announcement from May “overstated the scale of the incident”, causing distress to women that “were left anxious until they received the results of their catch-up screening appointments”. “We have found that for many years there has been a lack of clarity around the specific age range during which women should be invited to routine screening, and that this led to confusion about what should have been offered to women and what was offered in practice. This confusion continued and ultimately led to the Secretary of State declaring an incident in May 2018,” reviewers wrote. The inquiry found at an “early stage” that the algorithm used to carry out the randomisation for the AgeX trial was “operating as designed”, and ministers said the trial would continue as planned. “There was no large-scale failure to invite women because of a systemic algorithm problem as announced in May 2018,” the inquiry found. “The primary failing for the purposes of the incident declared in May was not the IT itself, but the absence of an appropriately specific policy to be delivered against, a lack of clarity about what the IT was designed to do and a lack of understanding of how women had been invited to screenings in practice for decades.” Women are invited to screening in “batches” created by units using the following IT systems: the National Breast Screening Services (NBSS) and Breast Screening Select (BS-Select), introduced in 2016, which takes information from another system, the National Health Applications and Infrastructure Services (NHAIS). The review found that these systems, although “dated and unwieldy”, were also “operating as designed”. However, over a period of nine years, about 5,000 women were not invited to their screening appointments, a failure caused by errors in using the IT and “slippages in units’ screenings which meant that some women might have had incremental lengthening of their screening intervals until they left the age range for core screening”. Brine told Parliament that Public Health England had now estimated that the number of women that might have had their lives shortened as a result of the incident was “zero to 34”. “We agree with the recommendation that PHE progresses as quickly and as sensitively as possible the clinical review with the NHS of all women who may have suffered harm,” the minister added. In his statement, Brine also said the government was pledging an initial £1.8m for the replacement of the NBSS system, acknowledging the review’s criticism, and that they would “continue to monitor closely all screening IT systems to ensure they are robust and operating as they should”. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

From Google hiring Geisinger Health CEO David Feinberg to drive its health care initiatives, then moving DeepMind’s Streams team under his supervision, to Apple getting its first FDA clearance for an atrial fibrillation-detecting algorithm and an ECG built into its Watch, it seems that big tech companies have been making significant strides during the past year in paving the way toward disrupting health care. In Europe, findings from an annual HIMSS Analytics survey, included in a recent report, indicate that patient empowerment will become the "key focus" in eHealth, with "patient-generated data" - through wearables and other gadgets aimed at consumers - and "patient/ consumer-owned health records" seen as some of the core trends changing the delivery of care as we currently know it. Based on the responses of nearly 600 professionals in the field, the results show, however, that a European country's priorities shift to patient empowerment only after a "certain level of EMR maturity" is reached. "EMR implementation continues to be the top priority among respondents in Europe, although its relative importance has declined compared to last year," it is stated in the report. "Initiatives to integrate and use patient-generated data as well as improve patients’ access to their information made it to second and third rank. "These patient-related activities are of the highest importance for governmental health authorities, whereas healthcare providers put less emphasis on them. We expect those topics to become even more important over the coming years as the shift to consumer-driven health(care) is likely to accelerate." Key challenges: securing talent, boosting cybersecurity capabilities amid strained budgets The Nordic countries, especially Denmark and Sweden, and the Netherlands are leading the pack when looking at the adoption of digital technology and innovation, according to the analysis, and trends uncovered indicate that the European C-suite digital leadership is "likely to grow" even further and include more Chief Nursing Information Officers, Chief Digital Officers and Chief Innovation Officers. “If you only have some of them in your health institution, you might not (yet) be in trouble. However, should you have none of these positions (established and funded), you may want to think twice,” it is explained in the analysis. And while the main eHealth hurdle remains IT security, a lack of funding is perceived as the “major challenge” for providers, with 59 per cent of employees arguing that their institution’s IT budget for the next 12 months is “too low”. What should we expect from 2019? Comparing the results with those of last year's survey, researchers wrote in the report that the "outlook for the coming few years has not changed much in 2018 compared to 2017's vision". “This suggests that progress in the key areas identified last year has been slow and that a lot still remains to be done. “Hence, the next two to three years will see more of the same: patient (owned) medical records, health information exchange with external providers, patient self-monitoring initiatives and EMR implementations. Contrary to the hype, and in line with last year’s results, few blockchain-based solutions will be implemented.” Healthcare IT News is a HIMSS Media publication. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Researchers in the UK will collect a range of data from five million healthy volunteers to develop diagnostic tests using AI and other cutting-edge technologies to detect and diagnose diseases earlier in a study thought to be the largest of its kind. The programme was unveiled in a new deal between the UK government and the life sciences sector, backed by more than £1.3bn of investment, announced at the beginning of December. Sir John Bell, Regius Professor of Medicine at the University of Oxford, will lead the Accelerating Detection of Disease initiative, which will see experts look into how the health of a group of participants changes over time to identify common characteristics that would help them understand how and why diseases develop. “In years gone by, the idea of eliminating smallpox, managing HIV or curing Hepatitis C seemed impossible and yet we are living in an age where the risks associated with these diseases have been either eliminated or greatly reduced. “The programme announced today will set us on the path to new medical breakthroughs, innovative treatments, and longer lives, cutting down suffering in the future,” the professor wrote in a recent blog. The study will also support the delivery of the Early Diagnosis Mission, part of the UK Industrial Strategy’s AI and Data Grand Challenge. Businesses will be able to access the £79m in funding that the government is pledging for the programme through competitions managed by UK Research and Innovation. “The project will support research, early diagnosis, prevention and treatment across the major diseases, including cancer, dementia and heart disease. "This will be a ground-breaking national health programme that will develop new diagnostic tests through applying leading-edge AI and other cutting-edge technologies. It will attract additional global investment from the sector,” according to the Office for Life Sciences and the Department for Business, Energy & Industrial Strategy. Other announcements include a commitment from global biopharmaceutical company UCB to invest £1bn in R&D in the UK over the next five years. A new £150-200m R&D facility will be built, supporting around 650 jobs, mainly in scientific research and early manufacturing. Meanwhile, Roche will also invest a further £30m in the UK, with £20m over the next three years in a precision cancer research partnership with the Christie NHS Foundation Trust in Manchester. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

The number of people seeking health information online across EU countries nearly doubled last year, compared to figures from 2008, according to research cited in a new report from the European Commission and the Organisation for Economic Co-operation and Development (OECD). The Health at a Glance: Europe analysis, published in November, looks at the state of health of EU citizens and the performance of health systems in the 28 EU member states, along with five candidate countries and three from the European Free Trade Association. Figures from an annual European Information and Communication Technologies survey mentioned in the report, including the responses from around 150,000 households and 200,000 individuals aged between 16-74, found that half of all EU residents sought health information online in 2017, with the number going up to around 70 per cent in the Netherlands and Finland. But the 2016 version of the survey found that only 13 per cent of EU residents made a medical appointment online, although the number went up by five per cent compared to figures from 2012. Looking at individual countries, nearly half of all Danish residents reportedly made an appointment with a health care practitioner online in 2016. Use of EHRs and ePrescribing  The Commission and the OECD’s new report also shows that the use of electronic health records has been increasing across the EU.  A 2016 survey of OECD countries, which included 15 EU member states, revealed that all or nearly all primary care practices in Estonia, Finland, Greece and the UK had implemented such a system. The situation was different in Poland and Croatia, however, where it was reported to be “much more limited”. Meanwhile, a 2018 survey from the Pharmaceutical Group of the EU found variation in the implementation of ePrescribing systems across EU countries. Although 90 per cent of prescriptions were transmitted to community pharmacies electronically in Denmark or Sweden, figures indicated that ePrescribing had not yet been implemented in Bulgaria, Malta or Poland. According to the Commission, these countries expressed an intention to implement ePrescribing at either regional or national levels during the coming years. “Digital technology offers great opportunities to deliver health services more efficiently, and the European Commission supports a digital transformation of health systems to empower citizens to have access to their health data and to promote exchange of health data among health care providers across the EU,” the report reads. "Every European citizen should have an electronic health record" In a mid-term review on the implementation of the digital single market strategy, the Commission said it would take further action in three areas: ensuring citizens’ secure access to and sharing of health data beyond borders, connecting data to drive advancements in “research, disease prevention and personalised health care”, and empowering citizens to take control of their care through digital tools. Until 20 December, the EU institution is accepting feedback on an initiative to create a recommendation for the establishment of a European EHR exchange format. "Every European citizen should have an electronic health record - and this record should be easily exchangeable across Europe. We will soon publish a recommendation on how this should happen,” Roberto Viola, Director General of DG Connect, European Commission, recently said at the EU Health Summit. Source: Health at a Glance: Europe report, published in November 2018. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

NHSmail national outage caused by “software issue” The national NHS email service managed by Accenture suffered a "severity 1" outage midday on 1 December, caused by a “software issue in the supplier’s internal infrastructure”, which meant that NHS staff were unable to access their accounts. All users had their access restored by 8pm, and accounts locked out after multiple login attempts were unlocked by 10.30pm the same day. The NHSmail service is approved by the Department of Health and Social Care for sharing patient-identifiable and sensitive information. “We apologise for the inconvenience caused and worked to resolve the issue as soon as possible, which was caused by an internal issue with the supplier’s software. Thank you to the teams today [1 December] who have worked hard to resolve this,” NHS Digital said in a statement. In November 2016, a software configuration error saw an NHSmail local administrator accidentally email all NHS staff in England after creating a new distribution list intended to include only employees within one Commissioning Support Unit. Around 500 million emails that needed to be processed were sent in only 75 minutes, as staff used the “reply to all” function asking to be removed from the list. The incident resulted in “significant service delays for the majority of the day” at the time, according to a report presented to the NHS Digital board. Webinar: What Innovation Means to Healthcare and Why it Matters Today NHS staff investigated for illegally accessing medical records of Sir Alex Ferguson The Sunday Times has reported that two doctors and a senior hospital consultant were being investigated and “at least” two nurses questioned for accessing former Manchester United manager Sir Alex Ferguson’s medical records. Ferguson was admitted to the Salford Royal Hospital in May this year after suffering a brain haemorrhage. In a statement provided to the paper, Dr Chris Brookes, Northern Care Alliance NHS Group Chief Medical Officer, said an investigation was underway “to determine if the individuals have accessed a patient’s record electronically without a clinical requirement or authorisation”. Last week, the Information Commissioner’s Office, the UK’s data protection watchdog, fined a former trainee secretary at a GP surgery in Norfolk for unlawfully accessing 231 patient records without a valid reason to do so. “People whose job allows them access to confidential and often sensitive information have been placed in a position of trust, and with that trust comes added responsibility,” said Mike Shaw, the ICO’s Criminal Investigation Group Manager. “Data protection law exists for a reason and curiosity or boredom is no excuse for failing to respect people’s legal right to privacy. Just because you can do something, that doesn’t mean you should.” New pilot moves the NHS further away from paper prescriptions Eight GP practices in England are piloting a new functionality that could, once fully rolled out, see more than 95 per cent of prescriptions be processed through the Electronic Prescription Service (EPS). The digital system currently allows GP surgeries to send prescriptions to a dispenser (such as a pharmacy) nominated by the patient. But if the new pilot, which will be extended to other practices in 2019, proves successful, the improvement will allow prescriptions for all patients to be sent using the EPS, according to NHS Digital. “In an NHS where thousands of GP surgeries already enjoy the benefits of electronic prescriptions, it can’t be right that there are occasions when archaic paper prescriptions still have to be used,” Health and Social Care Secretary Matt Hancock said earlier this year. Bupa extends partnership with Babylon Bupa’s existing and new SME customers in the UK with two or more employees will be given access to the Babylon app starting from January next year, the company said last week, after announcing that it would roll out the service to its corporate customers back in June. “Our business customers often say it’s hard to find the time to look after their health, this is even more apparent for employees or owners of a small company,” said Mark Allan, Bupa UK Insurance Commercial Director. “We’re always looking for ways to make access to quality healthcare easier and more convenient – extending our work with Babylon is a key part of this." Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

The UK's Academy of Medical Sciences has published a report outlining a set of principles to guide the development, evaluation and use of data-driven technologies in healthcare, through a project partly funded by a grant from the Department of Business, Energy and Industrial Strategy. The new framework is based on a series of workshops involving patients, healthcare professionals, the broader public, and discussions with key stakeholder groups, including NHS regulators and digital health companies. It argues that data-driven technologies should be designed and used for health and care to: Support clearly defined purposes upholding the social values of the NHS and benefiting the system, individuals or society Respect and protect the privacy, rights and choices of patients and the public Include them as active and meaningful partners Maintain trustworthiness in the responsible and effective stewardship of patient data Incorporate evaluation and regulation mechanisms to build understanding, confidence and trust in these technologies, and guide their deployment in the NHS. Webinar: AI: Evaluating Opportunities for Healthcare Providers To make this a reality, however, experts warn that improvements to the digital capabilities of the NHS, an integrated data infrastructure and a radical cultural shift are required, while further analysis is needed to understand their use in social care, given that the "experience of accessing and using social care data in the UK is very limited". “The Academy report builds on what the patients and the public have told us matters most to them," said Professor Carol Dezateux, associate director of Health Data Research UK (HDR UK), the national institute for data science in health, and one of the experts consulted for the project. "By putting the public’s expectations at the centre of the use of data-driven technologies, the NHS, scientists, researchers and developers will be able to work together to deliver maximum health benefits for all, while keeping public trust," Professor Dezateux added. A draft of the academy's report was shared with the Department of Health and Social Care during the preparation of the initial code of conduct for AI and other data-driven healthcare technologies released in September this year. Meanwhile, NHS Digital announced today that it was joining a new initiative called the UK Health Data Research Alliance, along with HDR UK, aiming to "mobilise the UK's health data for science and innovation". “This new alliance brings together the unique data assets across the NHS, and allows access to them by the research community in a safe, secure and ethical framework. From this will flow new treatments and insights which will transform outcomes for patients,” said health minister Lord O’Shaughnessy. Twitter: @1Leontina Contact the author: lpostelnicu@himss.org

Thirteen NHS trusts in England providing a mixture of acute, mental health and community services will receive a share of £16m to speed up implementation of e-prescribing. Former Secretary of State for Health and Social Care Jeremy Hunt announced back in February that £78m would be made available to help trusts move away from paper prescriptions, after a study found that an estimated 237 million medication errors occur in the NHS in England every year. "This is a large number, but 72 per cent have little/ no potential for harm. It is likely that many errors are picked up before they reach the patient, but we do not know how many," researchers from the York, Manchester and Sheffield universities wrote in the analysis. A Short Life Working Group established in September 2017 found that electronic prescribing and medicines administration systems were some of the "most challenging digital health systems to implement in provider organisations". Figures from November 2017 indicated that 35 per cent of acute trusts and less than 12 per cent of mental health organisations had rolled out an ePMA system. Webinar: How Chief Digital Officers Can Boost Digital Transformation “There is evidence that electronic prescribing and medicines administration systems will improve safety for patients, reducing the risk of harm and ensuring high quality efficient patient care which is as safe as possible,” said Andrew Davies, NHS Improvement Director of Hospital Pharmacy. The thirteen trusts to receive the funding are: Bolton NHS Foundation Trust (£1.02m) The Rotherham NHS Foundation Trust (£750,000) Mid Yorkshire Hospitals NHS Trust (£1.6m) Humber NHS Foundation Trust (£300,000) Northern Lincolnshire and Goole NHS Foundation Trust (£940,000) Kettering General Hospital NHS Foundation Trust (£820,000) University Hospitals of North Midlands NHS Trust (£2.19m) Barts Health NHS Trust (£1.7m) East London NHS Foundation Trust (£740,000) East Kent Hospitals University NHS Foundation Trust (£1.45m)   Frimley Health NHS Foundation Trust (£1.17m) Buckinghamshire Healthcare NHS Trust (£1.62m) East Sussex Healthcare NHS Trust (£1.7m). Twitter: @1Leontina Contact the author: lpostelnicu@himss.org