Friday, April 19, 2013

Intellect Stream at HC2013

I had the pleasure of participating in Intellect's stream at HC2013 last Wednesday. The overall event was very well organised, and the Intellect stream in particular had a great set of speakers. Kicking off the stream were several patients, who gave their perspective on the NHS, based on their own experiences of it as service users. A couple of them had previously worked within the NHS so their experiences had been enlightening for them. They all showed immense bravery in sharing their individual experiences around their own conditions; too often the individual is lost in discussions about tariff, technology, resource management, commissioning etc. The lessons they fed back to us were sobering in the modesty of their needs; specifically
  • access to their own records, the degree of access and control varied somewhat across the speakers;
  • treat patients as individuals looking at their overall healthcare status and needs, not as one participant in a series of discrete, disconnected transactions;
  • why do patients have to keep providing the same information?
  • in the case of a type 1 diabetic patient, why can't all of the devices he uses to monitor and control his condition talk to each other, and/or to his smartphone?
  • how can we achieve "no decision about me without me" without a sea change in culture and organisation?
  • as a patient, I see one NHS and expect it to interact with me on that basis, not as a dysfunctional collection (my words not theirs) of organisations grudgingly aware of each other.
During the subsequent discussion Ewan Davies made the excellent point that objections often made to change (e.g. information governance, less than 100% access to the internet etc), while reasonable should not in themselves be reasons not to change, as is currently the case. Joe McDonald in the last session characterised this as dictatorship by unanimocracy i.e. we are unable to do anything unless everyone agrees 100%.

I participated in the session on technology platform and architecture. This was really an opportunity to stimulate some discussion around the ideas that Paul Cooper, Jon Lindberg and I pulled together in the Intellect paper "The NHS Information Evolution" launched this week. We were joined in our panel discussion by Phil Birchall from Intersystems and Mark Treleaven from FDB, and the discussion was chaired by Andrew Hartshorn, chair of the Intellect Health and Social Care Council. The discussion was engaging and interesting, ranging from the question of how to create the environment that allows beautifully crafted apps to flourish, to the challenge of how to incentivise a view of healthcare ecosystems that goes beyond the narrow parochial boundaries of the individual healthcare provider organisations. A recurring theme was the need to support mobility; another observation was that clinicians have already started using tools such as Facebook and Google docs to collaborate with other professionals in treating their patients, so we need to move rapidly to provide equivalent functionality which also protects the integrity and security of patient data.

Moving into the later sessions these themes recurred; the following session involved a number of service developers who talked about some of the challenges they are facing in designing and deploying different kinds of technology services. Gary Shuckford from EMIS talked about his experience, from, of the kind of information that patients are interested in accessing. He also talked about some of the practical difficulties in ensuring take-up of the service. The final session aimed to pull together various themes that had come up during the day, chaired by Julian David, Director General of Intellect. What was interesting in this session was the degree of consensus, that had been evident throughout the day. There is a clear acceptance that we need to improve how we leverage technology within UK healthcare, and the things that are holding us back are far more people-related than they are technology-related.