Tag Archives: NHS

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Digital Engagement and Collaboration

Public Service to be saved by digital engagement?

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Using the Devon Local Authority area and demographic as a model, an assessment of this authorities annual social and economic benefits potential for public service digital engagement with citizens has currently reached a staggering value in excess of £2.4billion.

Realisation of these benefits will require the digital solution implemented achieving a true transformation of the current service delivery model, certainly one that services a more pro-active and well-being orientated approach to health and care requirements.

As the NHS England – Five Year Forward View strategy states “we now want to accelerate this way of working to more of the country, through partnerships of care providers and commissioners in an area (Sustainability and Transformation Partnerships).”

The key opportunity is the education and empowerment of the population through digital engagement solutions, the strategy goes onto offer;

“Working together with patients and the public, NHS commissioners and providers, as well as local authorities and other providers of health and care services, they will gain new powers and freedoms to plan how best to provide care, while taking on new responsibilities for improving the health and wellbeing of the population they cover.”

Critically however, digital engagement cannot only be about the NHS and it’s services, these are in essence after the fact and only engaged when you have a problem, the focus needs to shift to social care, and the up-front engagement that occurs with people with the potential to develop health concerns, the primary deliverable has to be about pro-active engagement that services better and more timely interventions and thus delivery of a wellbeing orientated focus.

Carers and Cross Service Collaboration is Key

Aiming for a family / carer orientated engagement approach at the core of any solution, implemented in a way that facilitates much improved cross service collaboration between public service functions, the Devon social and economic benefits to be obtained across service functions presently assessed at: health and social care unsurprisingly achieving the most significant benefit of circa £2.1bn, followed by Education at £151m, Criminal Justice at £100m and Welfare currently coming in at around £74m. With benefits research still underway it is very likely these values will grown by as much again.

A good proportion of these benefits would involve the realisation of cost savings and efficiency gains within each of these service sectors, and potentially at a scale that would make for a significant contribution on top of current sustainability and transformation plans. Given the maturity that exists in digital engagement technologies widely available today, perhaps the timeframe for achieving delivery of these benefits need not be too far away!

Troubled Families a Key Enabler

Whilst the NHS inevitably addresses requirements for improving use of systems and flow of information through the “Global Digital Exemplar” and further exploration and development of the “New Care Models” working with vanguard organisations and initiatives across the country. The more significant opportunity for transformation to a wellbeing orientated digital engagement approach is perhaps better defined by the Department of Communities and Local Government (DCLG), “Troubled Families” initiative (now in a second phase of delivery).

The fundamental differences between the NHS and DCLG approaches, is that the NHS is mostly geared to addressing issues once they have materialised, whereas local authority Social Care service provision in particular is being guided to becoming more pro-active in its engagement, through aspects such as the “Early Help” services targeted in schools to identify children at early stages of need for support, through to supporting adults to live independently and well.

The case for local authorities being the focal point for digital engagement with citizens is strong when you take into account that it is responsible for other key services that affect an individual’s wellbeing, such as education, housing, inclusivity in forms of transportation and access to digital services and other investments in local infrastructure to improve access to employment, all very significant in terms of servicing positive outcomes for individuals.

When we acknowledge that the issues and challenges the public service faces in trying to meet our needs are seldom caused by one single event or distinct set of parameters. We already acknowledge that deprivation and poverty are key issues affecting health and wellbeing, that poverty is also linked to crime, that mental health issues in adults affects the health and wellbeing of children, but that there is also a growing awareness of a significant gap in mental health support for children directly.

There is in fact a large body of work out there that has looked at cause and effect of different social dynamics and more importantly the benefits potential to be obtained from tackling negative social and wellbeing issues. Whilst some of this work warrants updating the models employed as a means of qualifying social and economic costs and thus potential in benefits remains good for today’s purposes.

Focus for Digitisation Strategy and Plans

The key to the client side digital engagement is to consider what can be utilised quickly to deliver benefits early, essentially adopting an agile and incremental approach to delivery. For example, much focus is being given to making patient medical records available and accessible online, but many struggle to appreciate what value is access to medical records going to achieve?

For those in the population that have an issue or pre-existing condition that perhaps is not being coped with or managed very well, wouldn’t just access to information and guidance that was more focused and capable of empowering the individual, and more importantly their personal care circle of family and friends to care better be a start.

Presently, Carers UK has approximately 6.5million registered carers*, and NHS England have identified 1.4 million unpaired carers providing fifty or more hours of unpaid care per week that they wish to better reach out to with engagement solutions, but are they right, is there only that many that care?

There are in fact over 40 million people aged between 16 and 74 years, many of whom have older parents or children under the age of 16 they care about, isn’t it this whole group that the public service solutions need to be setting themselves up to engage digitally with? We all care don’t we?


There is massive potential for social and economic benefits to be obtained by improved public engagement using digital technologies and tools, from a health, care and wellbeing perspective where services are under immense resource and funding pressures, this engagement and delivery of benefits cannot come too soon.

Critically however, whilst there is investment being made, most of it is presently being targeted at addressing shortcomings in inter-organisation information workflows and operational systems integration, which beneficial and therefore worth doing, but by comparison very little investment is being made on the wider opportunity that is direct digital engagement with citizens.

The key to securing the massive benefits potential that exists can only be achieved with a true citizen centric focus on their needs, and the subsequent servicing of this need with a digital engagement solution that services collaboration between carers, regardless of who these individuals are, or how they are funded, or who they work for.

Equally there is no reason why the solution cannot delivery short to medium term efficiency and cost saving benefits arising from better engagement of those with pre-existing long-term chronic conditions, whilst also and at the same time provide the framework for longer-term benefits from early help and intervention on children and adults with emerging issues. To establish a wellbeing orientation that over time benefits society through pro-active engagement that helps people to maintain healthier lifestyles.

Critically, if we are going to truly transform health, care and wellbeing for all and maximise the benefits to be obtained from a pro-active and wellbeing orientated solution, then maybe we need to move the focus from after the fact NHS and health, to local authorities and social care and what should be a pro-active and universal focus on concerns that have the greatest effect on citizens wellbeing and health!

Then and only then, will we see a transformed service delivering social and economic benefits of the scale mentioned at the outset of this article, which when extended beyond Devon and across the rest of the country would quickly amount to £10’s of billions for the UK economy.

* https://www.carersuk.org/news-and-campaigns/press-releases/facts-and-figures

** https://www.england.nhs.uk/commissioning/comm-carers/carer-facts/

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Kings Fund Digital Health and Care Congress 2017

Digital Health and Care Congress 2017

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Digital Health and Care Congress focuses on digitisation being the essential tool for meeting the needs of patients, their families, healthcare professionals, and the entire nation – in short, to improve the way care is delivered in the NHS. With a renewed national focus on technology and data, join us at this two-day event to hear the latest policies and learn from local case studies showcasing best practice from around the country.

Why Attend

You’ll network with more than 500 delegates, including health and social care professionals, commissioners, researchers, innovators, and policy makers, all interested in the implementation of digital health in the NHS and other health and care systems. With a thriving exhibition, and a choice of practical workshops, you’ll see how the latest innovations in digital health, mobile health, telehealth and telecare are being used to:

  • transform how patients engage with services
  • drive improvements in efficiency and care co-ordination
  • help people manage their health and wellbeing.

Digital Health and Care Congress Agenda

Day 1

8.30am: Registration, exhibition and networking – Breakfast workshop

Session one: Opening plenary

10.00am: Welcome and introduction

  • Professor Chris Ham, Chief Executive, The King’s Fund

10.05am: Keynote address

  • Beverley Bryant, Director of Digital Technology, NHS Digital

10.30am: Results from the Independent Patient Data Taskforce – Hear how this new taskforce will build on the work of the Caldicott review, helping to develop a framework for clear and transparent discussions with the public, patients and healthcare professionals about how data can be used to improve health.

  • Nicola Perrin, Head of Policy, Wellcome Trust, and Lead, Independent Patient Data Taskforce

10.50am: Keynote

  • Speaker to be announced soon.

11.00am: Questions and discussion

11.15am: Refreshment break, exhibition and networking

Session two: Breakouts

Delegates can choose to attend any of the following sessions:

  • T2A: Exploring place-based personal health records
  • T2B: Apps enabling citizens to take an active role in their health and care
  • T2C: Using telemedicine to extend the reach of clinical expertise
  • T2D: Releasing nursing time to care, enabled by technology

1.00pm: Lunch, exhibition and networking

Session three: Breakouts

Delegates can choose to attend any of the following sessions:

  • T3A: Sharing information to transform and improve services
  • T3B: Using apps to share health information with specific audiences
  • T3C: Using digital platforms to provide information and triage services

3.15pm: Refreshment break, exhibition and networking

Session four: Supporting integration of health and social care through technology

3.45pm: Welcome back

  • Tom Derwood, Director of Provider Support and Integration, NHS Digital

3.50pm: Keynote address

Hear some of the work being done to support integration of health and social care services through technology, the challenges of incorporating person-centred technology solutions into health, housing and care services and the recommendations of the TSA paper, Putting people first: commissioning for connected care, homes and communities.

  • Paul Burstow, Chair, Tavistock and Portman NHS Foundation Trust

4.10pm: DataWell: The DataWell Exchange Platform: Promoting Connected Healthcare for the Devolved Greater Manchester Health and Social Care System

Gain an understanding of how a federated approach to the sharing of patient records has been implemented in Greater Manchester to support their devolved health and social care system, integrating health and social care data and analytics.

Explore how DataWell has addressed concerns about interoperability, diversity of NHS and social care systems, data ownership and transparency.

  • Dr Sarah Thew, Innovation and User Experience Manager, Greater Manchester Academic Health Science Network

4.30pm: Questions and discussion

4.50pm: Closing comments

5.00pm: Close of day

5.15pm: Drinks reception

Day 2

8.30am: Registration, exhibition and networking – Breakfast workshop

Session one: Lessons from the vanguards and test beds programme

10.00am: Welcome and introduction

  • Professor Chris Ham, Chief Executive, The King’s Fund

10.10am: At the digital vanguard: place-based digital health

Unpick how new care models are applying technology and building the digital health ecosystem. Learn from examples of digital health initiatives across vanguard sites that illustrate the challenges, successes and learning from programmes that have been seeking to embed digital at the core of service transformation.

  • Andrew Fenton, Associate Director, Digital Transformation, NHS South, Central and West Commissioning Support Unit

10.30am: Panel session: Lessons from the test beds

  1. What lessons can you share from the methodologies you’re using e.g. Rapid testing cycles?
  2. What are the particular challenges in the health and care sector?
  3. How can the NHS collaborate with the tech sector?
  4. What lessons are there around procurement for digital health and care projects?
  5. How can we best engage with patients around data?
  • Glyn Jones, Innovation and Spread Lead for the Lancashire and Cumbria Innovation Alliance NHS England Test Bed, Lancashire Care NHS Foundation Trust
  • Elizabeth Dymond, Project Lead, West of England Academic Health Science Network
  • Steven Haigh, Director of Primary Care Sheffield and Programme Director for the Perfect Patient Pathway
  • Dr Helen Rostill, Project Lead Director, Surrey Dementia Test Bed Project
  • Dr Ramin Nilforooshan, Clinical Lead, Surrey Dementia Test Bed Project
  • John Craig, Chief Executive, Care City Test Bed
  • Claire Stidston, Programme Lead, Care City Test Bed.

11.00am: Questions and discussion

11.15am: Refreshment break, exhibition and networking

Session two: Breakouts

Delegates can choose to attend any one of the following sessions:

  • W2A: Improving data sharing and interoperability across the health and social care economy
  • W2B: Platforms to facilitate patient involvement, feedback and choice
  • W2C: Digital solutions to support access and productivity in acute care

1.00pm: Lunch, exhibition and networking

Session three: Breakouts

Delegates can choose to attend any one of the following sessions:

  • W3A: Technology to support self-care
  • W3B: Websites and platforms to facilitate self-care and joint decision making
  • W3C: Demonstrating benefits and productivity

3.15pm: Refreshments, exhibition and networking

Session four: Closing plenary

3.45pm: Welcome back

3.50pm: Reinvigorating the Rangoon General Hospital

Hear about the renovation of the largest hospital in Burma, including building an effective medical records system so that patient needs and clinical practice can be supported from admission to the patient’s return to the community.

  • Dr Michael Marett-Crosby, Trustee, The Rangoon General Hospital Reinvigoration Charitable Trust, Burma

4.10pm: Business-as-usual video call access to government health care services at scale

Learn about a collaboration between the Scottish Centre for Telehealth and Telecare and Healthdirect Australia, with the aim of enabling citizen video call access to the primary care and specialist appointments. The model is being piloted in 50 health care settings and includes research being undertaken by the University of Edinburgh around the use of video consultations in primary care.

  • Chris Ryan, Video Consulting Program Director, Healthdirect Australia
  • Professor James Ferguson, National Clinical Lead, Scottish Centre for TeleHealth

4.30pm Questions and discussion

4.50pm Closing comments

5:00pm Close of conference


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NHS CyberSecurity lessons makes you WannaCry?

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NHS CyberSecurity lessons arising from the worldwide ransomware attack that occurred on the 14th of May is already prompting much debate for the NHS, much of which focuses on the failure of affected organisations to ensure adequate levels of investment on IT systems to mitigate the risk of this event.

The ransomware exploited a known issue with Windows XP, for which a patch had been issued earlier in the year. The biggest news headlines here in the UK concerned the impact this exploit had on the NHS, with a great many organisations appearing to have been caught out by the Windows XP vulnerability.

As is the case when the public sector suffers an adverse event, the call goes out for lessons to be learned, usually with an assumption that these are all new, but inevitably there will be those lessons that have already been learned, but just not put into practice.

Windows XP Legacy

Those that have been around NHS IT for a while will remember the last elected labour government’s implementation of the National Programme for IT (NPfIT) tasked to deliver a standard national NHS IT system. Regardless of what is thought about the success or failure of the programme, it did leave a lasting legacy long after it was cancelled.

Not least with those NHS organisations that had progressed to implementing NPfIT systems and solutions and in doing so, had tied themselves to technology standards defined by the program that could not be easily changed. In the commentary on following the ransomware event it has been highlighted that the legacy of NPfIT Windows XP implementations was the reason so many organisations were adversely affected.

In September 2011, the government announced the acceleration of the dismantling of the National Programme for IT*. Whilst at the time the impact of this decision was not significant, because NPfIT technology was still current and thus supported by providers, it should have perhaps been better recognised that this state was not sustainable in the long term. Especially for Windows XP, because the next version Windows 7 was already available (released Oct 2009) and being adopted across health in non NPfIT legacy environment.

Things finally came to a head for XP when Microsoft announced that it would be ending its patching and maintenance support for the platform in April 2014. Thankfully in acknowledging that there was still a dependency on this technology platform, the government took steps and signed an extra-ordinary deal with Microsoft** that secured continued support for XP across the UK public sector for another 12 months.

Critically, a condition of this agreement, was that any public sector body wishing to take advantage of this extended support arrangement, had to commit to development of a “robust plan” to move off Windows XP, Office 2003 and Exchange 2003 within the year.

Roll forward to 2015 and the next government decision on the matter was just as they had advised, that they would be closing down this extra-ordinary support arrangement ***, and is has to be said for good reason, on the basis that it was felt that continued central government funding of this deal was not consistent with the need to encourage organisations to urgently upgrade or migrate.

The question here however has to be, “was it reasonable to expect trusts to be able to find the funds for wholesale upgrade of unsupported operating systems in such a short time frame (this being equivalent to a single financial year)?

To further compound matters at the time, NHS organisations had been shielded from the full cost of wholesale systems upgrade throughout the time of NPfIT. A national licencing deal with major suppliers like Microsoft, removed the need for software costs to be met locally by NHS organisations ****.

Straight Out the PRINCE2 Textbook

It is accepted best practice that when a pre-existing programme or project is to be closed down, an impact assessment of the consequences should be undertaken. Not least so that the risk can be properly understood and adequate mitigations planned. If nothing else there is nearly always a financial consequence to closing programmes and projects and this is a very good example of one.

The NPfIT programme along with central licensing deals transformed the model of IT investment within the NHS for a decade. Switching these off and closing down the national deals the programme created was inevitably going to have consequences for participating organisations.

Some will argue that the implementation of the extra-ordinary support arrangements for legacy software was an act of risk mitigation. However, was it reasonable in 2014 to expect affected organisations to plan and implement an upgrade or migration of XP in a single financial year, without any additional financial support being provided?

The NHS had already been managing financial pressures for a good number of years before the decision to end XP support was taken. Certainly long enough for organisations to flag this to be a risk of significance, that without additional and extra-ordinary financial support, there was no way they were going to be able to take the steps needed to address the situation accordingly.

In summing up, it is clear that although the NPfIT national licencing deals themselves had been closed down some years earlier in 2010, the impact of this decision on local investment plans going forward, was never properly qualified or understood, and that further opportunities to address this in 2015 were missed and all the way up to 14th of May this year, 7 years on!

Shout to the Top

As an acknowledged risk, the XP issue should have been raised on the Information Governance (IG) Risk Register and flagged as a serious concern to the Senior Information Risk Owner (who by now and as a result of improvements to NHS IG standards) was a role assigned to a senior management representative on the board of the organisation.

Additionally, given the dependence on technology in meeting clinical outcomes, the risk should have also featured on the Clinical Risk Register, which would have flagged it up to the Chief Medical Officer, also a member of the board.

Just a cursory glance at most organisations annual reports and board papers will expose the fact that IT barely gets a mention, certainly any reviewer will be hard pressed to find any mention of XP specifically in the dealings of the boards in any one of the organisations affected, at any stage of the timeframe of this being an ongoing concern.

This therefore exposes a potentially bigger issue in that information technology investment and dependence is not a matter adequately represented at the board level, then or now.

This clearly is a matter of concern, given as the recent event exposed the criticality of the services dependence on the information technology in the performance of its primary function, delivery of treatment and care.

Frustratingly some of the commentary on the event included the phrase “IT is not the primary business of the NHS”, suggesting therefore it is not the NHS responsibility to ensure the reliability and safety of the tools it uses to deliver care, this is clearly nonsense.

It is perhaps partly this attitude that has excluded proper IT representation at the board level? Given the next stage of investment required and proposed by “paperless at the point of care” and “integrated digital health and care plans” and additional dependence on technology this will deliver, it is now time for IT to have a seat at the top table.

Information Governance STILL Maturing?

The NHS has an excellent online tool and system of guidance and assessment addressing information systems, security and good practice management standards (NHS Information Governance Toolkit). The tool is well established having been around and in use for more than 15 years with NHS organisations status reports openly published and available for review.

In April 2014 in a blog article entitled Patient Record Access – A Perspective 2 Years On I set out the more fundamental data protection and information governance challenges that the NHS needed to address to maximise the benefits potential of digital engagement. Not long after the original 2015 target for achieving patient record access was deferred to 2018 and linked to the “paperless at point of care” requirement.

Then and still today, technology innovation is widely acknowledged and accepted to be the primary method by which transformation of current health and social care models, and opportunities to deliver service effectiveness improvements and efficiencies at a substantial scale (£20bn+) going forward is to be achieved.

NHS 2020 digital roadmaps across the country outline ambitious plans addressing technology integration and innovations requirements needed to achieving “paperless at the point of care” and “integrated digital health and care record”. The levels of investment are significant, but then so is the benefits potential. For the first time in the history of health and social care, the technology to support transformation to a more pro-active and well-being orientated model is possible.

Success however will be heavily dependent on the digital engagement of patients and their carer’s and how effectively this is achieved. In this respect information governance will be a key deliverable and factor in how much and how quickly the benefits of patient digital engagement are secured and maintained going forward. Patients will need ongoing assurance that digital engagement is safe, and that their right to privacy is being properly protected.

Of the 33 major NHS organisations (community and acute hospitals) identified to have been affected, all have reported a “satisfactory” rating in the information governance self-assessments completed in March this year, in particular for the following requirements:

Information Security Assurance
14-301 A formal information security risk assessment and management programme for key Information Assets has been documented, implemented and reviewed
14-307 An effectively supported Senior Information Risk Owner takes ownership of the organisation’s information risk policy and information risk management strategy
14-309 Business continuity plans are up to date and tested for all critical information assets (data processing facilities, communications services and data) and service – specific measures are in place
14-310 Procedures are in place to prevent information processing being interrupted or disrupted through equipment failure, environmental hazard or human error
14-311 Information Assets with computer components are capable of the rapid detection, isolation and removal of malicious code and unauthorised mobile code
14-313 Policy and procedures are in place to ensure that Information Communication Technology (ICT) networks operate securely


The recent CyberSecurity event serves to remind the NHS, that despite all the good work done in the development of the information security and governance standards and despite all the resources that have been provided to help organisations get good at this, there is so much more to be done, and this too is going to require additional investment at the local organisational level.

Links to Articles

* Gov Announces Dismantling of NHS National Programme for IT

** Government signs £5.5m Microsoft deal to extend Windows XP support

*** The UK government stopped funding Windows XP support to try and force people to upgrade

**** NHS loses massive Microsoft licensing rebate

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Future Health Summit

Future Health Summit

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Future Health Summit

Who Should Attend

24th May – Acute Services, Health Executives, Hospital Operators, ehealth, Clinical & Nursing Leadership, Payors, Providers,  Clinical Research Innovation

25th May – Patients Groups, Patients & Families, Community Services, Integrated Care, Mental Health, Life Sciences & Med Tech, Venture Capital, Personal & Corporate Wellness, Food, Public Health

Future Health Summit Agenda

The Future of Healthcare, the drive for more Personalized Care in the Digital Age

15 Summits, 3,000 delegates, 160 Speakers, Patient workshops, 120+ Exhibitors


Day 1 Day 2

Plenary Day 1 – Stimulate your thinking

Beacon Hospital Radio Surgery

eHealth Summit
VIP Dinner

Health Leadership Summit

Night Summit

Clinical Leaders Summit

Finance Leadership Summit

Dental & Oral Health Symposium

Plenary Day 2 – Stimulate your thinking

Future Wellness Summit

Homecare Summit

Life Sciences, Med Tech & Digital Health Summit

Neurology Summit

Directors of Nursing and Midwifery Summit

Oncology and Clinical Trials

Cardiac and Diabetes Summit

The Future of Health Care Your Vision

Corporate Benefits


Carefolk Workshop

Council of Clinical Information Officers Ireland Workshop

Neurological Alliance Workshop




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UK eHealth Week

UK eHealth Week

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UK eHealth Week

Returning to Olympia for the third year; e-Health Week is devoted to the people and organisations that use the power of IT to transform health and care.

Hosted by HIMSS, a global, not-for-profit organisation working in e-health for more than 50 years, and BCS – the Chartered Institute for IT;  the e-Health Week agenda is developed with the support of NHS England and NHS Digital.

With an overall theme of using data, IT and tech to transform health and care; a strong agenda will guide delegates through inspiring plenary discussions, informative workshops and practical tutorials.

Join more than 3,000 delegates to learn new skills, share ideas and bring your plans to life. It’s time to use the power of IT to transform patient care. 

View latest programme information here. Keep an eye on these pages as we confirm more content leading up to UK e-Health Week 2017.

Why attend

UK e-Health Week is the biggest and most influential e-health event run in partnership with BCS – the Chartered Institute of IT – and with support from NHS England and NHS Digital.

With an overall theme of using data, IT and tech to transform health and care; a strong agenda will guide delegates through inspiring plenary discussions, informative workshops and practical tutorials.

Attendees will:

  • Understand the implications of the two-year planning cycle linked to agreed Sustainability and Transformation Plans, supported by the established vanguard sites
  • Hear from health leaders and experts from industry with the best e-Health main stage speaking programme
  • Engage in panel discussions chaired by experts in data analytics, interoperability, e-hospitals, new commissioning, cyber security, leadership and genomics
  • Get the inside track from policy makers, strategists, chief executives, practitioners and patients
  • Learn from international exemplars and innovators
  • Celebrate healthcare IT as a key enabler in safe, effective and efficient health and care

What makes UK e-Health Week unique?

  • The only two-day e-health event with NHS England and NHS Digital acting as major contributors to the show
  • More CIOs and CCIOs than any other event
  • Free for NHS and public sector staff
  • Topical content including vanguard sites, STPs, roadmaps, Global Digital Exemplars, cyber security and paper free NHS
  • Dedicated sessions for key stakeholders including nurses, commissioners, GPs, clinicians, IT leads and directors
  • The largest number of senior speakers from the NHS than any other e-health event
  • A London-based event capitalising on the presence of relevant delegates and decision-makers
  • The first event in the new NHS two year planning cycle

Key themes for 2017

UK e-Health Week 2017 will tackle the challenges and opportunities in healthcare IT, including:

A digital NHS

UK e-Health Week will scrutinise the plans and roadmaps that NHS England and NHS Digital are putting in to place to make the NHS paper free, including:

  • A strong focus on the 12 Global Digital Exemplars – internationally recognised NHS Trusts delivering exceptional care and efficiency through the use of world-class digital technology and information flows
  • Cyber security
  • Interoperability
  • Driving digital maturity
  • The new Digital Delivery Board

Leadership and culture

The Wachter Review identifies CIOs and CCIOs as the key professional group to lead the NHS to a paper free future. UK e-Health week will explore:

  • The new challenges facing healthcare IT leaders
  • Emerging new customer profile and voice
  • How we put the patient at the centre of everything and leave no one behind
  • The new Digital Academy

Global success: learn from the best

UK e-Health Week will look at the countries, regions, cities and hospitals that use IT to transform the way they deliver healthcare. Hear from the people who’ve brought in whole system change, discover what the Global Digital Exemplar sites have planned and debate the future of population health.

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Patient Accessible Electronic Patient Records

Developing Patient Accessible Electronic Patient Records

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In November 2014 the National Information Board released ‘Personalised Health and Care 2020’ which sets out a framework to enable people to make the right health and care choices through ensuring citizens have full access to their care records and access to an expanding set of NHS-accredited health and care apps and digital information services.

This ambitious target will require all health and social care organisations to work together to develop patient accessible electronic patient and care records. This conference through case studies and in depth interactive sessions will share good practice from those who have already developed patient accessible and patient led electronic patient record systems in practice.

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Electronic Document Management in Healthcare

Electronic Document Management in Healthcare: Delivering a Paperless NHS

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“Implementing Electronic Document Management Solutions is a challenge, a major project and a substantial change to the way care is delivered but it is achievable, and others have achieved it and gained many benefits” Dr Masood Nazir Clinical Informatics Advisor NHS England, May 2014

Following NHS England’s committment to a paperless NHS, this one day conference focuses on a practical guide to delivering intelligent electronic document management in your organisation. The delivery of clinical care is no longer from a single place with a single record location but from multiple sites (including the patients own home) and the electronic record needs to be available in these multiple sites to improve patient care and aid clinical decision making in real time.

The conference outlines a number of different strategies for the implementation of EDM and discusses key issues including the legal framework and information governance. This will be complemented by practical case studies from NHS Trusts that have implemented Electronic Document Management in practice.

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Health records on your own Facebook-style page

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AN ambitious hi-tech £11m plan to allow any doctor or nurse to access a patient’s information from anywhere in the country is being launched by Islington health chiefs.

Patients will have their own Facebook-style  health records page or app, detailing all of their information, which they will be able to invite other people to look at from anywhere from “Cornwall to Scotland”.

eCulture Thoughts on Electronic Health Records

As a proposed solution eCulture certainly thinks it is a good way to go in so far as providing a patient consent based interface solution. The key will be however in what platform they build this to integrate with from an existing social network perspective. Or if they decide to establish their own, what additional functionality they would proposed to include beyond that concerning health to keep prospective clients engaged.

Electronic Health RecordOther fundamental aspects of concern, build out of the core infrastructures, taking into account the information governance and cyber security requirements, with the need to build in capacity for growth, this is not cheap, even from a start-up perspective.

Opting for a predominantly open source approach will keep costs down, but there will always be an associated cost incurred on a user by user basis some from commercial off the shelf (COTS) technologies, that cannot be displaced by open source alternatives and, subject to what functionality is provided associated increases in platform costs.


There is potential to offer certain services to clients on a subscription basis to cover this, but this is most easily addressed when the offering is from a commercial third party, not so easily implemented when the solution is being offered from an NHS body?

Affiliate revenues are another potential but considerable care and attention in how this is achieved has to be taken, i.e. if the solution is going to have in time an advertising affiliate revenue based model, then great care has to be taken in what is advertised, again more so if it is presented as an “NHS” solution.

Perhaps the business case at the end of the day can justify the investment and running costs be met by central government, on the basis of strong returns on investment achieved.

Information Governance 

When they launch it will be interesting to see what fair processing notice comes with the launch, if it is developed correctly with the right approach in terms of implementing a patient consent / data access assurance model then the notice becomes much less of an issue.

It’s all doable so one to watch for sure….

Article Links


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Patient Record Access – A Perspective 2 Years On

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peopleIn May 2012 I wrote an article (Patient access to GP Records by 2015) and offered some immediate thoughts on who would be the primary beneficiaries of this Department of Health mandate, with some thought on identifying the primary element of the patient population, access to medical information should be targeted at.

A little over two years on and with the benefit of additional insight from consultancy engagements with some very innovative and forward thinking solution providers, there remains much to be resolved if the target is to be met, especially with anything like a solution that delivers on the range of benefits that should be secured.

Current Focus Remains Narrow

Technology choice for electronic patient records (EPR’s) and patient record access is wide and varied, from traditional operational patient administration system providers, with these largely focusing on improving visibility and accessibility of clinical patient information operationally, to the more expensive and challenging to implement solutions that can integrate patient data from a wide range of operational clinical systems, from independent solution providers.

For the most parts investment in EPR technologies are currently health sector and organisationally specific, with current early phases of delivery focusing on clinical operational needs (data quality) and business performance improvement (QIPP), largely it is felt because these tend to be business case qualifications (QIPP deliverables) that are easier to define, over alternatives concerning wider benefits of patient engagement.

The technology to enable patient record access exists, and certainly with the right approach and focus, the target for enabling citizen access to at least key parts of their record remains achievable. There are however, some fundamental considerations to be addressed to move thinking beyond current operational focus, and onto the service transformation potential citizen engagement would deliver.

Patient (Citizen) Centricity

Citizen CentricA citizen view servicing “meaningful use”, requires the assimilation from multiple organisations, e.g. primary care, community care, social care, acute care and mental health, as well as systems, such as appointment management solutions, prescribing management systems, patient management systems and healthcare contact systems etc., especially when giving due consideration to the touch points across health and social care for patients for example with long-term chronic conditions.

This means that the maximum benefit to be secured by access to medical information can only realistically be achieved by a strong commissioning lead, and one that is capable of resolving the conflicting interests and competing requirements individual information host organisations will bring to the table.

It remains the case that the greatest benefit to be secured from improving patient engagement through provision of better information will be derived from engaging with those that are suffering from one or more long-term chronic condition, with which engagement succeeds in enabling patients and their carers to better manage the condition(s), to the point of reducing the numbers of calls and escalations occurring that require direct engagement of health professionals and any associated service provision.

Data Ownership Becomes a Concern

However, it remains the case that for this engagement to be most useful, the solution should provide the citizen (owner) with a mechanism by which they can consent access to the information, to members of their personal care circle (friends and family), citizens should be able to refine access according to need, i.e. allow some carers to see more of the record that others.

Inclusiveness, accessibility and security subsequently still also remain primary concerns, given the largest proportion of patients that stand to gain from engagement supported with access to health and social care information are those with long-term chronic conditions, a large proportion of which presently have limited engagement with technology.

Data Protection

Along with the issue of ownership, a further information governance concern arises from delivery of a single unified patient record, built from the assimilation of information from a multitude of operational systems managed by different organisations (data controllers), in that data moved into a new host, creates new data controller obligations and information governance responsibilities that can be difficult to align operationally.

AlertCritically new patient identifiable systems are necessary, such as a “Master Patient Index” for example, that enable different patient coding systems and identification methods to be unified, thus ensuring that data assimilated and presented is relevant to the patient concerned.

Administering a master patient index sitting in between a multiplicity of systems in different organisations would need to involve resources across all organisations, and in the process, would likely lead to an increase the range of access to patient identifiable information above and beyond current organisational focused remits.

Looking ahead, the range of benefits for all concerned increase when integration with social care information is incorporated but as before, concerns for data protection and information governance also increase.

Key to Resolving Ownership and Data Protection

DirectoryEstablishing a maintainable Master Patient Index (Citizen Directory Service) within a safe secure framework capable of accommodating the administration and multiple access requirements with the ability for the citizen to understand and appreciate the range of identifiers associated to them, with an ability to self-maintain appropriate identification attributes would provide for a solid engagement foundation from which service and bi-directional data flows could be managed.

Additional benefits to be derived from a self-maintained citizen directory include:

  • A range of health and social care data management needs that are outside of the current health and social care systems, these include:
  • Details on their personal care circle, family and friends supporting them and what level of care they provide, mentors, and additional support they may have contracted or secured privately from third sector providers and charities, support groups etc.;
  • Extending data flows for care plans, end of life plans, life stories, coping strategies, self-prescribing / medicating information;
  • Scheduling of personal health and wellbeing activities such as keeping fit activities and appointments schedules with third sector providers etc.;
  • Ability to link data associations from assisted living devices, tele-health and tele-care devices and solutions to that again may be acquired by patients by private purchases or through personal engagement with third party service providers.

These representing just some of the additional information that could be sourced directly from the citizen and / or their personal care circle that by virtue of association being known in the “citizen directory service” potentially provided back to health and social care providers to further help inform and shape the care delivery process.

Importantly, at this level the citizen (or person assigned power of attorney) is the data controller and owner of their information, thus resolving a significant data protection cost and engagement challenge for health and social care.

So What’s Likely in 2015?

The country is certainly more than one year away from securing the very significant efficiency, effectiveness and quality service improvements that could be achieved from patient access to medical information.

Perhaps not surprising given that since the announcement on patient access to medical records was made, there has been (and needed to be) a significant focus on the re-organisation of health care, that at best, patients will only be provided in 2015, with fairly rudimentary (read only) level of access to information and likely, primarily from just one source, the GP.

There is consequently the potential for a real and very significant problem emerging ironically from the re-organisation, which materialises from the devolution of control and responsibility for delivery down to a local level.

QueryThis because if it is agreed that a unified master patient index (citizen directory service) is a key foundation to progressing onto and integrated citizen centrically focused and bidirectional process of engagement, then this ought to be implemented to a national standard, and perhaps once?

Concluding Thoughts

With current technology supporting mobility for the population and rapidly emerging to support assisted living, tele-health and tele-care, the very process of caring and engaging in a patients care pathway / process is set to change dramatically.

Care closer to home is set to become a reality, technologies are emerging that can enable patient carers to become more engaged in the ongoing care process and management of conditions, along with technologies that also have the ability to increase levels of confidence for patients to live more independently.

Subsequently care, supported by the technology innovations emerging today, has the potential to become a true joint venture that engages personal care circles of family members, friends and personally engaged third sector charities or private sector providers of services and solutions with public funded health and social care service provision.

It is this potential that delivers the much need reform of the current health and social care model, certainly at a scale with potential to exceed achievement of £20bn of efficiency gains and savings.

Whilst there are benefits to initiatives having a local focus, so that variation in needs across communities can be accommodated there are some core elements that if not delivered as a national hub, must at least be supported by appropriate nationally agreed standards, addressing requirements such as interoperability, data / care pathway workflows to support engagement functioning across localities, however these are defined.

With that said, the patient / citizen user experience is another area for concern. With the potential benefits to be secure from engagement being undermined by patients / citizens experiences being widely different across the country, as features and capabilities vary as a result of variations in approaches.

But see, now this represents a case for some sort of nationally coordinated approach, and we’ve been there with the National Programme for IT (NPfIT), and if you believe everything you read that was a total failure, with nothing of any real benefit delivered.

But then maybe, the NHS SPINE, Summary Care Record and need for unifying the interface to offer citizens consistency in the engagement experience, if only there was an appetite to even consider the potential use of some of the NPfIT investments that did deliver?

What do you think?

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Digital Citizen Centred Healthcare Critical for Reform

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Citizen centred healthcare is part of a shift in focus which has drawn increasing interest in recent years, highlighting the importance of incorporating citizens’ needs and perspectives into care delivery. The citizen’s engagement with their care is now considered a key part of patient-centred healthcare.

Incorporation of health solutions addressing the Department of Health Digital First initiatives addressing patient engagement in particular, those identified initially with long-term chronic conditions as a first step, with delivery of health engagement solution that can reach the patients personal care circle, would provide a first significant foundation for service transformation to a patient centric service model.

As has been acknowledged in a recent Guardian article,

“Families are the biggest providers of care, yet carers can find themselves cut out of decision-making and bounced between bureaucracies.

If you care for someone and they need support, you don’t really care whether it is the NHS, a local council or nearby mental health services that provides it – all that matters is that it is the right support, on time, from a caring and well-trained professional

Better integration can solve that problem because it leads to the NHS, local councils and mental health services working better as a unit rather than as three separate entities. When services are integrated, all that matters is making sure that older, ill and disabled people and their families get continuous care regardless of their circumstances.”

The objective of integrated care is reflected in the NHS England mandate:

“An NHS for everyone, regardless of income, location, age, gender ethnicity or any other characteristic. Yet across these groups there are still too many long-standing and unjustifiable inequalities in access to services, in quality of care and in health outcomes. The NHS England Board has specific legal duties to tackle health inequalities and advance equality”.

“The Board’s objective is to achieve a significant increase in the use of technology to help people manage their health and care”.

Presently technology investments tend to be focused on filling gaps in operational information capability, electronic patient records investments being an example of note. Whilst these will make a positive impact on the operational efficiency of service providers, the focus of this investment is presently too narrow to facilitate radical transformation to a new service delivery model that better engages and supports citizens and importantly, those with long-term chronic conditions and their family members and friends operating in a carer role.


There is a large body of evidence that highlights “care closer to home” delivered by the provision of better engagement of citizen with their family and friends (carers) is fundamental to service transformation, at a scale sufficient to make a significant and demonstrable contribution across the health and social care “Quality, Innovation, Productivity and Prevention (QIPP)” agenda.

The Guardian article goes on to highlight:

“That in the worst cases, failing to support families can push them to breaking point and result in hospitals admitting both the carer and the older or disabled person. This situation is unacceptable but it is also preventable”

in a recent Carers UK survey,

“almost two-thirds of carers supporting someone after a hospital discharge said they had either been consulted late or not at all, and one in three carers caring for someone recently admitted to hospital in an emergency said that it could have been prevented if they had had more support at home”

Making The Case

This highlights one of the more significant well-being benefits to be derived from better citizen / carer engagement that can also make a very significant contribution for reductions in the cost of healthcare, by reducing for example the number of avoidable hospital admissions, a theme explored in a King’s Fund paper on (Dec 2010), which exposed a number of factors that were found to be associated with increased rates of admission, and therefore important considerations when targeting interventions with the objective of reducing avoidable admissions.

The Kings Fund report classified the consideration into the following categories:

Age; Social Deprivation; Morbidity Levels; Area of Residence;
Ethnicity; and Environmental Factors

The report recommendations that,

“Policy-makers should consider the impact of socio-economic deprivation and other socio-demographic factors when designing policy around admission rates”

The fact is these factors are equally important considerations for citizen / carer engagement.

Suggested approaches put forward by the Kings Fund paper towards identifying high risk groups focus on internal business intelligence (BI) approaches utilising the clinical knowledge base, notable threshold modelling and predictive modelling.

BI technology and capability investments are making important contributions to the remodelling of service delivery models with demonstrable progress already achieved towards Evidence-Based Health Care (EBHC), Pay for Performance (P4P), Diagnosis-Related Groups (DRG) of note, some of which are positively impacting costs through reductions in things like hospital admission rates.

The addition of a citizen centric dimension, with additional socio-economic deprivation and socio-demographic data inputs derived from engagement of citizens, their care circle and other third sector providers, charities and special interest local and national groups would greatly enhance the value of BI investments to provide a much stronger platform upon which service transformation decision making would be established.

Digital Citizen Centred Healthcare

Emergence of web and mobile app based technologies has provided a wide range of options for securing patient / citizen engagement with public services. Today a search of the Apple App Store for “NHS” will return a listing of 176 apps for the iPhone, and 44 for the iPad device, the Google Play App Store returns 155 apps for the IOS platform, some are the same apps, and some are not, a search on either App Store for “healthcare” generates a less than helpful greater return of results.

It is unfortunate however that the range of apps is beguiling, some are location or service provider specific, some relate to general information on services, some are condition specific, some are provider specific etc. etc., and makes for quite a wide and varied experience for the end user, with a wide variation in approaches addressing accessibility, presentation and most importantly privacy.

On the Internet the experience is just as varied and beguiling, and from an engagement perspective, services such as mainstream social networking platforms (Facebook, Twitter, LinkedIn etc.) are not able to offer the assurances on privacy and data protection required to underpin and maintain engagement, sufficiently to be utilised as collaboration tools on healthcare, beyond generalised messaging.

Exploiting Technology for Better Engagement

Unquestionably technology, and in particular web and mobile services are key enablers for engagement, service transformation, and the ability to offer a “choice for method” for engagement has some value. There is however merit in the unification of approaches, if the full benefits of engagement via mobile, internet and social networking services are truly to be secured, and at scale, quickly and for the long-term.

For this to happen, a digital citizen centred focus needs to be incorporated into technology investment considerations. This is important not only from the perspective of ensuring technology investment decisions are appropriate and aligned where necessary to engagement aims, but that also requirements concerning data protection and information governance, necessary to secure and maintain citizen and carer engagement, are also addressed appropriately going forward.

To be successful, any technology solution must also be highly scalable, flexible enough to support multiple healthcare transformation initiatives across multiple organisations and communities, seamlessly integrate multiple partners (interoperable), low cost and leave the public health and care providers in control.



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