The UK's National Health Service has been warned to plan tech investments carefully, address data governance and quality concerns, and boost staff training to ensure IT benefits rather than harms patients.
According to an in-depth review led by digital medicine researcher Eric Topol and commissioned by the UK health secretary, in 20 years’ time, some 90 per cent of all NHS jobs will require some level of digital skills.
The report estimated that smartphone apps will affect more than 80 per cent of the workforce by 2025, while speech recognition and natural language processing, and automated image interpretation with AI, will impact a similar proportion by 2030 and 2035, respectively.
The Topol review considered how technologies like AI, robotics, digital medicine and genomics will change the roles of clinical staff, what skills those staff will need and how the NHS will have to adapt training.
The aim is to tie them in to the NHS Long-Term Plan, which was published in January and had a strong focus on using tech to improve services and widening digital access.
In order to ensure patients can "benefit" from technology, the review said NHS organisations should invest in their existing workforce, through continuous, flexible and on-going training. Culture and attitude at all levels – including at the board – will also be crucial.
For instance, it said that "digital medicine" – such as appointments by app or video – must be embraced by leaders, with boards responsible for the safe and effective wide-scale roll-out of such tech. The NHS should improve systems for organisations to share best practice, and review the regulation and compliance requirements for new healthcare technologies.
For patients, the increasing use of technology will shift care closer to the home, which Topol warned should not “dehumanise” care – tech and automation must not replace human interaction.
The review also said it was critical that any new tech is adopted “in a spirit of equality and fairness” and that digital healthcare should “redress not reinforce” existing inequalities – this means marginalised and vulnerable groups need closer attention.
Similarly, healthcare workers will need to build up skills related to data and analytics – they will have to understand data provenance, curation and governance, as well as issues related to data quality, ethics and algorithmic bias.
“Uneven NHS data quality, gaps in information governance and lack of expertise remain major barriers” to the adoption of advances in computing power and analytics, the Topol review said.
“The complexity of data governance requirements should not be a reason for inaction,” it added.
The next decade is an opportunity to address data governance and cyber security concerns, with the creation of ethical frameworks.
The review called for a binding code of conduct and a transparent information governance framework “to support the analysis of anonymised patient data by industry, as well as guidance to support the evaluation and purchasing of AI products”.
But the onus is not only on educating healthcare workers – the organisations themselves are told to make careful plans for their investments in technology.
“As it can take up to 10 years to realise cost savings, investment in IT systems, hardware, software and connectivity, as well as the training of healthcare staff and the public, will have to be planned carefully,” the review said.
Right now, Tesco has more sophisticated and more efficient systems than the NHS...
In a speech to launch the review, health secretary Matt Hancock – who has made tech his main focus since taking up the role last year – emphasised the need for inter-operable systems, consistent data standards and to make better use of the NHS' existing tech.
"Right now, Tesco has more sophisticated and more efficient systems than the NHS. They know who you are through loyalty cards, where you shop through store IDs, and what you buy through the items scanned at the checkout," he said.
"In the NHS, we don’t have anything like that. We don’t use common identifiers to identify patients, we don’t know which hospitals a patient has been to, we don’t know which medicines have been put into them. We don’t even know what we already know!"
He acknowledged concerns about security, privacy and consent for data-sharing, but quickly went on to say the NHS is "missing out on valuable information" that could make services more efficient and safer.
"A world in which a hospital can’t pull up a patient’s GP record to see the reason for stopping and starting medications is downright dangerous," he said.
Commenting on the review, Harry Evans, a researcher at health think tank The King’s Fund, said it was vital for staff to be able to use digital tools and understand the data they create – and agreed that senior teams are a fundamental part of IT adoption.
“If your organisation isn’t taking to digital it’s almost certainly because it’s being de-prioritised at board-level,” he said on Twitter.
Evans added, though, that there was also evidence that poorly-designed tech could lead to clinician burnout and low morale – staffers shouldn’t be expected to have to keep finding workarounds for kit the sector as a whole is poor at designing or implementing.
Relatedly, he said it was a “huge error” that the review’s terms of reference didn’t include non-clinical staff, pointing out their role in implementing the tech and analysing the data.
Evans also said the review could have done more to assess how rapid changes in tech could change the composition of the workforce and whether it would help the NHS deal with staff shortages.
It seems a big part of this review could have dealt with the question: will tech be part of the solution to soaring vacancies? I don't know whether it will or whether it won't, but feels like we need some kind of answer to this.— Harry Aagaard Evans (@HarryAEvans) February 11, 2019
In response to the review, Health Education England has set up a programme for 20 digital fellowships in healthcare, both clinicians and non-clinicians, to carry out training in informatics and digital health, with the aim of kick-starting careers as clinical information officers.
There will also be a workforce implementation plan, led by Dido Harding, which will aim to put the recommendations in the Topol review into practice. ®