NHS Digital in collaboration with techUK organised a timely event on 1st May 2018, part of the NHS 70th year celebrations. The NHS Digital team highlighted some of the medical milestones achieved during the last 70 years. It is our hope that this post will contribute to make the information accessible to a wider readership and encourage participation. These are some of the cutting-edge innovations, which the population across the UK continues to benefit from:

• The discovery of the structure of DNA, 1953
• The introduction of the Measles vaccine, 1968
• The first test tube baby, 1978
• The first liver, heart and lung transplant, 1986
• The first double-hand transplant, 2016

There have been technological milestones too.  In 1953, the first heart and lung machine was introduced.  As early as 1975, GPs began creating electronic patient records.  MRI scanners came into use in 1980. The Organ Donor registration scheme, introduced in 1994, has saved the lives of 50,000 patients and counting.

Advances in technology introduced remarkable innovations in medicine.  As technology increasingly plays a more significant role in our everyday lives, the initiative to migrate NHS services to a digital ecosystem is a logical progression. 

"Put power in the hands of patients to manage their health with the use of digital tools." 

James Hawkins, Director of Programmes, NHS Digital

James Hawkins noted that, as the NHS continues to drive and inspire health care innovation across the world, it is important to remember that it is a modern, agile organisation.  The five key areas of activity in the updated infrastructure will cover:

• Empower the person
• Support the clinician
• Integrate services
• Manage the system effectively
• Create the future

Child Health Information Programme and the Social Prescribing Model of Health Care:

Empowering the person is part of our work on the development of the Social Prescribing health care model. The Digital Dental Redbook is part of the Child Health Information Programme and will be available through locally commissioned child services for new parents. These could be provided by various NHS approved providers, early adoption pilots are being operated locally for faster uptake. To drive the delivery of the Digital Redbook, there is an early adoption intitative in three areas of the country (London, Bristol and Lancashire). New parents will be offered this service in these areas and the child health information will come from local integrated care serivces. We hope we will be able to assist with the early adoption of the Dental Digital Redbook as part of Food, Performance & Wellbeing, a collaborative project with Charlton Manor Primary School in South London, to monitor childhood obesity and dental decay.

Migrating to a Digital NHS

The first big step towards empowering the person will be the introduction of a sign-in service that will allow users to access their information and provide easy access to services. As highlighted by Adam Lewis, Programme Director of NHS Digital, face-to-face interactions are very difficult to replicate with technology. It is important that, within the digital ecosystem, the user journey must be user-centric. 

Given the sensitivity of the data held within the platform, a robust facility for checking and verifying identity is a necessity.  To register, users will be required to submit personal information, such as an NHS Number, a verifiable email address and phone number, and a photograph of a suitable identity document.  They will also potentially be asked to submit an image of themselves created at the time of registration within the app.  The information submitted by the user is then verified centrally and the user gains access to the platform. The cost for ID verification will be covered centrally, making the sign-in service free to use for patients and suppliers. This platform has tested relatively well during initial trials. However, a date for the platform to go live has not yet been established.  The private beta testing will continue for the rest of this year, with the public beta testing potentially being introduced towards the end of this year.

Another significant innovation that the NHS Digital team are tasked with is establishing the NHS e-Referral Service.  The project is being led by Dr Paul Denton, Programme Manager of NHS Digital. The e-Referral Service (e-RS) is key to the success of the NHS paper switch-off programme, which all sites will need to achieve by October 2018. Dr Denton relayed that forty-five sites have completed paper switch-off to date. 

Through the e-RS, GPs or practice staff will be able to email details of appointments to patients.  The e-RS will give patients the facility to book appointments online following a referral from their GP.  Clinicians will be able to review the details of referral patients at the point that the GP makes the referral, in advance of the patient booking an appointment.  Patients will be able to manage their appointments via the Manage Your Referral (MYR) application. 

Dr Denton stated that his team are currently working to enhance both the patient and the professional experience.  They are aware that the e-RS needs to be intuitive and user-friendly.  They are aiming to improve written materials for patients, accessibility, integration, and professional communications. The e-RS will also provide the facility for Clinicians to accept, reject or redirect referrals.  These functions, and how appropriate they are, are currently being assessed via early adopters of the service.  The service also offers the potential for incorporating other services, such as optometry.

A challenge faced by both projects is the security of patient medical records.  The digital ecosystem requires controls to protect patient confidentiality. As highlighted by Adam Lewis, these controls will need to be consent-based and GDPR compliant. In instances where referrals take place, patients need to feel reassured that only relevant information from their medical record will be passed on.  Having a consent-based digital system could create more transparency for patients. 

Creating the Future: Get Involved

Today's event included several representatives from INTEROPen, including Amir Mehrkar, Clinical Joint Chair of the Board of Representatives. INTEROPen are, "An OPEN collaboration of individuals, industry, standards organisations and health and care providers, who have agreed to work together to accelerate the development of open standards for interoperability in the heath and social sector." INTEROPen define interoperability within an NHS context as, "A health and care community through which digital information seamlessly flows."

Interoperability will only be achieved if health and care providers work together to collaborate on establishing open standards.  INTEROPen are currently developing the existing Interoperability Charter (which is currently running with well over 100 members - Rob Blay, Chair of Health and Social Care Council, techUK), informed and led by international standards.

One benefit of interoperability, as set out by Dr Simon Eccles (not present today), could be the introduction of a universal set of diagnostic codes across care. Dr Mehrkar emphasised that they are eager for health and social care providers to get involved.  He urged that this is a, "Real opportunity to get involved and drive the standards that you need." 

Post Contributor:

Caitriona Fitzsimons Digital Reporter