Wachter Review: Questions remain for digital health in England

The report from Bob Wachter and his team has finally seen the light of day, after several months of being held up by purdah and Brexit and the like. Was it worth the wait? Well, that depends on who you ask.

If you are one of the 12 exemplar NHS acute trusts that stand to benefit from £10m of tech funding announced by health secretary Jeremy Hunt in response, yes it does. That this list does not include Cambridge after its Epic implementation is a surprise, as it is reporting good progress. However, the hope of creating an Ivy League of digital centres of excellence, based on existing digital maturity, appears exciting.

For the next group, the one in three of NHS acute trusts who are ‘digitally immature’ but could implement clinical information systems, there is hope that you could get £5m in funding. For the rest of the acute sector, and others not ready to digitise, Wachter recommends keeping the purse strings firmly shut until 2020, when the phrase ‘digital health postcode lottery’ will no doubt be entered into the English dictionary.

For mental health, community, social care, and every other care touchpoint that the regions should be looking to address through Sustainability and Transformation Plans, Wachter makes no recommendations. The report does note, however, that this may cause issues:

“The lack of digitisation in the US outside acute care settings now presents a significant problem. For example, although hospitals and outpatient practices are largely digital, most nursing homes and mental health facilities are not. An effort should be made to wire the entire UK system, leaving no sector – including mental health and social care – behind.”

The glaring omission of social care was also picked up by techUK in its response, which said: “Without adequate focus and resources on the digitisation of social care, as well as genuine interoperability between health and social systems, we risk compromising the quality of care available to patients.”

A report full of positives
There is much good in the report, and it does reiterate the long-held knowledge that there are insufficient skills and investment in digital health, and setting unrealistic targets such as being paper-free by 2020 are deadlines for headlines, rather than a pragmatic approach to the implementation of digital health.

Wachter notes the productivity paradox of IT investment – returns can take up to 10 years to realise, and are not just financial. “In health IT, patience is a virtue,” the report notes. The NHS can struggle with patients, I mean patience. Business cases with a 10-year timeframe for return on investment for technology might struggle in the current NHS funding environment.

Good ideas include forging national frameworks with leading electronic health record suppliers which would be useful for all trusts (though it would appear some would not have the money to use them).

The professionalisation of the chief clinical information officer role is to be welcomed, as is the request for £42m investment in the digital health workforce.

Patient access to records is a positive feature of the review, although you would think that the days of us all owning our health record on a mobile phone or other device are not too far away. Home health hubs that share information on your wellbeing from the comfort of your own home are also something that could transcend the delivery of health and social care.

Will we need health records in acute hospitals soon, or will acute hospitals draw on information that we control ourselves?

The call for greater usability is good, although the statement in the review that the NHS does not possess the skills to judge usability seems a little odd. Out of 1.3 million staff, surely they could send someone on a course?

And interoperability, that old chestnut, is there again. Standards on sharing information in a legible form to as many as possible have been around for centuries – look at musical notation. So it is good to see there is a further call for interoperability to be important on designing information sharing mechanisms that are loved ones depend upon.

Wachter echoes McKinsey’s call for greater funding
Wachter makes a bold statement that current levels of funding are not enough – a statement heard before in the McKinsey report from April 2014. This called for up to £8.3bn in health technology investment to achieve savings of up to £13.7bn.

Wachter calls for the £4.2bn already committed by the government to focus on the early beneficiaries of funding, with a further amount linked to local implementation plans to follow in 2020.

Indeed, it is interesting to compare the McKinsey report and Wachter. Electronic health records are highly difficult projects but with high returns. There are others, such as vital signs technology, that are easier to implement and bring some reward.

The review is good, and is well worth the read. For many, the question that the report leaves you asking is ‘show me the money’.

But I would say its limited scope is a real problem.

The acute sector is an expensive provider of healthcare, and populations need health and care provision underpinned by robust and reliable digital infrastructure that makes delivery as simple and efficient as possible across multiple care settings, starting with the citizen.

So despite the best of intentions, the Wachter Review does not address this. It provides only a partial roadmap for the future of digital health and care in England.