Better information, better healthcare
With such high demand for medical care, and a lack of funding and resources, the NHS can understandably face difficulty in addressing long waiting lists, overworked staff, and congested facilities.
In 2013, NHS Digital was created to help ease the pressure through technology and innovation. D/SRUPTION spoke to Andrew Meyer, Director at NHS Digital’s Digital Delivery Centre in Leeds, to find out how the centre is aiding the NHS and improving care.
A dose of disruption
As part of NHS Digital, the Digital Delivery Centre (DDC) provides IT capabilities and infrastructure to the NHS. Through a range of different initiatives, the centre enables medical professionals to access high quantities of information, which – importantly – is of a high quality.
“The main aim, for us, is to allow healthcare professionals to do their job in treating patients efficiently and quickly with the right information in front of them when they need it,” says Meyer, who has worked at the organisation for over ten years. Our role in this is to improve the relevance of the national data and to simplify the process in which that data can be made available to those who plan, commission and research healthcare. This ultimately leads to rich data to drive decisions on the most appropriate delivery of care.”
The DDC came into being, Meyer explains, through a project called Spine. Spine is the backbone of IT for health and social care, joining over 23,000 healthcare IT systems in 20,500 different organisations across the UK. The system is made up of four components: summary care records, a demographics service, an electronic prescriptions service, and messaging. The first iteration of Spine was developed 15 years ago, and was run by BT. Now, Spine is run in house with open source software and agile delivery methods.
“There are summary care records stored for approximately 66 million people, including information about patients that is really helpful in emergency environments when healthcare professionals might not know much about an individual,” Meyer says.
Spine also houses an estimated 90 million demographic records, and around two million records pass through the electronic prescription service per day. The messaging component supports a further 17 million files per month. Meyer describes messaging as a kind of Dropbox for health which facilitates, for example, messages about blood test results between labs and GPs.
Before Spine, getting test results could mean waiting weeks for a physical letter. If a patient was unable to remember or physically communicate certain information, it could mean endless phone calls to previous surgeries and GPs – that is, if they could be identified in the first place. But today, thanks to Spine, this information is instantly accessible… And often it’s more important than finding out when someone last had a flu jab.
“Certainly, from a summary care record perspective, knowing that someone is allergic to penicillin is really, really important,” says Meyer. “It’s about getting information more quickly. Electronic prescriptions have also saved two million pieces of paper a day, which is significant.”
The DDC is also working on a National Record Locator system, which directly responds to the issue that arises from a lack of knowledge about patients during emergency care. The National Record Locator will allow professionals to find out whether someone has been treated for an illness at a certain location, which could be relevant for treatments they are having at the time.
Protecting patient data
Spine is a powerhouse of personal, sensitive data. Protecting all of this information is the Care Identity Service, which is a smart card and PIN given to healthcare professionals. There are currently 1.3 million registered smart cards which enable 400,000 user logins to Spine per day. The user’s level of access is determined by their role. So, for example, a receptionist would be able to access a patient’s contact details but not necessarily their clinical test results. This means that information can only be accessed by relevant parties.
As well as identifying patients and their medical histories, the DDC is also working to make it easier to verify individuals who work in NHS related roles. Currently, the centre is experimenting with blockchain for identity purposes. This helps to confirm that people are who they say they are, and removes the arduous process of providing multiple documents on multiple different occasions.
“Each time a clinician goes to a hospital assignment, they have to go through a process of proving their identity through documents and certificates that prove they have passed their medical degree,” says Meyer. “We are looking at whether blockchain can solve that problem so that you carry clear personal identification in your digital wallet that you can share. I think that technology has the potential to make that much easier.”
A talented team is ‘no accident’
If the headlines are to be believed, working within the NHS is no mean feat. As a result, recruitment and retention have suffered. For Meyer, building the DDC from an initial handful of employees to 600 people has been one of the centre’s biggest achievements.
“It didn’t help that we used to be called HSCIC – Health and Social Care Information Centre – which means absolutely nothing. It helps that we’ve changed to NHS Digital because people sort of get it,” he says. “What made the biggest difference for us was going out and talking to the community about what we’ve done and the technology we are using. People have accepted that we are quite far advanced in our technology and approach.”
Another important reason to join the DDC is that it offers a sense of purpose. If contributing to the health of the nation isn’t a purposeful occupation, then what is? Building a talented team is only part of the process though. Through flexible working and a range of different opportunities beyond the office, the DDC has created an engaging workplace that other organisations are keen to visit.
“It’s no accident that we’ve got this hub of talent,” says Meyer. “These people can work from anywhere and for anyone. We encourage people to take time off to learn about a new technology and bring that back to the team through tech talks, guilds, and stand ups. We’ve even got a coding guild.”
Collaboration is the cure
It’s clear that the DDC’s team are no strangers to trying new things. Taking risks – like moving Spine in house – has become part of the centre’s DNA.
“Learning, for us, is everything. We try different technologies, and if they fail, we try something else until we find the right path,” says Meyer. “The worst thing that could happen is that we build something that ends up on a shelf.”
Before the centre decides to take a specific approach, or experiment with a certain technology, teams are sent out into the community to gauge the needs of end users. This doesn’t just mean talking to patients – the DDC also sends representatives to observe how surgeons, for example, interact with the technologies that support them through operations. This encourages collaborative development and interoperability across the NHS, as well as building richer talent and resource pools outside of the organisation.
“We don’t work just in NHS Digital – we go out into the community and do presentations at places like DevOps Leeds and Agile Yorkshire, to share our learnings and get learnings from other people as well. That value is everything to us, to make sure we’re doing the right thing,” says Meyer.
This also means that the centre is able to provide preventative care, rather than reacting to problems as they arise. On an individual level, this might mean equipping clinicians with the data they need to decipher symptoms that would otherwise have gone unnoticed until crisis point. For a wider audience, the DDC’s National Pandemic Flu Service has been set up to deal with pandemics as soon as they occur, using an algorithm to understand the type of flu and how best to treat it before it spreads.
Through the work of NHS Digital and the Digital Delivery Centre, national healthcare has received a vital dose of disruption. Data driven, secure systems are fundamental to delivering appropriate care across the board, from the waiting room to the operating theatre. As the health service continues to digitalise, those who depend on the NHS both as a healthcare provider and as an employer will be all the better for it.
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