After the announcement by the Department of Health of plans to expand the use of digital technology across the NHS, the RCP welcomes the publication of Making IT work by the National Advisory Group on Health Information Technology in England, chaired by Professor Robert Wachter. The director of the RCP's Health Informatics Unit (HIU), Professor John Williams, discusses what the report's recommendations mean in practice.
The Making IT work report details careful analysis and reflection of the current state of digital integration within the NHS and sets out clear recommendations. Importantly, the report encourages the allocation of 1% of the budget already ring-fenced by the Treasury for NHS digital transformation specifically for the development and expansion of a clinical informatics workforce of trained clinicians across all trusts. This places emphasis on the requirement to increase the number of individuals with clinical informatics expertise looking particularly at increasing the number of chief clinical information officers (CCIOs).
The report is also clear in its assertion that clinical leadership and engagement is critical to the success of the transformation it details.
The report is also clear in its assertion that clinical leadership and engagement is critical to the success of the transformation it details. In collaboration with the Royal College of General Practitioners (RCGP) and the Academy of Medical Royal Colleges (AoMRC), the RCP is currently in the early stages of establishing the Faculty of Clinical Informatics (FCI) to develop and support the growth of this essential health discipline. We particularly welcome the clear emphasis on the development and enforcement of national standards for interoperability, the core elements of which are due for implementation in clinical NHS systems by 2020.
The work of the HIU
Since 2007, the RCP's Health Informatics Unit (HIU) has been working to develop evidence and consensus-based standards for the structure and content of patient records, handover documents and discharge summaries. These have been endorsed by the AoMRC, NHS Digital and the Professional Record Standards Body (PRSB).
The widespread introduction and embedding of records standards will support interoperability and improvements in clinical data quality. This will occur as a result of:
- reducing duplicate data recording and collection
- promoting greater professional engagement and data validation
- enabling data to be used more effectively on local and national levels.
More accurate clinical data for audit and research will also contribute to benefiting patients by facilitating safer and more efficient care, which is right for them as individuals.
Responding to the recommendations
The report notes the need for the design of systems to be user-centred. The RCP thoroughly supports this, but it is important to recognise the wide range of potential users. Trainee doctors are one group that are likely to present some of the most challenging requirements for these systems but, due to the nature of the environments in which they work, will have the least time to engage in the design stages. In order to mitigate for this, consultants and postgraduate tutors need to safeguard time to enable valuable input from trainees.
The final recommendation detailed within the report also highlights the need for a robust, independent programme evaluation. However, it should also be recognised that in order to ensure a successful and meaningful evaluation, there must be some financial commitment to support it.
Overall, this report sets out some valuable recommendations that policy and decision makers must take into consideration in order to facilitate successful integration of digital informatics technologies into the NHS healthcare system. We look forward to seeing a clear strategy set out for how this will happen and will continue to support the evolution of health informatics nationwide.