Health Service Focus

The challenges of evolving technology and the paperless deadline

Jonathan McKee, governance manager at Tavistock and Portman NHS FT, and a co-chair of the London IG Forum, talks to NHE about the biggest challenges facing NHS IT.

The biggest problems in the NHS with regards to IT is “dealing with rapidly evolving technology and the implications for the safety of patient data”, NHE has been told. 

Jonathan McKee, governance manager at Tavistock and Portman NHS FT, and a co-chair of the London IG Forum, added that these challenges mean the system will require fundamentally different ways of thinking about “records management and handling information and data securely and safely”. 

Discussing the recent Wachter recommendations to extend the paperless deadline to 2023 for some trusts, McKee argued “it is all a matter of will”. 

“It started off as 2018, then 2020 and then 2023, why not 2025? Why bother at all?” he said. “If this this is the direction of travel, then it is the direction of travel – we can do it in our own good time. If it is imperative that we do it by a certain date then we should stick to the first date. There is no point in having a moving deadline for something that isn’t business critical or a patient safety issue.” 

Effective app assessment 

With regards to evolving technology, McKee spoke specifically about health apps and their exponential growth in the healthcare sector. 

“But what you can’t do is have an infinite number of apps, recommended by an infinite number of clinicians and organisations,” he noted, “without safely managing where is all this data going.” 

Instead, McKee reflected on the Tavistock Health Application Assessment Tool (THAAT), which was first developed at his trust, and then in conjunction with the London IG Forum. THAAT was set up to help inform prospective proposers about the level of risk associated with an application so that organisations can decide how best to proceed. 

At Tavistock no application may be used to process any personal data until it has been approved by the trust, and the organisation’s Information Management and Technology Strategy Board consider a THAAT report in conjunction with the proposal about an app’s features as part of the prospective asset consideration process. 

During the evaluation, the app is assessed and rated in several key areas: purpose; care pathways; evidence; evaluation tools within the application; patient safety; long-term compliance; corporate governance; and, of course, the security of patient data.

A score is presented in each section, and is added to the final total. The tool also automatically allocates a red (high), amber (medium), or green (low) score to each section, and to the assessment as a whole.  

“It is currently the only comprehensive approach that asks all the questions that you would need to ask about an application,” he said. “In the first place you need to decide what the need is for it, so it needs to be clinically viable before you recommend investing your organisation’s resources in setting it up. 

“Then the organisation, as a whole, needs to decide whether this is what it wants to achieve with the app and how the app will work with existing systems. The implications of bringing these apps on-stream are quite vast. Not least, none of the apps link to any of the current health records systems. 

“In summary, you need to know whether the app is going to help you clinically to the extent where you would change your practice and systems to work in a new way. That is quite a big ask. If that’s the case, you need to ask some sensible questions about who owns the app, where the data is kept, and how that links to the clinical record. If you have an answer to those things, and it is all very positive, it might be worth exploring.” 

App information for the NHS as a whole 

Asked whether the message around apps and their assessment from the centre is helping at a local level, McKee added that the “NHS as a whole is still getting to grips with this issue”. 

Speaking in his capacity as a co-chair of the London IG Forum, he noted that there are so many aspects to this issue, the complexity of which is the challenge. 

“There is the clinical aspect to it, the digital aspect to it, and there’s a data aspect to it,” he said. “They all have particular perspectives to consider when you are coming to a view about it, and there are many people engaged in exploring it, but as for the strategic direction, I don’t know where that discussion is being held. There does seem to be a lack of clarity over what the NHS trying to achieve.”

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