NHS patients with long-term illnesses could soon be able to be monitored remotely through high-tech gadgets that will link directly to their medical records. Within five years, patients across the UK should be able to speak to their GP online via videolink, order prescriptions or see their entire health record instantly. Nic Paton speaks to Beverley Bryant, NHS England director of strategic systems and technology, about the progress made in digital innovation in the NHS so far, and what changes will need to be made to meet this target.

"I want patients not just to be able to read their medical record on their smartphone, but to add to it, whether by recording their own comments or by plugging in their own wearable devices to it."

Science fiction? No, this was UK Health Secretary Jeremy Hunt in September, setting out his vision for how the NHS can better use technology to serve, diagnose, treat, care for and communicate with patients.

Indeed, Hunt argued that by next year he wants all NHS patients to be able to access their own GP electronic record online in full, seeing not just a summary of their allergies and medication but blood test results, appointment records and medical histories.
By April next year, he wants all clinical commissioning groups (CCGs) to have submitted plans for how they intend to eradicate the use of paper in the treatment of patients across all health and care services in their region by 2020.

By the end of next financial year, he wants a quarter of smartphone users – 15% of all NHS patients – to be routinely accessing NHS advice, services and medical records through apps.

By the end of 2018, Hunt wants all doctors and nurses to be able to access real-time patient information across GP surgeries, ambulance services and A&E departments, wherever in England their patients are.

Heady stuff. It is potentially a profound technological transformation for clinicians and patients. Beverley Bryant, director of strategic systems and technology at NHS England, says that Hunt’s plans are certainly ambitious but they are not unrealistic.

"My goal is to get the NHS to the level of digitisation that most of us already enjoy in our everyday lives. Many of us nowadays shop, bank, book tickets online and so on. Our interaction with the NHS should not feel any different," she says.

"I, for example, have a repeat prescription for an asthma inhaler. So the ability to be able to go online, click and collect in a manner that is convenient to my lifestyle – and be able to see the trail back – is important," she adds.
The ambitions outlined above are all of part and parcel of a wider technological transformation agenda set out last year by the NHS National Information Board (see panel), where the focus is on creating a much more personalised, joined-up – as well as a more efficient – healthcare system, explains Bryant.

"Within the NHS, technology already underpins everything we do; how patients, staff and clinicians engage and communicate with each other, diagnosis, treatment and so on. But this is about transformative change," she says.

"I am excited about it; the scene has been set for the past couple of years. One of the great things is that we have the same secretary of state we had before the general election, who has a strong feel for technology and for whom technology is a high priority. So the direction we are going in is quite clear now, we have a clear run. The strategy and the forward view are very much aligned," she adds.

However, while the general direction in which to move may now clearly be mapped out, the focus is slightly different between primary and secondary care, Bryant says.

"Within secondary care, we are absolutely committed to getting people off paper and on to electronic records. We want to help the clinical staff better manage workflow and manage their wards and better enable them to do their job of clinical diagnosis," she says.

"Through the use of digital records and digital technology we can help them to know better what is happening when a patient presents, and what has already happened up to that point. So, rather than having to go into everything again, to repeat things or write things down over and over, they are instantly able to access the information they need.

"Within primary care, that job – electronic records – has largely already been done. All patients are now on electronic records; they have electronic discharges and summonses. So where we are focusing more is the interface between primary and secondary care and, from there, pushing the technology into the hand of the patient. What we want is for there to be a two-way dialogue between the patient and the GP.

"Ultimately, our ambition is for the whole NHS to become a modern service technologically. It is about the NHS being able to talk to itself much more effectively," she adds.

Existing communication
However, Bryant is also at pains to emphasise that this does not mean existing communication and access channels are to be discontinued. Indeed, given the fact we have an aging population, and that the NHS’s time and resources are spent on managing the health needs of potentially less technologically savvy older generations, this is a vital point to make.

"One thing that is very important to stress is that it is not about stopping the current way that patients interface," she says.
"If someone wants to turn up at their GP surgery or use a paper form, they still can. But for a lot of people these days, people who have access to online tools and are happy to use them, it is about being able to do and access things online, should they so wish. And in the process, that frees up time and capacity; it allows those who want to see their GP face to face if they need to," she adds.
Another key question in all this is how robust and secure this brave new technological world will be?

Hunt, in his speech, moved to reassure patients and clinicians alike by announcing a series of measures to run alongside the technological elements of the programme.

National data guardian
These include a review of standards of data security for patients’ confidential data across the NHS, to be carried out by the Care Quality Commission.

Dame Fiona Caldicott, the NHS’s "national data guardian" for health and care, will also develop guidelines for the protection of personal data against which every NHS and care organisation will be held to account, Hunt says.

"She will provide advice on the wording for a new model of consents and opt-outs to be used by the care-data programme, which is so vital for the future of the NHS. The work will be completed in January with recommendations on how the new guidelines can be assured through CQC inspections and NHS England commissioning processes," Hunt says.

On top of this, Caldicott’s independent oversight will be strengthened and put on a statutory footing, making her role similar to that of the chief inspector of hospitals – a change the government intends to consult on over the autumn, Hunt adds.

Vanguard of health
While there is clearly a lot to achieve, Bryant is confident this agenda will mean that not only will the NHS catch up with the way most of us live our lives today technologically, it will actually put it in the vanguard of the way health interfaces with technology and vice versa, and ahead of health systems such as the US.

"I actually think, certainly within primary care, we are now ahead of the US. Because the US is not a national system, providers have a responsibility only to offer care where they are located. So, when it comes to transferring information from provider to provider, that can be problematic.

"The US is very keen to learn our lessons, especially around things like our focus on effective and meaningful use of technology," she says.

"Within the NHS, there is now an opportunity because of web technology development to embed this as part of the infrastructure, to make it just a natural part of day-to-day operation, make it a normal part of the way the NHS works.

"I certainly don’t think the ambition is too futuristic – everything we want to do is already being done in parts of the NHS. So it is just about spreading and joining it up; making it ubiquitous," Bryant adds.