Lauren Bevan, our Director of Consulting, reflects on Ethical Healthcare’s recent experience to set out what can be done to scale-up digital diagnostics in the short term.
In the past few years, Ethical Healthcare has supported a number of local and regional NHS organisations to develop their strategies and enterprise architecture.
We’ve encountered common challenges across all these geographies.
- There were uncoordinated systems investments resulting in data being locked in organisational (and supplier) siloes
- Records were difficult to find and identify reliably across sites
- Diagnostic image sharing was time-consuming and costly
- Tests were being duplicated unnecessarily
Regional diagnostics networks usually don’t always fit neatly into the geographical footprint of each ICS, compounding the difficulties of sharing the available data.
Our regional work – and particularly the South East region diagnostics strategy – was noticed by NHS England. We were asked by the Diagnostics Digital Capability Programme to produce a nationaldigital vision and strategy, providing a forward view to 2028. The Programme aims to accelerate the uptake of technologies that underpin the formation of regional imaging networks, promote safe, efficient sharing of data and provide a solid platform for future innovation, especially in exploiting research data and innovations in artificial intelligence (AI).
We’ve recently completed the first stage of that strategic work and it’s clarified our views on the future of digital diagnostics. Here’s what we think it will take to unlock precision medicine:
1. Get the digital foundations right
The money being spent right now on ‘foundational systems’ (centralised Laboratory Information Management Systems (LIMS) and Picture Archiving and Communications System (PACS) data-sharing infrastructure) needs to be spent wisely. The service should be actively discriminating against investing in systems that do not have collaboration and interoperability at their core. This is the cornerstone of any mature network – the ability to work across multiple systems and sites and operate as a network and not a collective of disparate trusts.
In some cases, the architecture required to support these complex networks needs the help of ICSs and even NHS England regions. What this implies is a whole new operating model – one where systems (capabilities) are shared between organisations and regulatory authorities, with clearly delineated roles/responsibilities and funding to pay for systems that flows between bodies as it should.
2. Standardise data in common storage and for exchange
Standards are key to getting collective working correct. In some cases, standards are well established but poorly implemented by suppliers. In some cases, there are competing standards whereas in others, the standards are only just emerging. Then there are the standards required for storage (highly structured and coded) and the standards required for exchange – yes, Fast Healthcare Interoperability Resources (FHIR), but higher category ‘patterns’ like IHE should not be discarded.
NHS England has a huge role to play here: we need leadership in selecting the correct standards to champion and develop – a selection process that can’t be done in an ivory tower, but by listening to the suppliers and our marketplace, by galvanising our whole community around those rallying standards. And then, through new frameworks and innovative funding models, to manage much more effectively suppliers that don’t conform to the patterns we’ve jointly established.
3. Establish a national data-sharing architecture for diagnostics
National services have a critical role to play here. If we can achieve the first two building blocks – essentially to establish consistency – we then need to open ourselves up for national data sharing. Only then can we ensure that there is a single, logical diagnostic record for our patients; a record that will follow our citizens around, ensuring equality of access and reduce the burden on the service through unnecessary testing.
Here we need, above all, a national diagnostic registry – a service that sits centrally, that contains a pointer to each piece of diagnostic information for patients, regardless of where it is stored. And an address by which that information can be retrieved in real time through those same open, simple information standards. Imagine how transformative a consistent national diagnostic record per patient would be. Imagine giving the power to patients to access and control it.
4. Harmonise practice around the patient
If the Covid-19 pandemic taught us anything, it’s the power of adversity to unlock innovation. Forced to reimagine how we’d deliver care, we came up with all sorts of new ways to engage and treat our patients – witness the Richard’s Review and how that’s jump-started Community Diagnostic Centres. Our patients are mobile, they are IT-literate, they are poorly served by joining the back of a long queue to be seen in acute care. And that is the adversity we’re facing: diagnostic networks struggling for capacity and a service that’s too oriented around place.
We need a push to reimagine diagnostic pathways. Not only do we need to standardise processes for efficiency across networks, but we need to bake in the latest innovations in terms of mobility, app-driven workflow and diagnostics at home – or at least, at centres convenient for our patients. And get patients involved in their own pathways! Why shouldn’t they be scheduling their own appointments or opting for home-testing equipment rather than going to the GP/local hospital?
This has happened much more effectively in other areas of the care pathway but the initial steps of screening or diagnosis are still steadfastly analogue.
5. Build a ‘virtuous’ data loop
In many ways this final pillar is the motivator and target for transformation.
Diagnostic data, properly controlled, is a huge boon to research; the insight from research can transform what tests are requested, the exams to be performed, and the diagnoses we come up with. Data should flow from diagnostics systems into research systems and then be pumped back into frontline systems to strengthen the knowledge and diagnostic capabilities of clinicians.
Here, we need to lean into the latest developments in clinical decision support, process automation and, of course, AI. Yes, there is a need to proceed carefully; no, we’re not going to scrap the need for human oversight and clinical safety appraisal. But building on the secure digital foundations outlined here, we can finally unlock the platforms to (cost) effectively deploy the latest innovations against a much more controlled and standardised hinterland of diagnostic data. A much more consistent, well-understood and supported diagnostic way of operating that ensures equality of access to our patients and a more manageable workload for our staff.
The NHS has the benefit of being publicly funded. Yes, there are inequalities and bias in the data but there’s a dataset from all, irrespective of the ability to pay. That is so useful in making usable diagnostic tooling and in getting a step closer to helping that system be the best it can be.
Get in touch
If you’re interested in learning more about our diagnostics work or discussing opportunities for collaboration in the healthcare sector, please contact the team at firstname.lastname@example.org.