Reflecting on his early days in medicine, at times with a wry smile, Charles Young talks of clipboards, trolleys stacked with patient files and the snail’s pace at which the hospital was able to operate.
Fortunately, times have changed and Dr Young – an emergency medicine physician at London’s St Thomas’s hospital and Group Senior Medical Officer for consulting and digital business services giant Capita – recounts just how much technology has transformed healthcare since he started as a medical student in the early 1990s.
“I think one of the biggest advances in healthcare has been digital access to patient results and medical history. So as just one example, I’m thinking about digital radiology.”
He said: “When I was a medical student there was this perpetual battle when it came to finding people’s x-rays, which often were either lost or weren’t where you needed them to be. The system and processes back then would require clinicians and medical staff devoting hours of our time to track down and locate vital patient information instead of spending time with patients.
“Being able to have those images, x-rays, CT or MRI scans almost immediately available on a desktop or handheld device, where I’m typing real-time notes into the patient’s record, is a massive step forward.”
What’s more, the digitisation of the process has aided clinicians to start benefiting from new technologies, such as artificial intelligence. Young doesn’t envisage a scenario, yet, where computers get to replace doctors, but the advances in machine learning (ML) – being able to detect irregular patterns in diagnostics for scans – is reducing the margin of error in healthcare.
“So that bit of technology of changing a radiograph from a physical thing to a digital thing has had a huge impact on workforce management and my ability to do my job on a day-to-day basis. But moving forwards it will allow us to use new technologies to make that process even more efficient.”
Like many technology players in the healthcare market, Capita is actively engaged in designing systems fit for 21st century patient care. One of the big challenges to overcome is connectivity, says Young, describing the issue as being the ability to collaborate and share data as the barrier to improved and integrated healthcare.
The provision of patient centred healthcare services is something that is tackled globally, every day. Across the world patients are being diagnosed, treated and supported as they cope with a range of conditions, from the rare to the more common, and yet we plan for and provide healthcare services locally and within our means.
“Without the ability to access and share data across all stakeholder communities, I think it’s really hard to deliver a holistic care service that’s focused on the individual and on the people that matter.”
He added: “When Covid happened it really disrupted everything, in almost every component of the healthcare system from a clinical point of view.
“From Capita’s perspective the same was true. I don’t think we should ignore the level of tragedy associated with it; it is and was an awful thing and has caused a vast amount of death and suffering, but one of the positives of the Covid pandemic is that it forced everyone to look at the system and say ‘hang on it’s not working as well as it could do’.”
As a result of Covid, some of the positive disruption resulted in changes to the way that systems interact together, and those gains are unlikely to be reversed.
At a wider societal level, there is also a recognition – an expectation, even – that digital systems have been integral to the way healthcare has functioned during periods of extended lockdown, in addition to people now accepting responsibility for their health and wellbeing.
In Scotland, Young argues the Scottish Wide Area Network (SWAN) is already a good example of data sharing across large networks; SWAN connects over 6,000 public sector sites in Scotland, including all NHS Scotland boards and bodies and many healthcare facilities.
It is that infrastructure backbone that has enabled Scotland to securely access and share digital data across primary and secondary care.
“Unlocking the data allows us to take a more people-centred view and allows us to use individuals’ skills better in a more appropriate way within the healthcare system. It also enables the journey towards a preventative, primary care-based setting.”
Moving forward, Dr Young would like to see an increasing focus on the intuitiveness of digital systems, so that they work at the point of use and do not require huge levels of technical knowledge on behalf of the user – whether that be a clinician or a patient.
He also supports the notion of more community-based healthcare – in line with the Scottish Government’s £1bn NHS recovery plan to focus on more “hospital at home” technology adoption.
In London, Capita has been extensively engaged with the Central London Community Healthcare Trust (CLCH), the largest community healthcare provider in the city. Capita manages and supports the trust’s innovation pathway and IT systems and processes, allowing an increasing number of people to get the care they need, where they need it, or as Dr Young calls it, “decentralising away from hospitals”.
It’s that focus – providing the tech backbone for virtual wards and remote triage – which is enabling the shift of more resource into the community, driving person-centric outcomes and better performance.
This strategy was highlighted in the NHS in Scotland 2021 report, urging all the relevant partners to work together and reduce delays in hospital discharges with the knock-on of so called ‘bed blocking’.
But is the adoption of these new tech-led approaches impacting the clinical safety of such systems, in pursuit of “efficiency savings”? Dr Young – who spoke at Futurescot’s Health & Care Transformation conference on 16 March – doesn’t think so. “One of the key elements of my role at Capita is to look at clinical governance, and I think we’re at the beginning of a journey with clinical governance and technology of this type.”
He added: “At Capita, we have a really sophisticated clinical governance approach modelled on the NHS but adapted for administrative healthcare processes and systems. “One of the things that makes me proud of the way we do things at Capita in healthcare is – because of our awareness and importance of what we’re doing – the safety of patients is paramount and you can ask anyone across our healthcare business and they will understand that concept.
“This, combined with our increasing ability to leverage secure data to gain insights and enhance decision making, along with policy makers now seeing the real value of data sharing and interrogation, makes me optimistic that we can turn the challenges of the post Covid recovery of NHS Scotland to the advantage of all those using healthcare systems.”
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