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LSCITS in Health and Social Care

LSCITS Initiative researchers assisting in the improvement of national-scale health IT systems

THE USE OF lT in the provision of health and social care is increasing significantly, both in terms of medical devices distributed across a population, eg. smart pacemakers, and in terms of centralised IT systems that underpin or support healthcare, eg. electronic patient records systems serving hospitals. Increased use comes with risk: such systems are invariably large-scale and complex, may have faults and may be misused. As a consequence, the LSCITS Initiative has, since its outset, had a major commitment to exploring and addressing issues in national-scale IT systems to support services that provide health and social care (H&SC).

The UK National health Service (NHS) has been the subject of what is probably the largest non-military IT project in the world, spending more than £10 billion on IT systems that enable data to be digitised at the point of capture, integrated with historical data for a patient and displayed in a context-appropriate fashion for whichever practitioner needs those data.

Members of the LSCITS Initiative team have delved into the safety issues associated with the use of IT in h&SC, in collaboration with the NhS Information Centre (NhS-IC; recently renamed the health & Social Care Information Centre) and NhS Connecting for health (NhS-Cfh). An overriding issue with these collaborations is the lack of understanding regarding how the risks associated with deployment of large-scale complex IT systems in h&SC can be identified and addressed, and to understand the risk-benefit trade-off that comes with such applications.

The Initiative’s collaborations with NHS-IC focused on supporting the organisation in their technology mapping and improvement activities. NHS-IC had been given a new mandate, which included producing high- quality, evidenced and robust statistics and reports for the UK Government, and also delivering statistics and reports under commercial contracts. LSCITS Initiative members collaborated with, advised and supported the NHS-IC in the IT systems mapping and modelling activities that this change in mandate required. In parallel, they made use of these models to carry out exploratory research on failure analysis applied to business processes used within and without NHS-IC. These analyses were targeted at identifying potential hotspots, eg. delays in NHS-IC processes that could lead to undesirable outcomes.

The researchers also worked with the NHS-Cfh team on the topic of safety assurance of health IT systems. The work focused on two areas: first, they explored the use of existing safety engineering techniques and processes from outside of the health domain to support the current framework of Information Standards Boards guidance on the development and use of safety-related health informatics; second, they provided input on the evolution of the guidance provided and regulatory practice for the UK NHS in this area.

Through the NHS-Cfh collaboration, LSCITS Initiative members were able to work closely with Rotherham NHS Trust in the trialling and observation of safety assurance methods on a real case study. They were also given the opportunity to disseminate the findings of the work to senior staff in the Trust. In addition, two related workshops were organised: the first on ‘Dependable Systems of Systems’, and the second (more exclusively focused on the health domain) on ‘Connected Health’. The Connected Health workshop examined the safety assurance challenges associated with both medical devices and health informatics.

LSCITS Initiative researchers also undertook a series of policy analyses, using the NHS in England as a case study. These were the first analyses to give equal weight to developments in the delivery of healthcare and in digital technologies. Although findings from this investigation suggest that the merging of medical devices, communications and storage technologies has the potential to transform the ways in which healthcare is delivered, they also reveal that this potential is not currently being exploited. This is in part because health systems are locked into using existing systems, based on an outdated data processing model, and in part due to cultural resistance; for example, staff are more reluctant to share data with patients and with other public services than their counterparts in other countries. The researchers also noted that policy making is still undertaken in silos, with some policies focused on NHS IT, others on medical devices and yet others on the quality and safety of care. A radical overhaul of policy making is needed, so that the potential of new technologies can be harnessed effectively to provide new, more patient-centred ways of delivering healthcare.



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