Fighting the monolith: Digital Health in the NHS

This week I attended a Digital Health Oxford event: Digital Health in the NHS - a Big Picture View, there were two speakers: Tracey Grainger, Head of Digital Primary Care Development at NHS England, Dominic McKenny, Chief Information Officer at Oxford Health NHS Foundation Trust. As the title of the event suggests, both spoke about how digital technologies were being adopted in the NHS, and the ambition for using them more widely in future.

Both talks covered electronic health records (EHR). This is a contentious issue in the UK after the government’s infamous attempt to introduce a range of centralised health systems within the NHS resulted in a estimated cost of ￡20Bn, large profits for global consulting firms, and a failure to deliver most of the services it had promised.

During the Q&A section, an audience member asked Tracey Grainger the inevitable. “Given past failures, what makes you think you can make it work this time?” Her answer was encouraging. Without wishing to misquote her by paraphrasing, it was along the lines of: “This time we’ve realised that one overarching system is not the answer, we need lots of smaller systems that do specific jobs, and for those systems to be able to talk to each other”. Likewise Dominic McKenny’s presentation covered the benefits of not locking down employees’ devices and allowing them the freedom to use the digital tools they need, and ended with one of those familiar 'ecosystem' slides showing lots of different digital platforms all talking to each other. 

Fighting the digital monolith is something I have spent a fair amount of my time doing. Side-stepping the monolithic content management system to deliver a web app that actually works, fighting with the monolithic CRM system to provide data that actually means something, accommodating some ancient device or software platform an organisation’s embattled users are forced to use. It’s an over-asked question, but how can digital innovation happen in an environment like this? And it's not just a problem for the NHS, corporations suffer from exactly the same issues.

Centralisation is attractive to large organisations and their IT departments, and for good reason; mitigating fragmentation, controlling security, and economies of scale are just some of the benefits of a singe monolithic approach, and there will always be parts of the digital landscape where a single system is the best solution. But ultimately the forces of centralisation are fighting a losing battle against the biggest force of decentralisation the world has ever known - The internet. It’s very encouraging that the NHS is beginning to recognise this new networked reality, and is trying to forge a path within it rather than trying to fight against it. Let’s hope this signifies the beginning of a new era.