Ups and Downs of digital integration

Why do we struggle to make it sustainable?

I have been involved with a public health team in commissioning some brand new technology to do some innovative work in managing blood pressure.

It is a great idea - using Internet of Things technology which beams readings from a blood pressure monitor direct to patient records. No need for set top boxes and local wi-fi connections and no faffing about with wires, switches and connections.

The GP on the group thought that it was great in terms of potentially cutting down their workload and helping to streamline their hypertension pathway. The company that was awarded the contract was more expensive, but seemed to leapfrog other applicants in terms of innovation. This was one of the main rationales for the bid – to showcase the possibilities of technologies in care settings and to demonstrate the potential for quality, value and patient outcomes.

Sounds simple? In fact there are always a lot of bumps along the way and every project is a learning curve.

We know that all that glitters is not gold and that the devil is in the detail with these technologies, however we are still hopeful that someday we will get it right and that we just need to keep trying.

It is important that we learn from past mistakes and I do think we are getting better as a result; however it does sometimes seem as though the basics are not there and perhaps we should try and encourage more attention to certain key issues at the beginning of projects.

Here are some of the things I have learned:

  1. If frontline staff who are going to be playing a part in implementing and managing the system are not on board it makes life difficult and things may fail due to lack of engagement. If you think this is an issue in your organisations, sometimes a larger piece of culture work needs to be done. It is only human to be sceptical of new things and all NHS organisations have very different cultures. Don’t underestimate the time it takes to win hearts and minds.
  2. Do your sums about impacts and benefits before you take on new things. Even if it is flashy and looks great (there are some really lovely, well designed bits of kit around) make sure it really will meet your quality criteria and staff and patient acceptability. Make sure there are no hidden costs too!  Often systems which need to integrate with other clinical systems incur a cost.
  3. Make sure the project will save staff time. There is nothing worse with having to deal with lots of technical errors which means a disruption to services. The benefits need to outweigh the pain which might be involved with moving to a new way of working.
  4. Make sure any additional information coming into the system is well managed – there is nothing worse than a deluge of information which obscures the important clinical information.
  5. Make sure that the technology works with your existing systems and that there is not an elaborate need for workarounds. The simpler the system, the easier for all concerned.
  6. Make sure your information governance team has assured the project. Getting half way down the road to implementation, with contracts signed etc, only to be told the technology does not comply with information governance guidelines on data management, could derail the whole project.
  7. Make sure the technology is sustainable and there are plans that it will be picked up after a trial period if it works successfully. There is nothing worse than having to take support from patients and revert to original systems (unless the original systems were better of course!)
  8. Make sure technology is aimed at the right people. Sometimes it is people who are moderately ill who will get the most benefit rather than the more severely ill people.  Let’s not forget that for some patients, hospital and face-to-face care really is the best option.
  9. Get your patients involved with reviewing the technology – they will give you a valuable perspective.
  10.  Make sure you have the right level of commitment and support from your organisation.

We know that when done well, the right technology can facilitate patient activation and help longer term outcomes, so we owe it to our patients to keep learning and trying to get it right.

Dr Julia Reynolds

Associate Director & Head of Programmes




Posted by: Dr Julia Reynolds, on: 09 August 2017