This week saw the second of May’s major healthcare IT events take place in the UK, Health+In4matics.

The timing of the show meant that it went virtually head to head with HC2012, which was held last week in London and has been in existence for more than 28 years.

The first show (HC2012), which is backed by both the Guardian and British Computer Society (BCS), appeared to have a more unique conference programme, with several of the health IT big shots taking up speaking slots as well as keynotes including Earl Howe, Jim Easton, Mike Farrar and Katie Davis. This attracted hundreds of the 1,500 attendees to packed conference sessions but perhaps away from the exhibition floor, which was relatively small in size but managed to draw in virtually all of the big players including Harris, Cerner, CSC, Allscripts, BT and Epic.

New kid on the block In4matics, which was supported by HIMSS drew in speakers including Dame Fiona Caldicott and Stephen Dorrell MP, as well as those well known professionals that regularly run the health IT events circuit. However, despite nearly double the floor space being taken up by exhibitors, the show’s focus appeared to be much more around SME’s and it saw fewer of the giants whose stands towered the halls of HC2012. Final attendee numbers are still to be announced but were clearly considerably lower.

While chitchat at these events is usually centred around what the activity is like in the marketplace, many conversations were dominated by which event had worked better, which had more delegates and ultimately, which one would survive, with many suppliers hoping common sense would prevail to provide one springtime super conference.

An answer already appears to be emerging… No sooner was In4matics over than it had placed a large advert on its website announcing the show dates for next year. On top of that, HIMSS and In4matics formalised their strategic alliance announcing that HIMSS has taken a financial interest in Citadel (the organisers of the show) to “provide a strong, integrated platform for health information technology events in the United Kingdom.”

However, with In4matics virtually set in stone for next year, it has also been interesting to see the announcement by HIMSS last week that a memorandum of understanding has been signed that will see HIMSS collaborate with the BCS to introduce HIMSS Analytics Electronic Medical Records Adoption Model in the UK.

So with HIMSS appearing to have its finger in a number of pies, we wait to see whether all those pies can come together to provide the health IT industry with one huge feast on an exhibition in 2013. My prediction…there will only be two key health IT events over 2013 and both will be in Birmingham!

Mark Venables, Founder member of One Health Alliance & CEO Highland Marketing

On the back of a bad week for the British economy where real growth is looking like a distant prospect with the news of double dip recession, it was nice to see lots of familiar faces (both NHS as well as suppliers) with an optimistic outlook at HC2012. I had many interesting conversations, some around disruptive innovations and some focused on business models, some about recent procurement decisions, all looking forward to the opportunity to participate in the much talked about change in the NHS.

The conference agenda was certainly interesting with a good mix of speakers and topics covering the national policy through to clinical engagement.

Jim Easton’s keynote was informative, his call for ‘Informatics to be a frontline service driving the integration’ and ‘making the information flow and empowering the people’ is welcome news for the informatics community. Further endorsement of this will be the clarity and commitment of some money for frontline IT on the back of the upcoming and eagerly anticipated Information Strategy. What is worrying is, there were repeated messages in his speech about budget squeeze; ‘the current efficiency savings being implemented across the NHS are a dress rehearsal for the next 20 years’, ‘it is going to get harder as we go on, we know we did the easier things first and if you look at the Chancellor’s budget, deep structural change is going to be with us for the next decade’.

For those that missed it, Tim Straughan, chief executive of the NHS Information Centre’s keynote made some predictions on the role of NHSIC in connecting up the primary and secondary care data and its new powers from 2013. He made an interesting reference to being allowed to handle the patient identifiable data, which was one of the key sticking points when the NHS reform bill was being passed. It will be interesting to see how the much talked about Open Data will enable the supplier community to commercialise some of this data?

I noticed there was still a lot of speculation about life after the National Programme and the role of the central agencies is still less clear in practice, particularly amongst the suppliers and NHS community.

I also found the announcement around the coming together of HIMSS Analytics Europe and BCS to bring the EMR adoption model to UK hospitals in order to allow the UK to benchmark itself against the rest of the world an interesting one, although, I would have liked to have seen more debate and engagement on the model at the conference. Perhaps this is only the beginning and more will be coming?

The question I was looking to get answered was around how SME’s are doing. Do they feel more engaged? Are they seeing more business opportunities? Is the landscape getting better for them? Though they certainly see improved engagement, informal conversations indicate that it is still the game of big boys. We all know that SME sector is important to the British economic recovery, it is equally important to keep the innovation going in the NHS and to the recovery of the NHS IT market.

Someone at the conference said, ‘a medal should go to Mike Sinclair for organising HC2012, and engaging the SME sector.’ I will vote for that and hope that enough is being done to keep the brand alive for years to come!  More engagement from all stakeholders and in particular SME suppliers and NHS decision makers will be the key to its continued success. HC used to be a conference that inspired; sadly I didn’t get inspired this year!

Ravi Kumar, Healthcare entrepreneur and chairman at ZANEC Technologies

Last month’s announcement by care services minister Paul Burstow that telehealthcare could save the NHS £1.2bn gave promise to the financially challenged NHS, however it appears to have stirred up a hornets’ nest!

Following a FOI request from publication GP, the Department of Health has blocked attempts to reveal documents detailing how the NHS will save this vast sum. The DH used the same defence as it did with the risk register, claiming that revealing the evidence could ‘inhibit future policy delivery’ and ‘undermine ministers’ and officials’ space for consideration and debate.’

The secrecy around this information does little to provide the NHS with the faith that it needs to consider telehealth as a real alternative to the systems that it currently has in place. Evidence for how telehealth can benefit the NHS is limited and the DH has yet to publish full results from its ‘whole system demonstrator’ (WSD) trial of the technology.

GPs and other experts have therefore backed calls to release the data fearing that telehealth – technology that tracks patients’ health – may not cut hospital admissions and could push more work on to GPs instead.

Despite the continuous pressure for more evidence to be released, ministers signed a ‘concordat’ with industry in January to provide three million patients with telehealth by 2017. This could cost the NHS more than £1bn.

General Practitioner Committee deputy chairman Dr Richard Vautrey said: “While investing in telehealth may superficially sound like a good idea, we’ve yet to see convincing evidence. The risk is that at great expense it gathers a lot of additional data from patients, creates increased workload for GPs, but doesn’t actually reduce admissions.”

Dr Deborah Colvin, City and Hackney Local Medical Committee chairwoman, added: “We need very robust evidence. The costs will be considerable and if we are chasing our tails coping with data that doesn’t benefit the patient it would be madness.”

David Barrett, telehealth lecturer at Hull University, said the £1.2bn figure may be a realistic estimate “if you deploy the right service for the right user in the right way’. But he said this was a ‘very big if’.”

It’s clear that without concrete evidence, provided by the Department of Health, it’s difficult to say how robust this figure might be. However, it’s likely to be based on numbers of consultations or potential hospital savings and some of the small-scale pilots that have been done. Can we really scale up these figures?

Telehealth is a disruptive technology and needs to be deployed on scale with call centre integration as well as combining other community services including a locally based triage centre. It appears that once we begin to realise these transformational changes (and cease to do the things we did before) only then will we realise the savings. What will not be acceptable, and this is supported by the GPs, is if implementation increases their workload for no additional gain.

Jeremy Nettle, Director, Global Client Advisor for Healthcare, Oracle and Chair of Intellect Healthcare Group

Earlier this week I attended a telehealth event that brought together a small number of suppliers to discuss the 3 Million Lives Campaign. The campaign, which aims to provide telehealth and telecare to three million people over the next five years, is still in its early stages with relatively few users and some way to go to convince trusts and commissioners that the technology is cost effective and can improve outcomes.

Attendees at the roundtable discussed a number of challenges for telehealth including standardisation, interoperability, commoditisation, cost and evidence, which was of course followed by the question of how suppliers can convince CCGs and trusts to purchase and provide telehealth solutions to their local population.

What struck me was that despite the key concept of telehealth being about empowering patients, giving them greater choice and encouraging them to take ownership of their health and conditions, there was little mention of the involvement of the end user.

Outside of my profession, most people I talk to about telehealth have no idea what it is, the best response that I get is usually “the red button elderly people have on string around their neck” or an iPhone app that does X, Y and Z.

In my mind, there is a huge amount of work to be done in terms of educating the patient about telehealth and its benefits. So far this has really been limited to a couple of national headlines that really focus on how the technology can help to redesign services and save money to the benefit of the NHS.

But surely in order for the uptake of telehealth to be increased there needs to not only be demand from commissioners in the NHS, but more so from the patient. There needs to be greater awareness in the public domain about how telehealth can impact the individual, improve their health and lifestyle and save THEM money from, for example, fewer trips to the hospital or keeping them out of residential care for longer.

Perhaps it’s not only time for telehealth to be making the headlines at a regional or national level on a more regular basis, but for a more front-facing approach where small telehealth shops take to our high streets with technology from a multitude of suppliers and experts on hand to give advice and demonstrations.

Although there could be issues around supply and demand here, which would need to be addressed, this could be a necessary step to truly educate the public and drive the demand from the people that matter most.

Sarah Bruce, Marketing Manager One Health Alliance, Communications and Digital Media Consultant Highland Marketing.

Earlier this week, health writer Roy Lilley leaked the long awaited risk register, which the government had fought a six month campaign against being made public.

Not surprisingly the register listed a number of potential risks that could see the NHS reforms lead to a loss of financial control and reduced productivity across the board.

But perhaps what many are surprised to see alongside risks such as design and implementation, is that technology and informatics are listed as three out of the 43 total risks on the register. In addition to this they are noted for their importance in ensuring the effective redesign of services overall.

The top risk categorised as ‘system design’ identifies that the ‘policy design for some aspects of the future organisation is incomplete, for example the future design of informatics comes too late to feed into the overall definition/architecture of the health bill.’

In addition to technology’s role in system design being a risk, the other key points relate to transitioning contracts and failing to secure basic IT infrastructure and tools as well as questioning how IT will support the new system.

In this context, the register’s over-arching concern is that following the reforms there will be new organisations with IT systems to support them rather than the transactions between them needed to support a joined up and integrated healthcare system.

It says this means there is a risk that “the enormous potential of informatics (the knowledge, skills, processes and technology which enable information to be collected, managed, used and shared to support the delivery of health and care and to promote health and well-being) is not sufficiently taken into account in the system design.”

One of the other interesting areas that is deemed a risk (interesting because the register was collated in September 2010 before the formal announcement to dismantle the National Programme for IT) is the obvious fear that the health bill could result in another type of national contract such as an ‘ICT Managed Service Contract’ that would have to be ‘superimposed’ to aid the transition through 2012.

The fact that IT is considered a risk in itself could probably be viewed as a negative thing. However, while each of these risks are valid, the reality that technology and informatics are referenced consistently throughout the register highlights how much the importance and profile of technology has been raised within the health service over the past couple of  years.

Just a few years ago, IT and technology was considered a nice to have and now it is an integral part in aiding service redesign and transition during the reform as well as supporting healthcare professionals and patients moving forward.

Mark Venables, Founder member of One Health Alliance & CEO Highland Marketing

After 14 months of extensive debate and more than 1,000 amendments, The Health and Social Care Bill will soon become the law. This law is expected to ‘Liberate the NHS’ and will give rise to a new NHS structure.

Despite almost two years of uncertainty around the Health Bill, change always brings opportunities to make things better. In the new NHS:

• GPs along with NHS professionals such as hospital consultants and nurses will be given responsibility for spending £60-80bn of NHS budget.
• Clinical Commissioning Groups (CCGs) will replace Primary Care Trusts and will decide on patient care, treatments and payments.
• All hospitals will become foundation trusts and will compete for treatment contracts from CCGs.
• NHS providers will be expected to bring in more competition on the basis of quality and safety.
• Local councils will play a role in health and well being including taking responsibility for public health aspects such as obesity, smoking and alcohol abuse. This will be led by a new body – Public Health England.
• The NHS Commissioning Board will become responsible in the ‘big bang’ roll out of the bill from 1 April 2013.

Massive structural change like this is never easy. 2012 is a big year for the NHS and pretty much all the foundation work for the new structure has already been done. Both the CCGs and NHS Commissioning Board will require significant support in establishing themselves and discharging their responsibilities, and the role of clinical support services will be key. Even with this bill in the New NHS, going forward, there are a number of points to remember.

• The NHS is still free at the point of use (in as much as it ever was). Despite speculation about the NHS becoming privatised etc, nothing seems to have changed on what will be charged.
• The Secretary of State is still responsible for provision of care in the NHS in England.
• Funding will still be an issue and that will continue to have impact on the quality and outcomes of care.

There is a lot of dissatisfaction and mistrust in the grass roots of the NHS and a huge amount of concern about the functioning of the NHS, which was clearly visible during the campaigns to stop the bill. Therefore there is a lot of work that needs to be done to rebuild the confidence that this reform will deliver what was promised.

Let’s not forget, underpinning all this reform is the QIPP agenda and the £20bn of savings to be made. In addition, the NHS IT Strategy is now handed over to the NHS Commissioning Board and we still await clarity on that.

That is the reality. Mandated change will bring plenty of new opportunity. Now the debate is pretty much over, time to get on with implementing the bill and make it work!

Ravi Kumar, Healthcare entrepreneur and chairman at ZANEC Technologies

I noted this week that the Centre for Connected Health is interested in evaluating sensors that may be used to detect and monitor changes in emotional states.

The effects of emotional stress on overall health are well documented and the Centre for Connected Health says it is committed to innovative methods of providing quality care, effective wellness programs, and clinical research.

Sensor-enabled tools that can support self-management of physical and mental health could provide a great opportunity for anyone developing or considering developing mobile devices in healthcare and an even better opportunity for those looking for a potentially cheap and easy way to improve emotional well being.

In fact, when I reviewed the papers on ‘The effects of emotional stress on overall health’, I was very surprised to find this piece of research:

“Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humour lightens your burdens, inspires hopes, connects you to others, and keeps you grounded, focused, and alert.

“So with so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health.”

Laughter is good for your health it seems:-

• Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress, leaving your muscles relaxed for up to 45 minutes after.
• Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease.
• Laughter triggers the release of endorphins. The body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain.
• Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.

So while we are all looking a different treatments, personalised medicines and healthy lifestyles to help us feel better, or more importantly, keep us in good health and reduce the burden on the NHS, perhaps we need to look no further than finding someone or something to make us smile.

If you think I’m joking, I may have just cured you…

Jeremy Nettle, Director, Global Client Advisor for Healthcare, Oracle and Chair of Intellect Healthcare Group.

The biggest HIMSS ever. Hundreds of exhibitors, 35,000 delegates and more technology on display than ever before. This was the big picture for HIMSS in 2012.

Numerous educational sessions were on offer to delegates. A big international stream was also a feature with workshops dedicated to the Nordic region and global challenges being newer additions to the programme. These offered interesting insights into themes and challenges in Health IT that span across the globe. There was a particular focus on measuring and evaluating return on investment and financial impacts of health IT within the healthcare environment.

Major themes at this year’s conference included: Mobility, interoperability, EHR / EPR, analytics, workflow, standards, health information exchange and finance. Many exhibitors focussed their displays and stands around these themes. There was plenty of overlap between exhibitors in these areas and realistically, there would be very little to differentiate offerings between many of the different suppliers.

I reflected on what the drivers were in relation to the exhibitions being focussed on these areas and the overwhelming trend was a focus on Meaningful Use and financial factors in healthcare. Vendors are targeting solutions and selling product based on their financial impact and their ability to assist providers to achieve Meaningful Use and other central standards.

But was there anything that was truly innovative and exciting – what was cutting edge? The solutions on display that met a true clinical or global health need were in my opinion the most innovative. Themes in this area were around RFID / RTLS (real time locating systems), clinical decision support, voice recognition tablets and population health solutions that hit the prevention agenda.

The products and solutions on display that were being driven by patient need and clinical need were probably 3-4 years ahead of the standard offerings. This was the key differentiator between good and great exhibitors.

Dr Lloyd McCann
Medical Director
Harris Healthcare Solutions, EMEA

It’s the customer that counts. With healthcare IT that means ensuring that the NHS, and private providers, can achieve their goals and deliver for patients. Unfortunately, as the regular tales of deeply troubled deployments prove, this does not always happen – undermining huge investments in time and money.

I would like to suggest a way forward. On the one hand suppliers need to have the integrity to advise customers on how to fulfill their real needs, rather than simply selling everything they can. On the other, healthcare organisations should take a good long look at their options. This can require a fresh approach.

There are three points that buyers should consider when choosing a supplier:

1. Do they have the proven ability to deliver solutions that do the job and which clinicians, and others, find good to work with?
2. Is the supplier agile – doing whatever it takes to ensure the customer can realise their goals?
3. Are they ambitious and creative – with a real determination to succeed?

I recently became aware of a case where someone was unhappy with what the big UK companies were offering and wondered if they should look to the USA. The jump across the Atlantic can be a big one, especially if you haven’t looked at all the small and medium sized suppliers in the UK and Ireland which have excellent IT developed specifically for local needs.

These are often companies that are already providing services for millions of patients and can readily handle health service needs. They are also the companies that survived years of being squeezed out by NPfIT specifically because of their ability, agility, and ambition. And certainly, if anything went to show that bigger is not always better, then it’s the national programme.

I have huge sympathy with any NHS organisation trying to determine where to go with its IT. In many cases the NPfIT experiment left them short of the expertise they needed to make the right decisions at a local level. Suppliers must pick up the baton and give genuinely impartial advice.

Not all legacy systems need to be replaced – some work fine, or should be gradually eased out. In other cases it may be best to concentrate on the basics first, ensuring there is a sound system for dealing with core needs like patient administration first, moving on to specialist applications later. There are even situations where a company knows that while its own products are ideal for most of a customer’s needs, there are others that would be best served by bringing in a partner.

Suppliers taking this approach build trust, and while no one gets everything right, they will give themselves, and the industry, a good reputation. They also need to look to the future. The best suppliers are there for the long haul and do more than just send out generic annual upgrades. That means ensuring that their products adapt to each customer’s needs – so their solutions are still delivering for many years to come.

Shane Tickell CEO IMS MAXIMS

Watching the progress and witnessing the government’s first defeat on its highly contentious plans to reform the health service, just a few hours after the Prime Minister mounted a passionate defence of the shake-up to the NHS, reminded me of a patient being diagnosed, operated on, discharged and then readmitted for the same condition!

With all the changes and opportunities that previous governments have experienced, the sad reality is that the health service, as it currently exists, is simply unsustainable. Spiraling costs in health and social care provision, due to extended life expectancy, being just one of the reasons as to why this is the case.

So is the bill good for us and should we just put up with the bitter pill in the short term? Perhaps it is just that the communication of the benefits has been poor or maybe it is a case of knowing we have to do something but this is all too much at a time when there are so many other financial restrictions.

The editorial simultaneously published by the BMJ, Health Service Journal and Nursing Times last week says that we shouldn’t accept the bill. It says: “the resulting upheaval has been unnecessary, poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings.” The publications suggest that parliament should establish an independently appointed standing commission “to initiate a mature and informed national discussion on the future of our national health system”.

So as the passage of the bill has been battling against ill winds, the focus is now on Andrew Lansley who has been widely criticised for its handling.

A No 10 source was quoted in The Times saying: “Andrew Lansley should be taken out and shot. He’s messed up both the communication and the substance of the policy.”

And so, the bill returns to the Lords, where it faces a mauling by peers despite the Government already making a string of concessions.

Lansley says the reforms will improve patient care, make services more accountable and cut bureaucracy. The changes will hand GPs greater control over the £60  billion budget to commission services and allow the private sector to play a larger role.

Health minister Simon Burns defended the reforms, saying: “By handing responsibility for purchasing services to doctors and nurses, we are shifting decision-making closer to patients and building on the trusted role GPs play throughout the NHS.”

He added: “I have met GPs in London who are looking forward to being able to commission services for their patients.”

However, it’s questionable whether those same GPs at the heart of the government’s policy, will feel it is most unjust if they are blamed for the potential failure of our local hospitals due to the enormous challenges that they face.

Jeremy Nettle, Director, Global Client Advisor for Healthcare, Oracle and Chair of Intellect Healthcare Group