With data growing exponentially and sophisticated technologies like Artificial |intelligence (AI) starting to demonstrate their potential, healthcare services have two powerful enablers of learning and improvement within reach – so it is easy to see why the learning health systems concept is gaining momentum. The challenge is putting this into practice at scale: embedding continuous learning and improvement into organisational or system processes, including through the culture and behaviours of staff at every level.
While we can see a growing number of examples where learning health systems approaches are being taken in the UK, they are not yet widespread or well developed. That’s where Health Data Research UK’s Better Care Programme comes in, which aims to support the development and scale of learning health systems.
As part of this programme, the Health Foundation is collaborating with Health Data Research UK to fund a series of projects to develop digital health tools, support knowledge management and create training modules for healthcare professionals. The Health Foundation is also leading work to shine a light on what will be required for learning health systems to take root and spread across the UK. Through desk research, interviews and workshops, we’ll be exploring key components of learning health systems, showcasing inspiring examples, describing what it takes to implement change successfully, and setting out what policies will be needed to support learning health systems in practice.
The critical role of technology – and the challenges of implementing it well
Health technologies and data tools hold enormous potential for enabling continuous learning and improvement and driving better outcomes for patients. For example, through identifying unwarranted variation in outcomes, enabling remote health monitoring, and supporting clinical decision making. And there is understandably plenty of enthusiasm at present to capitalize on this potential. The impressive pace and scale at which technology has been deployed in response to COVID-19 shows what is possible when teams are supported to make change happen.
The Better Care Programme Catalyst Projects are designed to demonstrate this potential, and are already showing promising results. For example, Project: AI-driven clinical decision-making tool to manage cystic fibrosis is using Bluetooth devices to monitor people with cystic fibrosis at home, coupled with an AI algorithm to predict when pulmonary exacerbations (the acute worsening of respiratory symptoms) might occur. The project has been able to identify signs within different health metrics that are indicative of a likely pulmonary exacerbation, which could help to minimize the number of routine check-up appointments, and enable resources to be targeted where they are needed most.
But while technology is an important enabler for continuous learning and improvement in healthcare, there is still significant potential to be realised, with some arguing that the NHS has fallen short of expected progress on digital transformation in recent years. If we are to narrow the gap between ambitions for technology and outcomes in practice, a focus on implementation and integration will be critical.
Seven key factors for health technology implementation
Implementation can be a challenging endeavour, one that shouldn’t be underestimated. While people often focus on a technology in isolation, it is of course the act of fitting it successfully into a real-world setting that enables the NHS to realise the benefits – which can take considerable time and effort.
To help people who are engaged in deploying technology in health care services, we have developed a framework, based on a literature review, and learning from both the Health Foundation’s improvement programmes and Better Care Programme projects, that describes seven key factors for the successful implementation of health technologies.
The interactive infographic below displays these factors: skills and knowledge; motivation and attitudes; user-centred design; ways of working; safety and equity; resources and infrastructure; and culture and leadership. Our framework aims to highlight some important practical challenges, grounded in real-world evidence, that can arise when implementing health technologies, and the actions that can help to surmount them and ensure success.
The interactive diagram below displays these factors:
How can teams be supported to get this right?
Given these multiple challenges, in order to get implementation right, teams will need support from their organisations to ensure they have the time, space, skills and resources to test and refine new technologies and embed them within services. Where technologies are ‘patient facing’, users will need support too, through training and awareness raising, so that they have the confidence and capabilities to use technology effectively.
There is also an important role for national policy makers to ensure the healthcare system has the support it needs to implement technology at pace and scale. This includes support for real-world testing and evaluation to show that new uses of technology are safe and effective for all.
Then there are the perennial challenges of ensuring the NHS has the IT, equipment and workforce it needs – issues NHS staff surveyed in a recent Health Foundation poll identified as among the main priorities and challenges for capitalising on recent technological progress. The next Spending Review for 2022 onwards will be an important opportunity to invest in the human and technical infrastructure the NHS needs to realise the potential of technology-enabled care and develop effective learning health systems.
Of course, investing in technology and implementing it successfully is only one of a broader set of challenges for learning health systems. Other issues we’ll be focusing on as part of the Better Care Programme include embedding a learning culture, improving access to and quality of data, and developing patient-centred learning communities that bridge the gap between research and practice – you can keep in touch with our work here. It’s only by making progress on all of these fronts that we’ll realise the potential of learning health systems to achieve better outcomes and experience for patients and staff.
Health Data Research UK and The Health Foundation will be publishing further updates on other important themes for Better Care throughout 2021.
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