Andy Kinnear, former NHS CIO and now Independent Consultant, reflects on the dramatic advances in AI in the healthcare sector which he has witnessed at recent conferences and meetings. The possibilities which the technology offers are undoubtedly exciting but are the discussions on ethics, standards and security falling behind?

AI brings amazing opportunities

The Artificial Intelligence revolution is phenomenal. AI has so much power within it to enhance all our lives and particularly so in healthcare, but the debate about where lines get drawn on what we could do versus what we should do is only just beginning. The discussion on ethics is running behind the headlong rush to harness, and profit from, the technological developments.

In recent months I’ve attended health tech conferences in the UK, Germany and The Netherlands which have been totally dominated by the latest advances in AI and the new AI solutions being showcased by vendors. I’ve seen some truly amazing and exciting developments which can definitely be categorised as for ‘the good of humankind’. It’s also evident that these developments, in the hands of bad actors, could be used inappropriately. Discussions on ethics, who can access AI systems and data, and the emerging cybersecurity issues, seem to be lagging behind the drive to harness opportunities.

From ‘Creepiness to Convenience’

In May 2024 at the North West Connect Conference in Blackpool, author Sina Kahen spoke on the need to broaden the debate on AI and ethics to involve non-technical people such as philosophers, futurologists, politicians, religious leaders and academics. Such groups could challenge the boundaries of debate and bring new perspectives to help plot routes through AI’s ethical conundrums.

Especially interesting was Sina’s description of the ‘Creepiness vs. Convenience’ journey which most technology goes through to gain adoption and acceptance. For example, smart speakers, which have rapidly moved in perception from ‘creepy spies in the home’ to widespread acceptance because of the benefits they provide. The ethical issues are still there but are now largely ignored because of the convenience delivered. Can we afford to allow AI in healthcare to jump from creepiness to convenience before we’ve identified and debated the serious ethical questions?

Finding the balance between rapid benefits and enduring ethics

In June I visited a health tech conference in Munich and then HLTH Europe in Amsterdam. Both events were dominated by AI offerings. With AI the latest marketing buzzword, every vendor had an angle on AI. Everything was AI-driven or AI-powered.

For once the possibilities opened up do seem to live up to the hype. Generative AI and the ability to process vast volumes of data at unbelievable speeds are really incredible. I attended one presentation where two large pharma companies spoke of how their ability to do the analysis needed in new drug development was currently limited by the number of scientists available, whereas in the future AI can go way beyond human capacity enabling research to move to a whole new level, speeding up the delivery of new drugs.

If AI expedites the development of new cancer treatments or speeds up discoveries that could deal with dementia or diabetes, it could transform the healthcare sector, benefit the whole of humankind, and make good business sense… and profits. Such transformations would relieve some of the current crushing pressures on healthcare services around the world too.

Ethical debates need to be wide ranging and out in the open

AI is likely to deliver tremendous benefits and relatively soon. However, the more I saw and heard, the more I thought about ethical debates in the past about healthcare innovations and how the current introduction of AI was creeping up on us without discussions on ethics becoming far reaching and high profile. Previous debates, for example, on advances in genetics which may have resulted in designer babies, made front pages and TV news reports. The debate about the genetic recoding of a fetus in the womb to prevent potentially life-limiting conditions vs. the ability to design the ‘perfect look’ by changing hair and eye colour was had in the glare of publicity. Who is asking the pertinent questions around the introduction of AI into pharma and healthcare?

At the same time, I thought that in the last 200 years the human race has managed to continually progress in the development of medication, and by and large this has been done in a safe, secure and morally sound way. Why should the take up of AI be any different? Am I panicking unnecessarily? Probably not based on the technology focus of the events I’ve attended.

The 4th Industrial Revolution

The two European conferences were dominated by the technical aspects of AI, with no discussion of the ethics. The presentations were all by people who were really excited about what they were developing and how we’ve reached a revolutionary moment. There was plenty of evidence given to back up these claims.

Russ Branzell, President and CEO of CHIME proposed that we are now within the 4th industrial revolution. Most of us, it seems, are still struggling with the implications and challenges of the 3rd industrial revolution which saw digital innovations usher in the Information Age. Technological advances are coming so quickly with AI that the 4th industrial revolution is already upon us. Is it any wonder that we’ve little time for the in-depth ethical debates as we’re pushed forward by, on one side, rapid technological advances, and on the other side, the very real pressures in the healthcare sector post-COVID?

Some groups are grappling with the ethical questions. At an event held by the British Computer Society (BCS) where I welcomed a group of clinicians who have become members, I spoke to the BCS CEO, Rashik Parmer about the challenges of AI. The BCS has already done a lot of good work on the ethics of AI and has produced a white paper on how to create professional standards for this area based on a survey they did on the topic in 2023. They have also developed an education programme for leaders in healthcare who want to be qualified in AI decision making.

Vendors have a role to play

Solution vendors, be they new AI players or existing suppliers building AI into their products, have a key part to play. Responsible vendors must stand by their ethics and morals and help drive industry-wide adoption of standards. If not, the nascent sector could be plagued by irresponsible organisations just as we saw at the birth of the internet and more recently with the explosion of crypto currencies.

Similarly in the field of Big Data, where, for example, in the 2010s we saw Cambridge Analytica apply powerful new technologies in less than ethical ways, harvesting the personal data of up to 87 million Facebook profiles to be used for political advertising. There needs to be a call to arms across the vendor community so they all behave in an ethical way that, by all means, makes a profit, but does so in a responsible way.

Imprivata, for example, has a key role to play as its applications help control who has access to what systems and data, and can provide the audit trail of who did what to whom, when. This becomes increasingly important as AI could open the door to new cyber threats.

AI brings increasing cyber threats

As AI gets ever smarter and more ubiquitous, the abilities and opportunities of bad actors to threaten and do actual damage in the healthcare sector grows exponentially. At the time of writing the effects of the recent cyberattack on the Synnovis pathology service, which had major impacts on NHS in South London, rumbles on. The issues were largely around the provision of test results and the scheduling of appointments. Imagine the impacts if there was an attack in the future on AI applications much more deeply embedded into healthcare service provision such as diagnosis and selection of treatments?

The global IT meltdown caused by the CrowdStrike software bug, though not a cyber attack by third parties, has shown the whole world how we rely on computer systems which we take for granted and are largely invisible to us. Hopefully this provides a wake-up call just as AI becomes more deeply embedded into systems which are in turn built into critical healthcare provision. Up to now cyberattacks have largely been about disruption and financial gain. In the future the issues could truly be about life and death. We must grasp the nettle and rapidly focus on ethics, standards and security as AI becomes rapidly embedded into the heart of the healthcare sector.

As the next general election approaches, there is change on the horizon – but also reduced certainty and a lack of focus from politicians on detailed delivery over the next few months. Andy Kinnear, former NHS CIO and now Independent Consultant, looks at four major ‘ocean currents’ which are shaping UK healthcare whichever party comes to power and whoever becomes the next Secretary of State for Health and Social Care. 

The state of the NHS is in the UK public’s top 3 issues

With the next general election set for 4 July, we are seeing politicians distracted by their own futures and campaigning, rather than detail and delivery within government departments. In particular the NHS finds itself in a state of limbo yet it will constantly be in the spotlight as politicians publish their manifestos, make health and social care commitments, and hit the campaign trail.

There are frequent polls as to what the voting public see as the key issues which will shape their voting plans. The Office for National Statistics (ONS) conducts a fortnightly survey on public opinions and social trends which asks GB adults about the important issues facing the UK today. The survey from the period 28 February to 10 March 2024, had the NHS at 83%, second only in the list of the most commonly reported issues to the cost of living at 87%. The economy was a distant third at 67%. A previous survey (11 to 22 January 2023) reported similar results with the cost of living at 93%, the NHS at 89% and the economy on 76%. So safe to say, with the NHS in the public’s top 3 issues, healthcare will be front and centre in the upcoming election campaign.

Focus on the underlying currents not just the crashing waves

In the healthcare sector it is easy to become focused on the next crashing wave which is about to hit you. This might be the latest strategic initiative coming from on high or an issue that could be in the headlines for a few days or weeks. In general election campaigns political ideologies drive policies and candidates react to what’s in the news. These things may be important but can distract from the underlying currents which are actually shaping the future of the NHS.

In my opinion there are four large ocean currents swirling round the NHS that are taking us in directions which cannot be ignored. These are:

1. Massive workforce pressures
2. Huge opportunities from new technologies
3. A switch to a collaboration culture
4. Inconsistency of funding

Workforce pressures cannot be ignored

The last two decades have seen unparalleled pressures on the NHS workforce. We’ve had nearly 20 years without a clear workforce strategy and plan. There’s been a decade of reduction in the real value of wages. The number of open job vacancies has increased and it seems that a vacancy level of 1 in 10 has somehow become the accepted norm. The staff have worked through a pandemic which has brought ‘hero status’ in the public’s eyes but left them fatigued and demoralised. There are continuing high levels of agency spend, with a Guardian article from January, 2024 headlined “NHS across UK spends a ‘staggering’ £10bn on temporary staff”. It’s pretty tough to be a frontline clinician right now.

Yet in a speech on March 7th just after Jeremy Hunt’s latest budget announcements, the current Health and Social Care Secretary said that “The productivity plan, along with the Long-Term Workforce Plan, will see productivity grow by 2 per cent per year. Meeting and exceeding the growth we saw in the last decade, and unlocking £35 billion of savings by the end of this decade.” The expectation of unparalleled efficiency gains leading to monetary savings seems to have been baked into financial plans stretching to the end of the 2020s. Ambitious to say the least.

To me it’s important that every initiative, strategy, plan and policy should be based firmly on how it will improve the lives of frontline clinicians day by day, not on theoretical efficiency savings. The focus of anyone in the digital health and care sector should be on how they can help the kindest people in our society. Nurses and doctors took the decision as teenagers to dedicate their lives to care for strangers. Strangers to them are family and friends to us. We must rededicate ourselves to support this workforce in all we do.

We’re entering the 4th industrial revolution

Some commentators are saying that we’re already beyond the Information Age including my good friend and health sector guru Russ Branzell, CEO, CHIME. We are already in the midst of the 4th industrial revolution – the Advanced Intelligence Age. Technology is advancing at an ever faster rate. This brings amazing opportunities but by and large leaders in the healthcare industry haves grown up and worked during the 3rd Industrial Revolution – The Information Age. A conceptual shift will bring new challenges for these leaders. How can we expect them to deliver the advantages the Advanced Intelligence Age brings if we do not support them in this endeavour.

AI and the further adoption of digital technologies will open up new possibilities but will change jobs, processes and interactions with patients. The current government is already counting on the digitisation of operating theatres to open up an extra 200,000 operating slots a year. Such changes will require innovators with clinical backgrounds and a focus on patients to harness real benefits. We need to be able to open the eyes of the workforce with ongoing education and trust them to identify and lead the innovations not impose theories.

From competition to collaboration

The NHS internal market was established by the National Health Service and Community Care Act 1990, to separate the roles of purchasers and providers within the NHS. For the last 3 decades this has resulted in a competitive culture with kudos being given to ‘winners’ - those driving hard on the latest initiative, or delivering against key targets. The space between Commissioner and Provider has too often been a battleground with the need to ‘win’ often trumping the need to serve.

The relatively new Integrated Care System (ICS) approach switches the focus from competition to collaboration and the integration of health and social care. It is a good thing, but such a major cultural shift will not just happen by itself. Post election, any additional ‘revolutionary’ rather than evolutionary changes, driven by ideology instead of a focus on our patients, our public and our care professionals, would introduce further turmoil to an already complex picture. I hope the culture of collaboration will be given time to flourish because it is not a 5-minute job.

Certainty of funding is needed

A long run up to a general election announcement and/or a protracted campaign will obviously create uncertainty in NHS funding. We’ve seen short termism already which makes planning and the delivery of the greatest benefits hard to achieve. This is especially true for digital initiatives where there has been inconsistency in funding and many silo’d programmes with single year funding which required major effort in securing and maintaining budgets for future years. The reality is that digital and AI solutions are here and now and need to be baked into day to day working and this can only happen with a long term funding plan.

In conclusion

General elections can defocus politicians from delivery. Ideologies and manifesto pledges can sometimes be at odds with what’s actually happening at the frontline and what’s really needed by staff and patients. Whatever waves break on the NHS in the coming months, the underlying ocean currents cannot be ignored. The fragilities and pressures in today’s NHS mean that we must focus on the fundamentals to turn the tide to support the workforce and deliver world class care to patients.

From the Frontline - a semi-regular series of blogs featuring independent thought leadership and comment from a range of leaders that span the healthcare industry.

The Health and Care Act 2022 is bringing some of the biggest changes in over 25 years to the way the NHS in England and the wider care sector will collaborate to integrate services for patients. The rapid adoption of digital health solutions including Electronic Patient Records (EPR) across ICSs is seen as vital to enable effective collaboration. The target is for the vast majority of trusts to be using EPR by the end of 2023 – but is simply achieving a numeric target a real indication of the successful delivery of personalised integrated care and truly harnessing the power of technology advances? 

Is success all about implementing the ‘right solution’?

Global research by KLAS Research (as part of their Arch Collaborative programme), which now includes feedback from clinicians in England, shows that the quality and functionality of the EPR IT solution is only one piece of the larger puzzle in delivering digital project success and satisfaction. The research, which focuses on improving the clinical experience of digital healthcare solutions, shows the same EPR solution being used in some of the most successful projects and also in some of the least successful too, where success is defined as clinician satisfaction. Clearly implementing ‘the best’ product doesn’t guarantee happy clinicians and higher quality patient care. So what are the other success factors to consider?

It’s not just about the supplier and functionality of the IT solution. The idea of a league table of systems ranked from ‘best’ to ‘worst’, is a false one. Success is actually about the clinician experience in the round. System capability is just one element of this, simplicity, usability, performance and security are others. Learning from other successful organisations can improve clinicians’ satisfaction, drive up adoption and improve the experience and outcomes for patients, all for a relatively low investment.

Focus on the clinician’s whole experience

The research indicates clinician satisfaction is just one third down to the EPR product itself. Two thirds of the success factors relate to the user themselves (skills, training, support, confidence) or the organisational situation (network performance, ease of login, hardware quality, recognition by management that the implementation project should be focused on people not IT).

Based on their personal experience of apps for banking, shopping etc. clinicians, like everyone else, expect digital solutions to be simple to access and use, and to be stable and safe. A clinician’s opinion about the EPR can be heavily influenced by how easy it is to log on and switch between systems, response times, and how confident they feel in using the solution to make it a part of their work processes. These factors have little to do with the EPR solution itself. Clinicians are judging their whole digital experience not just the EPR solution in isolation.

Transforming work practices not just implementing software

A large part of the success of an EPR implementation is how the project itself is positioned, perceived and measured. These are not IT projects, these are PEOPLE projects. Focusing on clinicians’ needs and their experience of digital solutions as a whole is the way forward. Is it easy to log in? Are response times fast enough? Is the hardware accessible and up to the job? Is it simple to switch between applications? Are processes intuitive so that users don’t need to repeatedly call help lines for advice? But when they do need assistance, is support easy to access? Satisfied clinicians will deliver EPR success, which in turn improves the experiences and outcomes for patients. This is the true ROI of EPR implementations. EPR solutions should continue to deliver value to Trusts over the next decade as clinicians embed them into workflows and discover ways to innovate processes and improve productivity.

When measuring Digital Maturity the NHS has previously concentrated on the deployment of systems, not the clinicians’ overall experience. Success has often been measured by whether a system went live on time rather than asking if clinicians are actually using it to improve processes, increase productivity and enhance patient experiences. The Arch Collaborative research now provides a way to measure the user experience and to benchmark results with other healthcare organisations in the UK and around the world. True success can now be identified, rather than a box just ticked.

Next steps

Improving the experience for clinicians is key to the success of digital health projects such as implementing EPR solutions. To find out more, download Imprivata’s white paper, “What can a unified digital identity strategy bring to an ICS?”.