What the doctor ordered

Written by Jane Rendall and Fredrik Gustavsson on 1 June 2017 in Opinion

An NHS-wide cloud for sharing diagnostic images and intelligence across the health service could mean huge economies of scale, stronger collaboration, and rapid digitisation, according to Jane Rendall and Fredrik Gustavsson.

NHS organisations cannot afford to continue with systems that are years out of date Credit: PA Images

Pressure to improve sustainability and reduce isolation in healthcare has renewed the hunger for a different approach to IT. Installing software in individual organisations, and then managing it locally on hospital servers, is a resource hungry method that for many organisations is starting to reach its limits in the race to digital maturity.

The UK is in an almost unique position to accelerate its digital progress and embrace truly national economies of scale by exploiting cloud technology, something that has already started to be seen in diagnostic disciplines.

Northern Ireland, for example, has one of the most effective and largest scale picture archiving and communications systems (PACS) in the world. By exploiting cloud, a single imaging system is now accessible by healthcare professionals across the whole of Northern Ireland, allowing different disciplines to access a patient’s radiology record from almost any location.


Large scale cloud deployment has also already been seen in England where more than 400 sites across the NHS are using the Image Exchange Portal (IEP) to make images rapidly available to the right professionals. Supporting regional working and new ways of delivering care across organisational boundaries, the IEP is used by NHS staff to exchange some 15,000 studies every day that would otherwise need to be burned onto CDs and sent via costly courier services.

But achievements so far are just the beginning. There is now greater potential than ever for the NHS to use cloud to leverage rapid expansion of digital technology across organisations and sustainability footprints.

Cloud has the potential to speed up the time in which all parts of the health service benefit from the latest innovation and software updates, to enable the collaboration demanded by evolving models of care, and to use the ‘N’ in the NHS to greatest effect, whilst still allowing specialist functionality demanded by the frontline.

Ensuring the NHS spreads digital innovation quickly

NHS organisations can no longer afford to be working from IT systems that are years out of date. But the reality is that too often, hospitals can today be working with software that at best receives an update every one to two years, and at worst, isn’t updated in closer to a decade.

Other industries do not work like this. Organisations ranging from Facebook to Google upgrade their applications almost immediately, and make those updates instantaneously available to users across the globe.

Whether it is the electronic patient record (EPR), or a vendor neutral archive (VNA), technologies are becoming so central to the delivery of care, that all healthcare organisations must have access to the latest innovations.

Professionals must not be denied the functionality they need because of contractual limitations or because internal datacenters or resources are not in a position to support the latest versions needed by staff delivering care.

Advances in care mean that software innovation is now a continuous cycle, where vendors must be responsive to the immediate needs of healthcare professionals. Cloud adoption could help all healthcare organisations ensure these innovations are available to their own staff, irrespective of the internal resource that might traditionally be needed to ensure continuous uptime, or the hardware to ensure compatibility.

Cloud now signals an opportunity to leap frog digital maturity, and beyond that to ensure rapid expansion, innovation and growth. The conversation needs to shift from which hardware to buy. Just as consumers can now instantly stream films to their home through online services like Netflix, without the need for a DVD or a DVD player, a clinician should not have to wait months or even longer to get the latest functionality, whilst upgrades are carried out to hospital servers, or whilst negotiations are completed with the software vendor.

Security and other economies of scale

Security, often cited as a point of concern in cloud adoption, has the potential to be significantly enhanced, particularly at a time when resources are in high competition. Individual trusts trying to attract the right candidates with the knowledge and skills needed to safeguard their systems are not only competing against other trusts, but against wider public sector bodies, security services and high-paying private sector organisations, where cyber and IT security expertise are in extremely high demand.  

Cloud driven economies of scale that allow better prices, apply just as much to security. Although NHS chiefs are quite rightly trying to encourage responsibility for cyber security at all levels of the healthcare enterprise, a collaborative approach to securing shared cloud systems, could provide the NHS with another boost.

Put simply, NHS organisations have a different primary purpose and different resources than large scale IT organisations. They are healthcare organisations. Expecting individual IT departments across more than 200 trusts to be self-dependent for security is an unnecessary burden that does little to leverage the economies of scale of the healthcare system.

Nevertheless, cloud does require a pragmatic approach when it comes to security. It would not be appropriate, for example, for the NHS to base its information in a public cloud, where other actors and other countries may share access to the same servers. A large scale private cloud could however be an answer for the NHS, allowing economies of scale across the country in everything from licensing to hosting, hardware, operations, monitoring and security.

Creating an NHS-wide cloud for diagnostics

Just as Northern Ireland is already using a PACS to share radiology images across the entire region to relevant healthcare professionals, VNAs are now increasingly being seen by healthcare organisations worldwide as a way to share information from a full range of diagnostic departments.

VNAs will become as central to healthcare as the EPR, and cloud offers a chance to deliver such technology at pace. If done at a national scale across England, resulting economies could help ensure a robust and resilient, continuously up-to-date system.

At a time when the face of healthcare is in a state of flux, cloud means the potential for responsive and future proof technology in the NHS, supporting accelerated adoption followed by a forward momentum of innovation. 

Collaboration and regional working is also intrinsically much easier to accomplish in a cloud environment by moving away from peer to peer networks. As the Image Exchange Portal has proven for hundreds of trusts, cloud can allow the rapid integration of different organisations’ information.

This is about supporting all trusts, regardless of digital maturity, and removing complexity for local IT teams by paving the way for healthcare pathways where information really does follow the patient.

Jane Rendall is managing director and Fredrik Gustavsson is chief technology officer at supplier Sectra

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