Electronic decision support ‘to be the norm for all clinicians’ under NHSE plan

The massive increase in clinicians’ use of technology forms a major part of the draft plans, seen by HSJ, with the new directorate set to launch ambitious targets for the health service.

Other targets include expanding virtual care wards and installing electronic patient records at every NHS trust.

The proposals are led by former US healthcare chief Tim Ferris, NHSE’s new transformation director, who was appointed last year.

It comes as NHSX and NHS Digital merge with NHS England in a bid to speed up the digital transformation of the NHS.

According to the plans, NHSE’s ambition is to increase the “safe and effective use” of computer assisted processes and clinical decision support so it becomes the “expected norm for all clinicians”.

CDS systems provide clinicians with computer-assisted help to treat patients, for example by analysing data to identify patients at risk of deterioration. NHS trusts’ current use of clinical decision support systems is “inconsistent”, the documents state.

NHSE aims to boost uptake of CDS systems by developing national standards for CDS, accelerating robotic process automation through funding and a national procurement framework, and working with ICSs to tackle issues such as incentives, training and education support.

The plans also set out plans to expand the use of virtual wards in the NHS, where patients are treated away from hospital – such as in their own homes – but monitored by hospital-based clinicians.

There are currently 35 such wards across the NHS (largely set up to help the pandemic response), with NHSE estimating around 136,000 patients having been treated in a virtual ward by March. NHSE’s draft plan stated an ambition for every ICS to create the equivalent bed capacity of a district general hospital (around 500 beds) through virtual wards by 2025, but an NHSE spokesman said this was included by mistake. The spokesman said the national ambition was for 40 to 50 virtual beds per 100,000 population, which was set out in its planning guidance. 

Under the draft plans, trusts should start to scale up their virtual wards with patients who are frail or have acute respiratory infections, before adding other high-volume pathways such as COPD and heart failure.

NHS leaders have welcomed the use of virtual wards to improve home care and reduce hospital occupancy, but clinicians have warned of safety issues within virtual wards, with some prominent doctors calling for a careful implementation of the policy.

The plans also target “the universal adoption of electronic patient record systems” which are described as “foundational” to the “ICS vision”.

A significant minority of trusts do not have an EPR in place, despite ongoing national attempts to achieve this since the mid-2000s.

Last year NHSX launched a new nationally led pilot to speed up the procurement and implementation of EPRs within trusts.

NHSE’s plans state the transformation directorate will “set clear interoperability standards”, agree a “common architecture” and “invest strategically, providing clear, stable, pre-agreed financial envelopes, enabling multi-year planning and delivery – with rapid business case approvals and appropriate procurement frameworks”.

• Article updated at 4.42pm on 2 February after NHSE said the slides referred to incorrectly included a target for ICSs to have 500-bed virtual wards. NHSE said its ambition was for ICSs to have between 40-50 virtual beds per 100,000 population.