'Flip' incentives to get NHS using tech, says US digital guru

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Finding ways to encourage digital adoption is one of “fundamental challenges” for Robert Wachter’s digital review
American “meaningful use” programme has been “mostly successful but still flawed”

US digital health expert Professor Robert Wachter has said finding ways to change the financial and regulatory incentives in the NHS to encourage digital adoption is one of the “fundamental challenges” for his government-backed review.

Speaking exclusively to HSJ about his review, which Jeremy Hunt said in October was part of trying to ensure the NHS becomes a world leading digital health system, he talked about addressing several overarching challenges.

These included clinical engagement, the balance between central and local leadership, and financial and regulatory incentives.

Professor Wachter said: “One of the fundamental challenges that we have to overcome is to ask the question: what is the incentive system that would have [a struggling hospital chief executive] saying ‘I need to digitise’?”

He said the current system meant chief executives were too focused on short term operational and financial pressures and the prospect of losing their job if a big IT deployment went wrong.

He continued that the current regulatory and financial incentives needed to be “flipped” and that trust leaders needed to have assurance that they would have “the protection so even if they have a slightly bumpy [IT project] rollout it was the right thing to do”.

In the US, “meaningful use” standards, part of the national digital health programme, has been used to incentivise digital adoption. It requires hospitals and family doctors to meet national IT standards to be eligible for incentive payments.

With the caveat that he understood the funding constraints the NHS was under, Professor Wachter said: “Some new money and some new standards which come with that money [like the meaningful use programme], I think that’s a reasonable formula. How that exactly translates to the NHS is an open question at this point.”

He said the meaningful use programme had been “mostly successful but still flawed”.

“Getting hospitals and doctors to computise took some new money [seed funding rather than enough to buy complete systems] and they also knew that if they did not implement the systems they would get penalised,” he said.

Professor Wachter’s comments follow Lord Carter recommending that NHS system leaders put a “meaningful use” clause into provider contracts to require trusts to meet key digital standards by October 2018.