Wachter: NHS needs a 10 year digital roadmap

Speaking exclusively to HSJ nearly two years after the publication of his review of NHS IT, the US physician said the system had made good progress on improving digital technology in challenging circumstances.

“Given the constrained resources, the emphasis on technology and building the workforce has been pretty impressive,” he said.

“My sense is they [the NHS] are about where we thought they would be and maybe it has been a little bit harder because the money is a little tighter.”

However, the NHS now needs to look further ahead at how it would take advantage of digital investment over the next 10 years, he said.

“Now is probably the right time to take a step back and say, over the next two to four years we are going to have a pretty digitalised and pretty interoperable system, what is the strategy for 10 years out?”

“It would be terrific to have a strategy that thought beyond the horizon.”

Dr Wachter also said the rise of genomics and precision medicine would make artificial intelligence essential to support clinical decision making in the future.

“In a world where we may treat a person differently with that gene pattern rather than with this gene pattern, there is absolutely no way the average clinician can keep that in their head.”

“Building clinical decision support/artificial intelligence solutions that help guide people is no longer going to be elective but absolutely essential to getting the work done.”

However, Dr Wachter warned that, like any new technology, artificial intelligence would bring with it new safety risks that would need to be managed.

“The more artificial intelligence there is, the more likely it is that people are going to take their hands off the wheel and stop paying attention. But those are all predictable problems and we have to build in ways to mitigate for them.”

Dr Wachter’s review, published in September 2016, recommended the government drop its “paperless 2020” target, invest first in making a small group of digitally advanced providers advance further, and boost digital clinical leadership and skills.

While the government has never formally responded to the Wachter review, his recommendations have heavily influenced IT investment policy since, most notably the global digital exemplar programme and the NHS digital academy.

Other recommendations that have been adopted include the appointment of a national chief clinical information officer and dropping the 2020 target. 

However, investment in NHS IT has also faced substantial delays in the two years since the Wachter review, sometimes with substantial reductions in the funding reaching the frontline.

The current NHS IT strategy runs to 2020-21 and is based on a combination of the personalised health and care strategy, published in 2014, and parts of The Next Steps on the NHS Five Year Forward View document, published in March 2017.

There are no plans for a new separate long term technology strategy for the NHS.

However, the overall NHS 10 year plan currently under development includes a digital and technology stream, which is being led by NHS chief clinical information officer, Dr Simon Eccles, and NHS Digital chief executive, Sarah Wilkinson.

Initial proposals are expected by the end of September.