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(R)evolution Interviews

Digital transformation: it won’t be easy

Despite their complexity, many frameworks could actually help to assess digital innovation. However, revolution is not the only thing to consider: we should invest in the quality of basic infrastructure which are obsolete and require updating.

Interview with Kathrin Cresswell

Chief scientist office chancellor’s fellow, Director of innovation, Usher institute, University of Edinburgh

By December 2019May 3rd, 2021No Comments

What are the main obstacles and challenges faced by large-scale digital transformation initiatives? How can they be overcome?
The unhelpful answer to this question is that challenges are endless and there is no simple recipe to overcome them. That said, there are some strategies that can be put in place to tackle these issues and set up conditions in which initiatives are more likely to work. These include considerations at technology, people, organisational and macro-environmental levels. We are in the process of publishing a framework that takes decision makers through these dimensions relating to individual implementations. At large-scale programme level, these dimensions become even more complicated and there is no agreed way on how to best achieve intended outcomes. If I had to pick one dimension that is crucial though it would be a functioning technology that is usable and brings benefits to end-users, whether these relate to safety, quality or efficiency of care.

What kind of digital technologies are considered the most interesting by health care systems? How are they being used? By whom?
Again, a very big question. I’m not sure if I’m the best person to answer this. My initial reaction would be to be cautious of new technologies that are at the top of the hype cycle. There are many basic needs that may deserve resources but that do not come with the same political kudos e.g. we still use fax machines in many parts of the NHS but this just does not sound as sexy as new AI robots delivering care. It probably takes a parallel strategy of investing in existing infrastructures addressing basic needs whilst also building new tools
that may be potentially risky and have unknown unintended consequences. The focus on data is unavoidable though and data strategy needs to be firmly positioned in every organisational and national strategy.

What are the potential applications and the potential benefits for patients in the use of novel health information and digital technologies? Also, for which patients? Are there categories that can benefit more than others from these applications?
Sticking my neck out a little bit, I think there is significant potential for technologies that promote increasing patient involvement of those with chronic conditions. There are, however, risks associated
with these that have to be taken into account for example in relation to data interpretation and integration with other health information systems. Formative qualitative evaluations tracking emerging risks can
help to mitigate potential adverse consequences.

The future is a dream and anyone’s guess.

What are the main safety concerns related to digital health technologies? Could you give a few examples of safe and effective uses of digital health technologies?
There are many examples of safe use of technologies but also many of unsafe use. By nature, these relate to both technological and social factors. For example, clinical decision support systems can be very effective in improving decision making of prescribers but they can also introduce new safety threats associated with alert fatigue, where prescribers are faced with so many alerts that they ignore them and miss potentially important ones.

What does it mean “Digital Excellence” in health care? Why is important to define, measure and asses it?
Digital excellence is a moving target and means different things to different people. This makes it difficult to define, measure and assess. Nevertheless, organizations and health systems will never know how they are progressing if measurement is not even attempted.

How can we do it (measure and asses it?). Are there tools? Which one? Are there tools that are being studied (such as the framework you propose)?
There is HIMSS Analytics® Electronic Medical Record Adoption Model (EMRAM), and various related frameworks such as the Infrastructure Adoption Model (INFRAM) and the Continuity of Care Maturity Model (CCMM). The problem is that these are very much based on a North American model health system and many of their components may not translate well to other contexts. They also assume that digital maturity is an end-goal that can be achieved by progressing through a series of stages, and they very much focus on technology rather than social dimensions of change. Our proposed Evolve in Context model of digital excellence in health care addresses these shortcomings but also provides less straightforward answers as it reflects the complexity and constantly evolving landscape in which digital transformations take place. As a result, it does not provide the clear roadmap to change associated with existing HIMSS models.

How do you imagine this digital revolution will shape the future of healthcare? The upcoming as well the more distant (2050) future? What can we expect to see and what are instead scenarios that still belong to sci-fi books and movies?
The future is a dream and anyone’s guess. I would certainly like to see the increasing development of learning health systems facilitated by data and also the establishment of learning ecosystems where
organisations learn from each other’s digital experience. Automation to the extend of routine application of care robots is still quite a long way off I think.