Towards a Digital Ecology: NHS Digital Adoption through the COVID-19 Looking Glass
Betton, V. (2022). Towards a Digital Health Ecology: NHS Digital Adoption through the COVID-19 Looking Glass. CRC Press. https://doi.org/10.1201/9781032198798
This is fantastic resource. Notes will appear here from the very many highlighted paragraphs in my local copy.
A static markert
Section titled “A static markert”The dysfunctional marketplace for NHS software…
“According to Tussell, the top ten suppliers to the NHS earned twice as much as all SMEs combined in 2019. Even more surprising, 90% of suppliers worked with less than ten NHS trusts, suggesting that adoption and spread is not travelling all that far for many producers of digital health products and services”
“The sector is dominated by a small number of large electronic patient record companies whose products are the mission critical to the health services… To give you a sense of scale, Manchester University NHS Foundation Trust signed a 15-year contract worth £181m with American company Epic in 2020”
“As the dominant players in the market, electronic patient record companies aim to create and deliver the entire ecosystem rather than seeking synergies with others.
“A number of these companies are large US vendors, such as Epic and Cerner, for whom the UK is a tiny fraction of their billion-pound business… The standards with which such vendors would have to comply to open up their systems are not yet in place. Even when international standards have been put in place, the NHS has created its own idiosyncratic versions, requiring global companies to re-engineer to meet their requirements. From a bird’s eye view, it appears that the NHS is as much complicit in creating those castle walls as the vendors in guarding them.”
An Open future
Section titled “An Open future”“Standards in healthcare data and systems are like toothbrushes,” he tells me, “everyone has one, but nobody is prepared to share.”
However, clouds are making way for blue skies in the shape of a new standard for integration called HL7 FHIR. David Hancock (co-chair of INTEROpen) believes that HL7 FHIR, at last, gives a comprehensive, universal, open standard that really is a standard and not just a guide, as previous healthcare interoperability standards have been.” (Betton, 2022, p.288)