Jason Mitchell is a Partner at MHA, supporting technology and life sciences businesses.
A ‘single patient record’ has been discussed for over a decade, but every time benefits of greater data sharing have been raised, so have objections around data privacy and data control. At last, this debate may be coming to a finale as the government seeks to make a single patient record (SPR) a reality through its Health Bill.
Many people can agree this is a positive development. Clinicians in all parts of the NHS have had instances where they cannot access the full information about a patient while treating them because data remains fragmented and siloed in primary, secondary and tertiary care. This creates a situation in which patients are left repeating their medical history to those caring for them, who cannot view their whole health record when they need it.
Yet moving towards a SPR, which will join up information from different sources through enforced interoperability, will have a significant impact on the digital health sector as it will change the incentives, business models and ways of working of many companies, whether they provide electronic health record (EHR) software or specialised tools that interface with it.
Functionality becomes more important
Historically, EHR procurement was driven by a fear of fragmentation and a desire to increase data visibility. Clinical Commissioning Groups (CCGs), and later Integrated Care Boards (ICBs), frequently bought into large, prominent systems simply to ensure their local network of sites could share data between themselves. If a patient used a GP and hospital in the same locality, it was more likely that more patient data would be visible. But if you were receiving care elsewhere, your record was less likely to be fully visible.
This meant that many EHR providers operated business models that incentivised their adoption based on data visibility, as using one provider within an area provided fuller access to patient data (contingent on privacy settings). Pressure to enhance interoperability between systems has historically been met with a patchwork response that has been good in some areas and poor in others.
By establishing a good (and eventually comprehensive) baseline of data visibility, the Health Bill’s effect will be to weaken the ‘supplier lock-in’ dynamic and mean business models will have to change. The companies that will succeed will be agile software providers that build niche, intuitive clinical overlays that can work with this joined up data through APIs.
EHR companies will have to change the way they work and focus more on engaging with users and developing new, user-friendly functionality and tools that improve productivity and are easier to use. I believe this will result in greater competition, innovation and added value for the NHS.
UK companies, which often have intimate familiarity with primary care pathways and the realities of the NHS workflows due to their physical proximity, are well positioned to out-innovate international giants who rely on rigid, one-size-fits-all platforms build for different markets.
Innovation will accelerate
While industry awaits further details on implementation, a single record may provide a more straightforward access point for software and tools that seek to use or add to this data, avoiding the lengthy negotiations and partnership agreements with individual organisations that many have become used to.
With the appropriate information governance and data safeguards in place, a single point of connectivity will allow companies to work directly with NHS Trusts to pilot new technologies and research tools and make it easier to innovate in digital health. This will be a boon to established health tech clusters like those in Leeds, Manchester and London.
However, it’s worth highlighting that the Health Bill does not provide a legal gateway for research, so the SPR can only be used as a source of data for research where there is an existing legal basis to do so.
The plan is for a phased rollout of this single record, which gives industry a predictable timeline against which they can develop new tools and software products. The rollout will begin with specific areas like maternity and frailty services by 2027, before patients will be able to access a core record through the NHS App in 2028.
My view is that the immediate opportunity lies in developing specialised tools for elements of the record that will be focused on first. Those who build AI supported diagnostics, remote monitoring tools, or clinical workflow solutions that integrate with maternity or frailty record information will establish a reputation and first-mover advantage that will help accelerate their growth once these areas are expanded upon.
The SPR has been a long time coming, but industry now has clarity about how this will become reality. This is an opportunity for those who are able to quickly adapt and move away from a focus on data sharing and towards developing specialist tools that enhance clinicians’ ability to use data more effectively.
