With all the hustle and bustle of hospitals, hard-working staff, and extensive cutting-edge equipment, we often forget about the invisible infrastructure that underpins our healthcare institutions. They all rely on the backbone of databases, and quick access to the data housed within them, to ensure systems at the front-end run seamlessly. From the instant access to patient records to the rapid sharing of information between health units, access to data is paramount for the successful work of frontline staff.
With the pandemic, the way we receive our healthcare services has had to change, and very quickly. The rise of telehealth was the solution to many of the issues posed by physical interactions, but the rapid move to online services has not necessarily been straightforward for the NHS in the UK.
While digitization has been a long-term strategy for the NHS, The Committee of Public Accounts acknowledges ‘it remains a huge challenge to deliver’. The Department of Health and Social Care didn’t achieve the initial goal of the NHS becoming paperless by 2018, and this target has now been watered down and moved back by several years. And the NHS is still plagued by a proliferation of legacy IT systems.
The publication of the UK budget in October may, however, go some way to helping achieve some of the goals of digitization, particularly in the post-pandemic world we will live in. With remote services likely to remain commonplace, and a huge patient backlog that requires addressing, digitization is needed now more than ever.
Fortunately, more funding is heading for the NHS, with measures announced by the Chancellor of the Exchequer in the October Budget and Spending Review including £2.1 billion over the next three years to introduce digital technology.
So, with a committed budget being earmarked for technology, what might this look like in practice? On the face of it, it appears a substantial investment, but there are so many priorities, amongst which the management of data must surely come high on the list in four key areas.
The sharing of data
The funding is said to cover the ‘innovative use of digital technology so hospitals and other care organisations are as connected and efficient as possible’. This is in line with The Department of Health and Social Care’s established ambition of digitally transforming the NHS to enable the seamless sharing of data between the many organizations that make up the health and social care system. We often hear this referred to as enabling the ‘interoperability’ of healthcare systems.
Remote access to data
Remote access to data is the key to achieving the goal of interoperability. But, as mentioned previously, the ‘paperless by 2018’ target has been pushed back more than once. And in 2019, research by OpenText revealed that only 12% of NHS Trusts were actually fully digitised and paperless, with some even still relying on fax machines to obtain required data. Undoubtedly, some of this can be attributed to underfunding in recent years which the new budget appears to be addressing to some extent.
The Head of UK public sector at OpenText, explained how a ‘one patient, one record environment’ can help NHS Trusts manage digital patient data: ‘Ultimately, accurate and timely patient data is at the heart of delivering high quality care and will ensure all front-line care staff can access this information where and when it is needed, boosting their productivity and enabling them to help more patients, more quickly’.
The proactive monitoring of servers
From our experience working with the NHS, in some cases there may only be one DBA in place for an entire NHS Trust, so all of the onus is on them to manage large – and growing – server estates. They need to be able to proactively diagnose problems and find solutions to maintain and speed up processes for vital development work. If there are unresolved issues, it can literally stop clinical systems from running. As a consequence, effective database monitoring tooling is another area where we may see some of the new funding spent.
It has been reported that some of the budget will be invested in technology and data ‘in a bid to improve efficiency and security within the health service’. Data security is indeed another important area to focus on because health information remains one of the most sensitive and personal types of data at risk of being compromised.
That said, breaching the security of a GP surgery or hospital in the UK is likely to be a much less tempting option than a US ‘for-profit’ equivalent health body. An Indiana Hospital paid $55,000 just last year to regain access to its locked computer systems following a ransomware attack. However, although UK public health bodies are comparatively a much less lucrative option – the NHS is known not to pay ransoms for stolen data, and threat actors are well aware of this – it doesn’t stop the risk of breaches occurring. The Information Commissioner’s Office reported 3,557 data breaches across the UK health sector in the two years to the end of March 2021, most being within the NHS. And as the nature and extent of stored data grows, so does its value.
Investment to protect against future breaches could cover areas like cyber monitoring and vulnerability testing, data-masking and secure database provisioning. But it is likely to remain unclear, at least publicly, how money for data security will be allocated, as openness about spending by the NHS on system security is generally treated with caution. However, in 2019 it was said that by 2021, the government will have committed more than £250m i10 n national funding over a five-year period ‘to improve the cybersecurity of the health and care system’ across the UK, so it’s clearly a key focus, and likely to remain so.
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