Internet-first impetus could connect NHS diagnostics

Cloud-first and internet-first government policies have been a feature of public sector procurement for years. But where the NHS has been slower to respond, momentum is now starting to build in the health service as private networks are set to become a thing of the past.

Health and social care secretary Matt Hancock has insisted it is time to “stop the narrative that it’s too difficult to do it right in health and social care”, with online services now the way forward.

In May this year, NHS Digital extended its internet-first policy to reflect this, emphasising the numbered days not only of the N3 network, but also of its relatively new replacement, the Health and Social Care Network – designed as a stop gap measure to allow transition from private to public networks.

Healthcare providers are now being strongly encouraged to look to cloud options first, and to move services to the internet when updating or changing technologies.

Going internet-first whilst actively and aggressively replacing applications which are not internet ready, with those that are, is the order of the day.

It’s already happening in diagnostics – but only just

Moving digital services to the cloud opens new possibilities for the NHS. Hosting services on the internet opens opportunities around ubiquitous access to important data for consumers and users – be that the public using healthcare services, or clinicians involved in the delivery of care.

It also opens doors around interoperability, around innovation and adoption of new technologies such as artificial intelligence, and in removing a great deal of IT cost, complexity and limitation.

Running services over the internet could have significant implications for NHS diagnostic departments across the country. And the evidence that it works in this environment already exists, albeit in a single example for the UK.

So far one NHS trust – Guy’s and St Thomas’ NHS Foundation Trust – runs its enterprise imaging over the internet, with its picture archiving and communication system (PACS) now in the cloud – hosted by Sectra, the trust’s imaging technology provider.

This is having a tremendous impact. The trust no longer needs to worry about network capacity to deal with an ever-growing volume of diagnostic images. The organisation is in a stronger position to remain up-to-date with the latest patches, virus software and Windows updates. And a whole layer of additional management and complication has been removed, that doesn’t need to involve the trust’s busy IT team, whose responsibility ends at the externally facing firewall.

The appetite for cloud is growing fast

More and more NHS providers I engage with fully recognise the value of moving their imaging services into the cloud; and in fact many are starting to demand it.

And it’s not difficult to see why. Put national directives to one side, and the benefits are immense.

From the radiologist’s point of view, and for other healthcare professionals, imaging can be made accessible much more quickly to make vital diagnoses and to support decisions on patient care, with internet facing applications allowing greater flexibility and simplicity in where and how images are accessed. Patients too will gain easier internet-based access to images.

From an infrastructure perspective, imaging demands are only set to grow as more ologies generate ever larger amounts of digital images that in turn require larger amounts of bandwidth. The transfer of diagnostic imaging already accounts for one of the largest uses of bandwidth over private NHS networks, and with more diagnostic specialities set to digitise, demand for digital space will continue to grow. Moving to the cloud can remove this obstacle entirely for trusts, placing the requirement to scale up storage on the vendor.

Security can also be enhanced in the cloud. Cloud hosted environments typically have dedicated cyber security expert resources not typically available in individual NHS trusts. In a single environment, penetration risks and vulnerabilities can be better controlled.

Advancing regional diagnostics

But perhaps the biggest impact cloud and internet-based approaches to diagnostic imaging will have is in support of the regionalisation agenda.

The days of trusts procuring their own imaging systems are largely a thing of the past. Procurements for enterprise imaging systems in the NHS now almost exclusively span regions and trust consortia.

Regions are collaboratively procuring to ensure they can operate their diagnostic services across geographies, allowing them to make the most of scarce specialists, to deliver crucial diagnostic imaging to the point of care wherever that might be, and to leverage significant economies of scale.

Cloud infrastructure is the perfect fit for large regionalised deployments. This approach can be scalable very quickly to bring in new organisations, respond to mergers or takeovers, and to the evolving needs of the clinical environment, allowing trusts to consume additional bandwidth with ease.

Moving to the cloud also removes a political obstacle traditionally encountered in regional procurements – which trust is best placed to host. In the past this can leave trusts not hosting the solution feeling disempowered.

And once regions are established with their regional solutions, what is to stop regions eventually connecting their clouds to other regions – forming an NHS wide imaging network?

How will cloud take hold?

If there is one lesson to take from the history of NHS IT, it is that one size does not fit all. Embracing cloud will be no different.

We can expect a great variety of different demands from providers. Some, like Guy’s and St Thomas’ might more immediately seek support from their imaging vendor to host their imaging solution and remove an immediate headache.

Others might seek out cloud providers to host many more of their applications, with imaging forming just part of their cloud.

Whatever the way forward, vendors must be ready to listen and support the needs of trusts to manage this transition. The opportunities are too great to miss.