February 27, 2023
February 27, 2023
Joe McDonald is a long-standing advocate for the adoption of healthcare technology that works for clinicians and patients. In this interview, Parsek’s medical director tells us why he has come to believe that a collaboration platform is the essential ‘third tier’ of NHS IT – an idea he will discuss at Digital Health Rewired 23.
Can you tell us a little bit about your background?
Joe: “I am a former NHS psychiatrist. I worked in the NHS for almost 40 years. I’ve never been particularly interested in computers per se, but I got involved in healthcare technology through an improving quality of care project. If you are going to improve the quality of care, you need data; and to get data, you need a computer.
From there, I moved into a medical director role, but then my trust merged with a neighbour. So, when I saw a job advertised at the National Programme for IT, I went for it. NPfIT hadn’t been around for very long, but I soon discovered that it had signed contracts with companies that knew little about mental health.
I put in some temporary electronic patient record solutions at mental health trusts, and they are there to this day. I was also asked to try and make one of the big, acute solutions work. I went out to India, where it was being coded, and concluded it would never happen. When I put that in a report, I was fired for ‘career-ending frankness.’
So, you worked on EPRs and then moved on to shared care records?
Joe: “That’s right. I returned to the NHS, but I also tried to put my career-ending frankness to good use by writing a column for eHealth Insider [a website that became digitalhealth.net]. That helped to get me hired by a programme called Connected Health Cities, which was part of [former Conservative chancellor] George Osborne’s plans for a Northern Powerhouse.
The programme never ran at the scale promised, but the North East and North Cumbria got some money, and I spent some of it on a shared care record, which we called the Great North Care Record. We got some hospitals and GPs interested and linked them up using something called the Medical Interoperability Gateway.
Then, we took it to some A&E doctors, who were just blown away by the information it opened up for them. Now, the GNCR holds data from hospitals, GPs, community trusts, the ambulance service and social care for 3.2 million people. It’s a huge asset, and the experience taught me some valuable lessons about improving regional collaboration.
One is that it’s difficult because it’s what is known as a ‘collective action dilemma’ – everybody has to move together to make progress. Another is that you have to work with your installed base. You are never going to get everybody onto one system. You need to put a connector in the middle of what is already there.
How did you become involved with Parsek?
Joe: “I reluctantly retired from medical practice during Covid, and the next day a start-up called me to ask if I would like to be its medical director. Since then, I’ve developed a portfolio of medical directorships, of which the latest is with Parsek.
I thought they were an interesting company because they solve a problem I encountered when my mother developed dementia. During the pandemic, she came to live with us, but then she needed to move into a care home. I thought she would be there for the rest of her life, but, unfortunately, she had to move again, this time into a secure mental health facility.
One of the things you have to do when you move somebody into a facility like that is to get everybody involved in their care together. In my mum’s case, that meant a cardiologist, a cancer specialist, a falls team, community nurses, her GP, the nuns who run her care home, her hairdresser – and lawyers. It was incredibly difficult to arrange – but what Parsek’s Vitaly platform is designed to do is make it much easier.
You’ve called collaboration platforms the missing tier in health tech. What do you mean?
Joe: “Until recently, I thought I’d been very clever. I’d implemented an EPR and created a shared care record. But what my mum’s experience taught me is that these can save clinicians time and support care, but they can’t integrate care.
In psychology, there is a well-known theory called Maslow’s hierarchy of needs. In a health tech version, the bottom tier of the hierarchy would be an EPR, which collates information across a single organisation. The next tier-up would be a shared care record, which lets clinicians in different organisations exchange information with each other. But then you need a third tier, a collaboration platform, to let clinicians and other professionals work together. That’s the layer that Parsek provides.
Above that, we need another layer, the patient-held record, to let patients access their own records, add their own monitoring information, and share that with their clinical team. It’s that layer that enables you to start automating some processes, like ordering prescriptions, booking appointments or enrolling patients on app-based therapy, where that’s appropriate.
What features does a collaboration platform need to have?
Joe: “At heart, a collaboration platform is there to coordinate the work of people who do not usually work with each other. So, it has to implement the lesson I learned from the Great North Care Record and interoperate with the IT systems those people use. It has to plug and play with EPRs, GP systems and shared care records and everything else that’s in place.
At the same time, it has to work for people who don’t use IT systems but rely on documents, like care homes – or lawyers. And Vitaly does that. It’s built on open standards, so it interoperates with health and care systems. And it logs documents so everybody on a multi-disciplinary team meeting can have their say, even if they just send in a pdf note.
A collaboration platform also needs to plug and play with video conferencing platforms. The NHS has made a big investment in systems like Microsoft Teams, but that’s not enough to drive integration. You need scheduling tools, systems integration, and a structured way to capture decisions, and that’s what Vitaly delivers.
You’re going to Digital Health Rewired. What will you be talking about?
Joe: “It’s interesting to look back at some of the columns I wrote for eHealth Insider because many of them were about my mum and the technology she needed at different points on her journey. A lot of that IT is now in place. The GP record is there in A&E. Remote monitoring is available.
I once wrote a column about trying to gaffer tape an iPhone to a kettle, so it could tell me if mum was up and about and drinking tea; but now we have smart plugs and pulse oximeters in people’s homes, and we’re starting to use them through the PHR layer.
However, what I’m going to say at Rewired, is that we haven’t done enough. EPRs are not enough. Shared care records are not enough. PHRs are not enough. We need that third tier, the collaborative platform tier, to let people work together in the interests of the patient. That’s the missing link. The bit that will put the I in the integrated care systems that we’re trying to create.
Joe McDonald, (former CCIO at North East and North Cumbria ICS and now Medical Director at Parsek) will take the stage in the Best Practice Showcase at 11:30 Rewired 23 on March 14th to talk about enabling a digitally integrated approach to MDT meetings.
Parsek will be exhibiting at Rewired 23, Stand no. A3.