McKinsey: Looking for value in healthcare technology is 'like chasing a phantom'

Consultancy declares that both centralised and localised healthcare technology projects are likely to fail, and advocates looking to the start-up community for inspiration

A lot of money has been spent in healthcare in recent years, but it can be hard to find the value that all the investment has generated. In fact, looking for this value can feel like "chasing a phantom".

Those are the words of Stefan Biesdorf, partner, business technology office at consultancy McKinsey, speaking at the Westminster Health Forum titled "Electronic Health records and IT in the NHS: data protection, Care.data, and implementing personalised health and care 2020".

Biesdorf referenced the failed National Programme for IT (NPfIT), from the now defunct health authority Connecting for Health, which cost the British taxpayer £12bn while providing very little real value.

"We distinguish two approaches," continued Dr Sundiatu Dixon-Fyle, senior expert, healthcare practice, also from McKinsey. "The centralised or top-down approach which relies on central planning. The issue with this approach is that it fails to gain sufficient acceptance from key stakeholders like clinicians, so you get long, costly projects, and you fail to deliver against initial expectations."

While NPfIT is an example of this approach, Dr Dixon-Fyle cited an electronic health card project in Germany that kicked off in 2004, met with resistance from end users, and then finally launched this year.

"It was originally supposed to carry health data, but currently only manages administrative and entitlement data on patients. It cost a billion pounds, and failed to meet initial expectations," said Dr Dixon-Fyle.

The other approach she described is the decentralised or bottom-up strategy, which fares better when it comes to local acceptance, but worse when it comes to inter-operability.

"Denmark is a decentralised country and much of their healthcare IT is done at a local level, but their challenge is to make it national. They're all local solutions and not interoperable. This is now being experimented with in the UK due to the challenges of centralised programmes in the past, but then will we end up in the same situation as Denmark?" asked Dr Dixon-Fyle.

She went on to discuss another issue with both types of project, which is the focus on data privacy concerns, asking "...is this really such an issue for patients who are already sharing private things about themselves on Facebook?".

"The old approach isn't really working, we need a new approach," she concluded.

And this new approach, at least according to McKinsey, is to look to the start-up community and the burgeoning ecosystem of healthcare software and apps which has appeared in recent years.

"There is a new approach, tens of thousands of start-ups are trying to make a difference in healthcare," continued Biesdorf. "They have not been building large IT infrastructures, they're using what's already there, like smartphones. They're not focusing on clinical data which resides in thousands of different software applications, but data that's generated in real time by the patients themselves, and this may even replace the interaction with the doctor.

"The data is controlled by the user, the user decides who to share information with."

So where does this leave the NHS? Biesdorf argued that the NHS should redefine itself as the platform and ecosystem manager.

"Even Facebook does not develop all the applications that run on its platform," said Biesdorf. "There are hundreds of thousands of developers worldwide to do it. The NHS is maybe not the best body for developing the most user-friendly apps in healthcare. But it should own the data and the platform. It can then make sure that only the parties it wants in the ecosystem are part of it. So the NHS should focus on keeping the data under control, creating a platform and forming an ecosystem that others can take part in," he concluded.