Comment / The art of the digital business case

Digital transformation is sometimes considered a potential silver bullet for the NHS – helping the service to communicate better and enabling people to access the care they need quickly and easily when it suits them. However, digital tech business cases are still regularly rejected, even when backed up by a compelling list of facts about how they will transform healthcare and create the future NHS.

At the same time, we know that while there are several successful digital tech deployments across the NHS, there also high-profile failures. One high profile example is care.data, which was announced in 2013 and abandoned in 2016.

So, with digital transformation now a key part of the NHS long-term plan, what should the NHS do differently to ensure it creates compelling and, more importantly, successful, business cases for digital technology in the NHS?

The NHS long-term plan specifically references the use of patient and population data to improve the planning and delivery of services. Good quality evidence and data are therefore crucial for success.

It’s easy to overcomplicate business cases, and they then become unwieldy and difficult to manage. Everybody is afraid of repeating the mistakes of the past with major IT infrastructure programmes. Therefore, a pragmatic approach to building business cases is the best way forward. That’s not to say they need to be overly simplified – far from it.

First, and quite simply – as has been said before – digital tech ideas ‘should be designed to solve a need and must have all the required regulatory approvals and a compelling (and replicable) business case’. The UK government underlines this by stating that every good product starts with a clear answer to three questions. What problem are you solving? For whom? How?

All business cases should cover certain criteria – the clinical/scientific outcomes; the impact on patient experience; the impact on workforce or workflows; and the value-for-money and financial impact. But there are some specific issues that should be dealt with in technology business cases. These include:

• The need/problem that the technology addresses
• Ethical considerations
• Can the dignity of the patient be preserved?
• Patient safety
• Health inequalities and accessibility (meeting the needs of a diverse set of users)
• Information governance – data protection, cybersecurity
• Human factors including human-centred design and usability
• Interoperability with other healthcare systems
• Cost effectiveness and value for money
• Financial impact – cost to budget holder/commissioners or trust budget holder
• How it works in a real-world setting
• Scalability and impact on resource use
• How upgrades to digital technology impact on the points listed above and other outcomes

The best business cases for health technology make their arguments using the most granular level of patient activity data, helping to demonstrate real value to the NHS and across the whole system.

There is also a role for health economists in generating evidence on the effectiveness, cost effectiveness and financial impact of the relevant digital technology.

The business case and data analysis process must also involve engagement with stakeholders to understand the problem and demonstrate how the system needs to change, the current baseline picture, the parts of the system amenable to change, and the predicted eventual impact.

The inclusion of budget impact modelling can also help, using real-world data and analytic/visualisation tools to clarify how the proposed initiative/technology is likely to impact on budgets following introduction and scale-up.

My team often provides evaluations from the perspective of NHS healthcare, but with the emergence of integrated care systems and new partnerships, business cases need to consider a wider perspective.

It’s clear that the increased use of digital technology and the data it produces is critical to the future of the NHS. A robust, well-evidenced business case demonstrates the potential of a new idea to deliver real value across the whole health and care system, giving a digital tech innovation the best chance of being adopted by the NHS.

Wayne Smith is part of the Health Economics Unit, a team of specialist economists, econometricians, and analysts with extensive experience within the NHS and industry. The HEU is hosted by Midlands and Lancashire Commissioning Support Unit.