NHS Digital Capabilities Framework – How to achieve it

The NHS is starting its digital refurbishment with a frontline digitisation programme that introduces adherence to the Digital Capability Framework (DCF) and will touch primary care, secondary care, tertiary care and community care. Digitisation will unify solutions into an integrated EPR system that can link up all facets of care in one longitudinal record for clinicians, providing start-to-finish management of patients along their care journey. 

First, we should define what frontline digitisation is: 

Frontline digitisation is the evolution of frontline care (direct health and social care, with a patient or client). It is the transition from paper-based patient notes and records to digital editions. These electronic copies are hosted and operated by healthcare software, and the technology allows data to be accessed in more than one place at a time. This is a huge benefit for coordinated care, better protection for privacy and security purposes, and means integration with other healthcare software to improve care coordination and efficiency.

NHS Digitisation can’t be and won’t be delivered by just one healthcare solution provider, however. Companies like The Access Group offer a range of software (such as Rio EPR) with a number of optional modules, to give our NHS customers choice about selecting the best solutions depending on their patient, clinical and organisational needs. Introducing digital solutions isn’t a small endeavour: Good quality solutions cost money and transformation of services takes time. Ensuring new solutions are accepted into working procedures and practices across services requires backing from the top and a skilled team at the sharp end. Balancing a pace of change against keeping services running safely and efficiently at the same time is no mean feat.

The UK government is keen to improve efficiency within frontline services to free-up clinician time, with the goal of bringing down waiting times and addressing care quality concerns. Articles on the BBC News website about record high waiting times in England and the Independent about NHS England experiencing its worst A&E waiting times since records began are challenges that the NHS is looking to remedy. 

Healthcare software – from providers such as The Access Group – is now being rolled out in trusts and ICSs around England, and in conjunction with the devolved NHS in Scotland, Wales and Northern Ireland. The first priority for NHS England is electronic patient records (EPRs). By digitising services, irrespective of the software solution, we can increase the speed of patient data being available at the right time - leading to greater efficiency, better diagnosis and treatment, and better outcomes. 

Even the EPR rollout has been slower than planned though. The British Medical Journal reported that “Electronic patient records (EPRs) must be implemented in at least 90% of NHS trusts by December 2023” according to then-Health Secretary Sajid Javid. Digital Health reported the news however that and the March 2025 target of 100% of NHS trusts have been labelled as “unachievable” according to the government’s Infrastructure and Projects Authority (IPA). Targets have now been pushed back by 12 months to March 2026 to allow NHS England more time for onboarding. 

NHS frontline digitisation isn’t just about implementing EPRs though. Integrating the EPR with best of breed other software solutions, tackling things such as electronic observations, mobile enabled workforce, patient flow through the hospital and electronic bed management. This leads us on nicely to the digital health capability framework and the minimum digital foundations for the NHS.

We’ve already touched briefly upon what the NHS Digital Capability Framework (DCF) is, but there’s more to it than just ‘a list of requirements’ and strategic expectations. 

What is the Digital Capabilities Framework? 

The DCF is a plan for NHS Trusts to incorporate into their organisational digital strategies, as part of their ongoing digitisation process. It comprises of three levels of digital capabilities. These are:  

• Core
• Transformation
• Innovation

Within these three levels are over 100 requirements that the NHS organisations need to meet. This has to be done at pace and at both a clinical and operational level, whilst maintaining safety standards and not impacting the usual healthcare and care provisions. These requirements mean there’s extra challenge in the time and resources organisations to procure, adopt and embed the changes needed. 

NHS England expects all Trusts to meet the Core requirements - the minimum level of digital maturity – by sourcing market solutions to meet their needs. These needs are stated within the Core capabilities in the form of eight capability categories, including things such as Diagnostics Management. 

Resources are being provided to Trusts to help them achieve the frontline digitisation required by the Digital Capabilities Framework, but it’s important for organisations to act now as funding will only be on offer between 2022 and 2025 – a three-year window. It should be noted that the least digitally mature Trusts will get priority funding, but there are now rumours via news outlet Digital Health that digitisation funds will be used to cover the cost of strike action for all NHS England trusts. 

Once Trusts have achieved the Core capabilities, then they are permitted to move on to Transformation and Innovation. This is to aid digital strategic planning, as some organisations are slightly ahead of target.  

The transformation requirements revolve around market solutions for the additional implementation of new software that can expand care provision beyond the functionality of the core solutions, whilst Innovation is even more forward-thinking and looks at ways of further enhancing efficiency of services or the scope of care a Trust has.

With the size and scope of the NHS, it’s no surprise that the organisation has digital information standards to ensure Digital Capabilities Framework are achieved, but the question is what are these NHS digital standards, and how do they relate to the core aims of the NHS and government? 

The NHS Digital data and technology standards framework is handled by NHS England, who adhere to the Digital Technology Assessment Criteria (DTAC). They are a dedicated team of experts overseeing the NHS’ approval of software solutions based on a scoring system to ensure these solutions are meeting DCF requirements. 

There are two simple goals: 

1. Software solutions must ‘talk’ to each other (aka be interoperable) 
2. The NHS must gauge patient and staff feedback as it progresses with digitisation 

Frontline digitisation comes with the challenge of needing to train staff. Some will find this easy, some might not, but clinical safety is paramount so it cannot be introduced in a brush stroke. There has to be time to learn, understand, and process new information. To assist with the transition and education, the Health Education England digital capabilities framework gives tools and resources for training and accreditation purposes.  

This brings us on to the NHS Frontline Digitisation Programme, and how it will benefit the public health going forward.

The NHS Frontline Digitisation Programme is a battleplan to drive the digital development of the National Health Service, and to ensure that the UK public health system is improving as a result of the investment of both funds and effort.  

The first step of meeting the DCF’s Core digital capabilities is implementing electronic patient records nationwide. We already know the benefits of electronic patient records are primarily through improved efficiencies, great security, and cost-saving, but there’s more to appreciate. 

One of the core goals of the Digital Capabilities Framework is to have a longitudinal record which, put simply, means that the user can click to get the information they need from within the electronic patient record (EPR), irrespective of whichever system the data is coming from. The appeal of a longitudinal record is that the user can click on a patient record within the EPR and access a variety of national or regional systems; including but not limited to: 

• NCRS – National Care Records Service 
• GP Connect – National detailed GP record 
• NRL – National Record Locator 
• NEMS – National Event Management system 
• Regional Pathology systems for orders and results 
• Regional Shared Care Record 

Electronic patient records are the perfect vehicle for a single longitudinal record. They are already a centralised record that can be accessed and updated in real time, but they are also highly suitable for integration with other solutions and systems. 

As an example, at Access we achieve this two ways. Firstly, our Rio EPR solution allows a user to click out of a user or patient record via a hyperlink to then access the national systems in user/patient context and return without the user losing their place. Secondly, Rio EPR supports integration via a suite of APIs, meaning third parties (in specialist areas such as wound care or patient portals) can be embedded into our software.  At Access we give our customers choice by partnering and integrating with a range of organisations who provide specialist solutions as well as offer specialist solutions ourselves.  

EPRs can take this further though, and this ties in to both the Core and Transformation capabilities within the DCF. With their functionality, EPRs can support other aspects of care too. Electronic observations from the patient’s bedside can be immediately uploaded to the patient record. Electronic whiteboards replace outdated physical boards, meaning more accurate bed management, patient data attached to the bed record, and a greater control of a hospital’s patient flow. 

With everything in one place there’s no need to waste time logging into multiple systems trying to find the right information or data. When integrated, it’s all easily seen and quickly accessible. This leads to safer, more efficient care.

TechUK ran a great article in January 2023 about the challenges for digital health. Their research and surveying of the health and social care sector listed four major challenges which would inevitably impact digitisation: 

1. 45% highlighted the NHS ‘crisis mode’ as the greatest challenge to digital care
2. 20% pointed to “insufficient funding for digital transformation”
3. 17% criticised a “culture that is resistant to digital transformation”
4. 11% flagged “a lack of awareness of the potential capabilities of digital technologies” 

There was a further problem flagged in an article by Health Tech Newspaper (HTN). In their piece on frontline digitisation, they focused on the first step of the digitisation process – the EPR onboarding. Phill James, a managing consultant for digital healthcare consultancy Apira, said that re-procurement of a solution is a new big issue. Due diligence has to be shown in the procurement process to consider alternative solutions, and this is time-consuming in cases where a trust or organisation might be happy with their existing partnership.  

There’s also an issue of funding, with lower digital maturity trusts prioritised in order to build their minimum digital foundations and achieve the Core requirements of the DCF. This approach is sensible, but any funding reduction might metaphorically pull the rug out from under trusts that has EPRs in place. National funding is distributed by Integrated Care Boards (ICBs). This means that Trusts and other organisations have to set out a detailed business case for each funding requirement that clearly shows broader strategy, the benefits to care output, acknowledgement of the challenges of implementing new digital tools, and the potential for cost saving or returns. It also means Trusts and partners are working to the goals of that region’s ICB, and not purely to their own targets. 

These are big business propositions and rightly being treated as such, but that means taking the time to study all propositions and award funding appropriately to achieve the greater good. Not all Trusts can win. Some will be delayed in their digitisation plans, and to add further strain Health Service Journal (HSJ) confirmed in July 2023 that the target of digitising all NHS England trusts by 2025 was now unachievable following £700 million worth of government cuts to funding.  

This lack of financial backing goes some way to explaining data from Health Tech World that few NHS trusts have reached the top level of the HIMSS digital maturity benchmark. The article reports that approximately 76% of NHS acute trusts have not yet achieved HIMSS Level 5, less than 9% have reached HIMSS Level 6 or HIMSS Level 7, and specifically fewer than 12 hospitals have hit this HIMSS Emram Level 7. Again it’s worth stressing that the NHS adheres to the Digital Capabilities Framework primarily and not HIMSS, but it’s a useful comparison.

If you have any prior knowledge of digitisation in the NHS you’ll recognise the digital capabilities framework called HIMSS Emram. This electronic medical record adoption model is a popular standard for acute care and digitisation, but what is HIMSS? 

What does HIMSS stand for? 

HIMSS – sometimes mistakenly written as HIMMS – stands for healthcare information and management systems society. There are several levels of digital capability within the HIMSS framework, and whilst it is acute-centric, it can be useful to see what it strives for. 

• HIMSS Level 5 NHS
  HIMSS Level 5 equates to the NHS minimum digital foundation goal at present. It requires expansion of services to providing telehealth and virtual care services; all whilst demonstrating internal and external security measures to protect data and monitor access. 
• HIMSS Emram stage 6
  HIMSS Level 6 sees the integration of medical devices, such as wearables, and the introduction of online support via patient portals; engaging patients in their own care and educating individuals about their conditions and long-term wellbeing. 
• HIMSS Emram stage 7 
  This requires healthcare organisations to be able to integrate data from multiple external sources, as well as to support tools like alerts or reminders for patients, and to automate certain appropriate services for clinicians.

Digital solutions in the form of healthcare software offer the NHS opportunities to improve efficiency within departments and teams. By streamlining certain processes – clinical or administrative – we can save time and money.  

• Time can be repurposed to provide additional care, or for a clinician to engage in new learning, or even to allow staff to rest and recharge.  
• Money means additional services can be provided, equipment can be bought, or staff can be hired. 

The NHS works from its own Global Digital Exemplar (GDE) Blueprinting workstream, as part of the national Provider Digitisation Programme. This is a guide for delivering digital tools using experience gained in the NHS through previous implementations of software solutions. 

Below are the four main healthcare programs that can help improve the NHS, and that will play a big part in the NHS frontline digitisation.

Electronic patient records (EPR) 

Also referred to as electronic health records (EHR), the EPR is considered one of the NHS minimum digital foundations. Digital patient records operate from a centralised data bank and can be accessed by multiple users at a time. This longitudinal record allows access to real-time information, a higher accuracy of patient information, and less duplication of notes and the effort to make notes – thus avoiding any updates not being added to a person’s records. 

At Access, we have our own interoperable solution in RioEPR.

eMAR 

The electronic medication administration record (eMAR) is a great medical records tool for delivering medication to patients, though often in a care environment rather than an acute NHS setting. 

Tracking which patients have taken which medication – or perhaps which medication they have missed – is a crucial part of monitoring their wellbeing, tracking recovery, and generating bigger picture data for how impactful certain medicines are at a demographic level.  

For more on medication records, please visit the Access EPMA software page.

Patient Flow Management 

Optimising the flow of patients through a hospital is a big step for hospitals to take, and one that Access is supporting with our Patient Flow Manager (PFM) solution. By layering on top of any hospital system, the solution will give a command centre view of bed capacity and availability. 

The premise is simple enough: patients flow through a hospital and demand fluctuates 24/7. By actively tracking this patient flow, clinicians and managers can see an accurate hospital population at any one time. By tracking who is occupying which beds, how long they have been there, and offering access to their current care information to see what treatment they’re receiving it can be ascertained whether they are suitable to move away from an acute bed to another ward, or to be discharged for home assessment and continued monitoring. This increases capacity and reduces population. 

At Access, our Patient Flow Manager solution displays tasks which need to be actioned on digital whiteboards. This interface aids the patient management and movement described above, but it also tackles a risk with whiteboard systems. Statistical evidence from Berkshire Foundation Trust - one of our customers - showed that before using Access Patient Flow Manager 23% of whiteboards were outdated at any time, and 22 minutes was being lost per day per patient double-checking patient data. On top of this, not all clinicians were checking the EPR as well as the whiteboard. Our PFM solution mirrors EPR data to the whiteboards, ensuring much more accuracy and reducing the element of risk. 

Managing risk is about maximising the things that go right and minimising the things that go wrong. The clinical indicators in Patient Flow Manager ensure that care needs of patients are not overlooked. Furthermore, the broadcasting of data in real-time allows teams to plan more effectively, delivering a safer and more efficient experience for patients.

There are two options for onboarding solutions once a Trust, or other organisation, has highlighted what their requirements are. 

Option 1: Convergence – an all-in-one solution 

Option 2: Multiple ‘Best in Class’ solutions 

The appeal of an all-in-one solution may seem a simpler direction to take i.e. one system with all the functionality needed by your organisation to undertake patient care supplied within one solution. This could make life easier for clinicians as there’s only one system to do the work without having to be mindful of multiple systems. Managing one supplier contract and having one system to manage  maymanage may also appear to be easier i.e. dealing with just one organisation rather than many. 

However, the impact of ripping out your existing systems that have become established for many years and replacing with one single system is not to be taken lightly. The cost of all-in-one packages are hugely expensive and complex to successfully implement. Having “all your eggs in one basket” means organisations may become heavily dependent on that one supplier to meet to the organisation’s needs now and in the future. If that software provider is hit by a technical, political, financial or organisational issue, your whole organisation could be detrimentally affected with little room to swap and change suppliers as you’ve gone from many to one.  

By opting for a single supplier across the board, your organisation may lose the potential for adapting to rapidly changing needs in the future, adopting cost effective new innovation as it happens, maintaining the free market competition of smaller organisations competing with one another to deliver you best quality and value.

This is why we would advocate for option 2. There are several ‘best in class’ solutions coming from the same providers. Converging to a few interoperable suppliers is more contacts and contracts to manage but it potentially spreads risk. It keeps flexibility for change in the future which is crucial to an evolving digital healthcare ecosystem meeting the needs of the people. 

If you’re pursuing interoperable solutions and adhering to best practices around onboarding solutions – using things like a trust integration engine – then the process will be seamless and unnoticed by patients/clients anyway, so that problem is avoided, which just leaves us with the benefits. A spread of solutions encourages competition, which drives performance and value for money. The bidder’s market wants your custom, and that gives NHS Trusts the advantage.

This is why the NHS has the Digital Capability Framework. Modern healthcare needs to rapidly evolve, and the tools are there to do it. With growing demand and tighter budgets, digitisation offers a way of fighting against the tide. The Digital Capability Framework will help level up the NHS to make sure nobody falls through the cracks again.