Dr Alistair Hann: August 15, 2018
I recently joined the NES Digital Service, and even suggested the name, so it may seem strange that whenever I hear the word ‘digital’ I get twitchy and a cheeky voice in my head says ‘analogue’. That concern is about why something needs to be called ‘digital’. I have never heard my thirteen-year-old niece use the word – she doesn’t think of her smartphone, Google, or Alexa as ‘digital’.
One thing that can go wrong is when the word digital means that something has been through the process of ‘digitisation’. If hand-written forms and notes are scanned and turned into a three-hundred-page PDF – is there any value in that? Yes, it can be emailed or accessed remotely, but the content cannot be searched, and the data cannot be combined with other results to show trends. A doctor presented with it will likely abandon it and make decisions based entirely on the patient in front of him. Digitising provides a minor advance but fails to deliver the wider benefits we see from the use of technology elsewhere. Another reason that scanning a document would fail as ‘digital transformation’ would be if the process that creates and consumes the document remains unchanged. What needs to happen is for the whole process to be considered and redesigned for today's workers, with technology embedded.
The Microsoft Encarta CD-ROM was a ‘digital’ Encyclopaedia Britannica. It wasn’t just digitised as it had a few improvements over a scanned series of books - it was portable, searchable and had multimedia content. The modern encyclopaedia is, however, Wikipedia – free, entirely online, multi-lingual, up to date, and with a hundred times as many entries. Wikipedia’s success and Encarta’s demise came from entirely rebuilding the process – who creates content, how it is maintained, and how is it consumed.
That journey didn’t stop with Wikipedia’s launch in 2001 – it continues to develop and goes beyond being an encyclopaedia. The fundamental job it is doing is helping someone who doesn’t know about something to learn as much about it as they want to – and that means being in the right place and delivering sufficient information - for example, summary Wikipedia content is often in the widget next to search results on Google.
The ‘encyclopaedia’ has moved from a library book, to CD-ROM in the home, to a subscription website, to a free website, to a widget on another website. Content creation has developed from experts only, to an internet free-for-all, to an authoring process that still benefits from the crowd and manages to maintain entries for the most contentious of topics. The entire ‘service’ of providing knowledge has been, and continues to be, redesigned.
There are plenty of other examples of this, just as Wikipedia is not a digital Britannica, Skyscanner is not a 'digital' high street travel agent, and Spotify is not a 'digital' HMV. While it is easier to develop new services from scratch and not having to redesign existing ones – it is still possible to achieve these results when there is already extensive infrastructure and existing users to serve, even in the public sector.
I recently renewed my UK passport – the experience was entirely online, I could use a photo taken from my smartphone, and I got SMS updates about the status of my renewal. I didn’t need to get my photos signed by an accountant, teacher, or doctor – my identity was confirmed behind the scenes by reference to my photocard driver’s licence (I presume). Another example is BBC iPlayer, which feels in place next to Netflix, or Amazon Prime Video – and a long way from a box in the living room playing a schedule published in a weekly magazine.
What does this mean for the NDS? If we were to ‘digitise’ the work of clinicians and social care workers, then we would create an Encarta CD-ROM and with similar consequences. Robert Wachter’s “The Digital Doctor” describes a world where technology has failed to fulfil its potential to improve health care, with Electronic Health Records that often started as electronic equivalents of paper processes; in software systems designed for the finance departments that paid for them.
NDS must instead consider the whole picture of any processes and systems we work with. We need to engage with doctors, nurses, carers, patients and all the other people involved in these processes and work with them to produce new services, enabled by modern products, that use today’s technology (which happens to be digital technology).
Given my aversion to ‘digital’, why did I suggest the name NES Digital Service? Firstly it is a signpost to other digital services (e.g. GDS, USDS) that are overhauling the way software is used in the public sector. Secondly, people understand what we refer to when we say ‘digital’. That said, our job will not be done until the word ‘digital’ in ‘NES Digital Service’ is as bizarre an artefact as the reference to a grubby sheet of paper when someone sends you a ‘carbon copy’ of an email, and until the products we build look in place alongside Google, YouTube, or the step counter on my niece’s phone.