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NPfIT 2: This Time it's Angry

Right, so I'll start this piece with a feeling of slight bewilderment. So a week last Wednesday, Matthew Swindells announced that every Trust is the country will in essence have to take one of a handful of EPR systems.

THIS. IS. MASSIVE. It's the biggest announcement in the digital health marketplace for years. As HSJ pointed out, this means that the market has been basically sewn up for the GDE suppliers. It is exactly the same as NPfIT, the only slight difference is that Trusts will be able to choose which of the handful of suppliers they are forced to take. Wonderful. Of course, there are the caveats that new suppliers can of course join the approved list, but that is a nonsense. Having been frozen out of the NHS market, how will a supplier with no UK reference sites get on to the list? Ridiculous.

Why has this announcement been met with overwhelming silence? That's not a rhetorical question- I am genuinely at a complete loss. Where are the screams of anguish from suppliers that have essentially been put out of business? It's bizarre.

But who cares about the suppliers to be fair. This is about the NHS, and there is merit to argument that Trusts inheriting proven systems configured in the fires of front-line work is much more efficient than everyone trying to reinvent the wheel. In the short term that's true.

But every good capitalist knows that plurality and competition in the market is the engine of innovation. Admittedly, you could argue that this isn't a massive shift in the competitive landscape- Cerner, Epic, Allscripts, Intersystems etc. have always been competing with each other, with the threat of the smaller suppliers largely negligible. And in controlling places on the new GDE framework, the NHS will be able to mandate that suppliers develop certain functionality. Basically GPSoC.

But I really wish someone had given Mr Swindells a refresher on business strategy. The first key thing to think about is blue ocean vs red ocean. The key principle here is that continually competing in the same market leads to convergence of products. Basically, as a marketplace matures, if you make an innovation that gives you a competitive advantage it will soon be copied by your competitors. Likewise, you'll be sure to copy anything successful your competitors do. Which leads to everyone just having the same product, little reason for suppliers to innovate and almost no reason for any customers to bear the pain of switching. GPSoC anyone?

The way to break this process is to create a 'blue ocean'. This is basically a new market, as yet untouched by the blood spilt through fierce competition. In the EPR marketplace, this would represent an innovative way of thinking about clinical systems, a break from the established model of proprietary models that lock information away in organisational silos. Open source anyone?

But I'm afraid thanks to Matthew, the gates are locked to the lovely blue ocean. Everyone is stuck in the bloody red ocean.

This is what will happen: Yes, there will still be progression of these systems but the speed of that progression will be increasingly slow as the handful of systems converge even more. No Trust will change system as they're all the same anyway and the pain of it all won't be worth it. This means that competitive pressure to innovate will then truly die, with suppliers knowing their customers will never leave them. The only way the NHS will be able to push things forward is through mandating functionality through the framework.

I mean, this isn't that bad is it? It's not like these suppliers don't have half decent systems. This will really work in the short term. But is absolutely terrible for the longer term. As long as this framework remains in place, there will be no true innovation in the EPR marketplace. As in proper innovation. Breaking the mould and not just making a slight tweak to get a slight advantage over your identi-kit competitors system.

I'd love to end of some sort of pithy punchline, but it's just really depressing.

Thomas Webb2 Comments