The F35 in healthcare data strategy and digital health

“The best thing is how quickly and effectively the F35 allows the pilot to make decisions – fusing sensor and other data … to display what’s out there and what’s going on” – UK F35 pilot on the aircraft’s single best characteristic¹.

The Royal Air Force’s and US Marine Corps’ newest Strikefighter, the F35B Lightning II, is unusual in aviation history in that it is not as maneuverable, long-ranged or well-armed as some of the aircraft it’s replacing (caveat - according to the lay press).  Despite this, it is a quantum leap in capability for the UK / US military (and many others).  

Amongst several aspects, what makes the F35 such an absolute game-changer are two particular characteristics:

That it automates large parts of operating the aircraft, with simplicity of operation and user interface being core to its design.

That it is in part essentially a stealthy data-processor, with incredibly advanced sensor systems that absorb vast amounts of information in multiple different formats and then (most importantly) synthesise it and present it to the pilot in a way they can understand and use.  

These factors have a huge impact on the pilot’s ability to employ the aircraft in the most effective way and achieve the desired effect in the safest and most efficient way possible.  

We argue that many of these same characteristics are also required in Healthcare systems and Health data strategy, (or indeed in any large organisation’s data strategy).

First, we will focus on the effect of the F35’s data integration capabilities and later, we will discuss the importance of the User Interface, although obviously both characteristics are linked.

By automatically gathering all the required data, filtering it and then, most importantly, synthesising it and presenting it to the pilot in a way they can easily understand, the pilot is able to make the decisions that deliver the desired effect in the safest and most effective way.  

In healthcare however, the situation is often exactly the opposite – too often data is not integrated or presented in a usable fashion to the decision-makers (long routine reports anyone?), meaning that key information is lost in the noise rather than becoming usable intelligence.  Decision-makers become reactive “fire-fighters” constantly playing “whack-a-mole” rather than having the relevant intelligence and headspace to proactively make decisions.  This leads to missed opportunities for early intervention which results in worse patient harm, worse patient experience and more cost.

Note that it is almost never the case that there is not enough data.  It’s estimated that hospitals globally produce over 50 petabytes of data², with healthcare now accounting for over 1/3^rd of all data produced annually³.  In hospital leadership this is bed-status reports, national audits, HES, staff and patient feedback, Complaints, incident reports, GIRFT etc etc etc).  Rather it is the lack of synthesis and effective presentation to turn it into usable intelligence that is the issue.

This is not a new problem - both the Francis report into the failings at Mid-Staffs NHS Trust (“The report has identified numerous warning signs which cumulatively, or in some cases singly, could and should have alerted the system to the problems developing”⁴) and the report into the surgeon Ian Paterson (“information was not shared… making it difficult to identify concerns”⁵) highlighted the key role failure to synthesise and transform data into usable intelligence played in the respective safety failings.

The parallels between aviation and healthcare have sometimes been over-used but often the underlying point stands.  In an era of increasing resource shortage, having automated systems that synthesise and present the relevant data to leaders and decision-makers at all levels in an intuitive, comprehensible format is ever more essential.  

It enables leaders to have the headspace to do the things that algorithms cannot– to proactively make decisions, prioritise resources and decide how best to deliver the organisation or unit’s desired effect. Without it, we will continue to spend all our time reactively trying not to fall out of the sky rather than achieving our mission of reducing avoidable harm and improving the outcomes, experience and efficiency of care.

Next, we can describe how another characteristic of the F35 – that of simplicity of use and placing the user (pilot / groundcrew) at the core of its design is also fundamental to delivering high value, safe healthcare.

The F35s systems are designed to be easy to fly and efficient to operate with user experience experts and end users (maintainers and pilots) all being integrated into the design process at an early stage.  This simplicity massively increases the pilot’s headspace, making them much less likely to become distracted and task-saturated (because they’re not spending so much time simply trying not to fall out of the sky, crash on landing or use convoluted systems etc).  

This means that tasks can be achieved more efficiently and the whole system is, as a result, much safer and more effective.

Too often in healthcare however:

Many systems are designed and procured piecemeal with clinicians being required to simultaneously use multiple legacy systems that don’t connect to each other.

Procurement is performed by senior staff often with little involvement of the actual end-users (often junior clinical or administrative staff) meaning that the user interface and usability has not been tested by the people who will actually use the system.

As a result basic processes take longer and care is less efficient, which results in longer delays for patients and over-loaded staff with lower morale, which ultimately all combine to produce a less safe system.  

This is not an abstract concept, it is a major issue with real impacts.  For example, a report by the UK Royal College of Physicians found that the “excessive burden” of administrative tasks and poorly designed systems were among the biggest sources of stress on junior doctors⁶, worsening burn-out and potentially exacerbating already serious staff shortages.

Likewise the World Health Organisation estimates that around 40% of health spending is wasted through inefficiency⁷, while the OECD estimates that 20% of health expenditure either does not improve health or actively worsens it⁸.

Digital systems, Robotic Process Automation, AI and the like will be fundamental to delivering high value and safe patient care, but poorly designed and procured systems can be harmful not helpful.  Unless, like the F35, health IT systems are built with simplicity of use and the real-world (often junior) end-users at the core of their design, then delivering safe, efficient, equitable and value-based care will continue to be an elusive goal.

‍

This article was originally published on Peerr in September 2024

‍

1. Interview with a British F-35B Lightning II pilot: Semper Fidelis to Semper Paratus | Hush-Kit (hushkit.net)
2. 4 ways data is improving healthcare | World Economic Forum (weforum.org)
3. https://www.rbccm.com/en/gib/healthcare/episode/the_healthcare_data_explosion
4. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary HC 947, Session 2012-2013 (publishing.service.gov.uk)
5. Report of the Independent Inquiry into the Issues raise by Paterson (publishing.service.gov.uk)
6. Royal College of Physicians. Being a junior doctor. 1 Dec 2016. https://www.rcplondon.ac.uk/guidelines-policy/being-junior-doctor.
7. World Health Organization. The world health report: health systems financing: the path to universal coverage. 2010 The World Health Report 2010 (who.int)
8. OECD, Tackling wasteful spending on health, 2017.  Tackling Wasteful Spending on Health | OECD  

‍