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This is the first of a series of essays which record the history of the Clinical Digital Transformation Programme at University Hospital Southampton, from its roots in the history of digital computing in the 1940s and of digital computing as applied to healthcare from the 1960s onwards. The core theme of this project is the productivity and clinical safety in healthcare which can be unleashed in the UK Public Sector through intelligent design, imaginative innovation, a clear long term institutional vision, focussed teamwork and agile, iterative development. These are fundamental elements of digital transformation in a benevolent and supportive management environment. All of these factors combined in the early 1990s in Southampton to create a unique, locally developed clinical informatics environment with powerful design elements and component systems, through close interaction between the computer specialists and clinicians, and at very modest cost. We are at a point where core development and the design optimisation of user facing IT systems appears to have stalled nationally after the initial rush of healthcare IT investment a decade ago, and the arrival of AI tools have created new distractions from getting the basics right. The Southampton experience of the IT development process and its outputs contain many lessons which may be of value for the NHS, for other global health care systems and for commercial system developers. In this essay, I provide a brief historical overview of the development of healthcare computing from its earliest technical origins, and of the UK national context of healthcare computing through which the Southampton programme developed. This includes the Wessex Regional Health Authority Regional Information Systems Plan in the 1980s, and the UK National Programme for IT (NPfIT) in the 2000s, from which many important lessons were learned. These translated into a nationally unique clinical information architecture at University Hospital Southampton UK which continues to evolve. |