When systems that are designed to support medicine aren’t embraced by clinical teams, the adopted solution is often forced rather than re-evaluated. It’s therefore refreshing to see organisations take a more pragmatic approach, and at the King’s Fund Annual Conference in November, two talks in particular challenged the way in which existing healthcare practice and IT systems adapt to one another to ensure successful outcomes for patients.
Humanising care with technology
Dr Parashkev Nachev, a Senior Clinical Research Associate at UCL and Honorary Consultant Neurologist at University College London NHS Foundation Trust, talked about the choice we face between mechanising humans, or humanising machines. For too long, he argues, digital patient record systems have been a disruptive factor in patient care, because they aren’t designed with input from clinicians. He pointed to the fact that, especially in hospital care, clinicians need to be hands-on - looking at, touching, and examining patients. But health record systems require users to turn away from patients to enter data via a keyboard, which represents a barrier between patient and carer.
This turns highly trained consultant physicians into data-entry clerks – mechanised humans. A more obvious solution is to rethink the way this data is recorded so it reflects how clinicians work – to humanise the technology.
This led to Dr Nachev and his colleagues at UCLH developing the StrokePad – a comprehensive, natively tablet-based, digital patient record for stroke care, which was demonstrated at the conference on a Dell Venue 11 Pro device, powered by the Intel® Core™ i5 Processor. Crucially, it natively supports a range of inputs that come naturally to clinicians in the way they record data, including handwriting, iconography, and the spatial positioning of notes.
Another huge benefit of the system is that it can produce human-readable discharge reports by combining the patient data that it holds with natural-language-generation techniques. These reports are vital for follow-on care once a patient leaves hospital, and can take up to an hour for a human to write-up manually. Indeed, most stroke units will commit time equivalent to one junior doctor per day to writing these discharge summaries. Existing digital patient record systems can produce them, but the output is more of a data dump, whereas caregivers want readable prose – another example, Nachev says, of software design that doesn’t take end-user behaviour into account.
He adds: “StrokePad lets us digitise data at the point of care in a way that properly engages with the natural modes of communications that doctors use, and it takes advantage of digitisation to save time in accumulating data and distilling it into a letter. Then it generates an output that’s intelligible to a human being, not a machine. No systems, certainly in stroke care, do this adequately at the moment.”
One view into patient data
Hasib Aftab, Assistant Director, IT and Systems, NHS Camden Clinical Commissioning Group (CCG) was facing a different set of problems, but the theme was the same: technology that should have been making care easier was actually adding complexity.
Healthcare in Camden was delivered by multiple providers who all used different systems to store their patient records, making accessing and sharing information very challenging. To overcome this, NHS Camden CCG set about building Camden Integrated Digital Record (CIDR), a web-based portal based on Dell/Intel architecture that allows health and social care professionals in the borough to view information from multiple care providers in one place.
It combines data from four NHS Trusts, the local authority, and the NHS Coordinate My Care system, and covers eight different information systems. Future developments include more comprehensive single-sign-on capabilities, more integrations with care and technology partners, and mobile applications.
Improving the quality of care
The primary driver for this was improved quality of care. By having visibility of all of a patient’s data, clinicians can make more informed decisions, better understand a patient’s previous experience, and ensure patient safety in areas like prescribing.
Patients most likely to benefit are those with the highest need and most complex conditions. On top of this, CIDR obviously reduces the administrative complexity and cost of delivering good care by reducing duplication.
The StrokePad and NHS Camden CCG projects have a common goal at their heart: the adaptation of technology to suit the needs of healthcare, rather than compromising healthcare practices to fit in with technology that doesn’t support them in the right way.
With a vast number of opportunities available and a growing appetite to innovate, healthcare organisations need to ensure they are equipped and ready to tackle the challenges that lie ahead. Better collaboration between organisations and technology providers will ensure that all parties are able to identify what capabilities they need and understand how technology can help address them.
Dr Parashkev Nachev and Hasib Aftab presented alongside Gordon Morrison, Director of Government Relations, Intel Security, as part of a session entitled “Technology solutions for better value.” Read Gordon’s blog Shifting our thinking: Healthcare and the cyber security landscape to learn more about the event.