HTN Digital Week Day Four: Thursday 23rd January 2020
Day Four of HTN Digital Week saw another 3 excellent webinars on the back of the HTN People and Partnership Awards on Wednesday night.
Below, we have Chris Reynolds who presented first on ‘overcoming organisational barriers’. Followed by a presentation from Graham Walsh, CCIO at Calderdale and Huddersfield NHS FT on ‘Digital Day Case Knee Pathway’. Thirdly, we had Stephen Lake and Patrick Chapman on digitising consent forms, then to finish the day, we had the ‘online meetings made easy in primary care’ session across YouTube.
Chris Reynolds, Chief Information Officer, Penine Care NHS Foundation Trust presented ‘overcoming organisational barriers and culture – maximising potential’
A great presentation to share learnings and experiences, Chris has 20 years in health informatics.
Some of the highlight messages from the presentation included: “Ensure you have the clinical expertise in order to implement systems.”
“Here, we have put in video conferencing, an EPR, patient and guest Wi-Fi, audiology system unification, electronic data transfer and Paris Child Health 4 into 1 – we’ve spent a lot of time putting systems together.”
“Organisations are often described as ships, difficult to turn around. We have lots of boats at different points and different sizes; the only unifying factor between them all is technology, and we can do standardisation at scale.”
Six Steps to Effective Collaboration
- Common tools – “You should make best use of common tools; we have always used NHS Mail, its free and I can share information with my colleagues easily. Low level tech which isn’t healthcare specific should be utilised to their full application to make collaboration easier.”
- Sharing records – “Everybody wants to share information so the ‘Share for You’ initiative is something we implemented in Rochdale, records are shared across all sites.” Chris says that many clinicians who they reached out to about the initiative had a positive experience of using it. “The professional records standards body; it is really important to work to those standards.”
- Have a strategy not a religion – “it is important to be as flexible as you can and we must be able to flex that strategy. It is ok to deviate from your strategy as long as you know you are doing it.”
- The personal – communication between people is key
- Levels of collaboration – “I have to have pictures in my head about how all this stuff works together. Collaboration occurs between lots of different local organisations, between similar local organisations and between similar national organisations and also on a national level.”
- Credibility and success – “I am a believer that the NHS is a very good organisation for technology. Things are achieved in the NHS that are undervalued because of the levels of overall investment. One of the reasons I put so much emphasis on this area is because; I am passionate about telling staff how good they are doing, I am passionate about technology and its ability to change patient care, and passionate about professionalism in healthcare.”
Graham Walsh, Chief Clinical Information Officer, Calderdale and Huddersfield NHS Foundation Trust presented ‘Digital Day Case Knee Pathway’
Graham presented to us wearable technology that aids in the rehabilitation of patients post knee replacement surgery. A fascinating insight into this tech which enables users to speed up recovery times through a means of different methods as well as saving money for the NHS and a host of other benefits.
Graham started his presentation by highlighting some facts about traditional knee replacement surgery. Knee replacement is a common operation in the UK with 110,000 being done per year with patients staying in hospital for around 4 days.
Graham highlighted that patients tend to have to ‘self-direct’ their recovery and receive little prompts to their rehabilitation and end up being in outpatients at least 5 times.
The Pathway was then shown to us on screen, which was a comprehensive flow chart detailing the patient journey.
“We need to make sure the pathway is safe and that the patient is removable from that journey at any time if they feel unsafe.”
The outpatient consultation is the start of the pathway for the patient and this is where Graham says patients were selected and the concept is introduced to them. Patients enter a bespoke pathway which is tailored to them and their rehabilitation. Graham does point out here that patients do need a smartphone/laptop/tablet as the device relies upon connecting with the patient’s own device.”
The patient then sees the physiotherapist to discuss exercise and talked through the device as well as handed the device at this stage. It should be noted here, that the day of surgery process is largely unchanged.
About the technology; patients work through daily exercises using the wearable sensors and can progress through them as quickly as they want to. Physiotherapists remote log onto the portal to see how the patient is progressing and so removes the need for as many home visits, if any at all! The patient can message the therapy team if they have concerns.
“This technology is really simple; a wearable device connected to their smartphone that gives the patient instructions how to exercise.”
“Pain and discomfort are logged through the app as well as goals and targets. By doing this, physiotherapists can tailor rehabilitation to the patient based on the patient’s needs. We can check suboptimal progress to then follow up with a call and we can tailor care to the patient based on their progress. Patients have said it was great to receive this feedback and gave us reassurance that everything we were doing was the right thing to do.”
“Patients do not need to come in to see us; the reality is patients want to get on with their daily lives.”
The point of removing the necessity of the patient returning to hospital for check-ups is something we hear a lot of from clinicians across many fields of healthcare. Graham continued to make this point by stating video technology is being used increasingly to negate the need for patients to return to hospital.
“Patient benefits were massive and loved the ability to receive feedback; patients managing themselves were doing better, quicker. Wearable technology is a real enabler to patient satisfaction”
Stephen Lake and Patrick Chapman – Digital Consent: Why Trusts can’t afford NOT to digitise consent processes, ‘A surgeon’s perspective, experience and insight’
Stephen has been involved in the development of the eConsent product which is used at Worcester hospital in order to move to paperless consent forms and to bring clarity to patients about to undergo surgical procedures.
“Are digital consent affordability questions misplaced? – isn’t the real question, what are the risks involved?”
“We must get it right the first time – the most common causes for claims; judgement/timing – 739 claims 51.5%. Interpretation of results/clinical picture, 324 claims 22.4%. Unsatisfactory outcome to surgery 200 claims, 13.8% and failure to inform consent” which made up the remainder of complaints.
Failure to warn is up 30% and has been increasing year upon year – “we need to start somewhere to reduce that percentage.”
Legal & compliance – “I spent many years talking to patients about their options, we need to come to a shared decision about surgical treatment.”
“We need to go paperless” – Stephen and Patrick both expressed huge desire for no more note taking or jotting especially when talking to the patient about their options. A more professional approach can be achieved through digital implementation.
The challenges: Impact and cost of procedure delays, ensuring signatures clearly relate to the risk/procedures outlined, lack of standardisation of process, ability to modify for the individual patient, legally robust audit trail in event of litigation and missing paperless targets.
“Digital consent is revolutionising the consent to surgical procedure treatment process.”
“One of the key things is oversight” – manual systems can lead to risk of delays, cancellations due to omissions, mistakes or loss of the paper copy.
“Handwritten documents are unlikely to cover all specific risks, also, important points may be abbreviated which creates confusion. This contrasting to a digital form where everything is laid out in a structured fashion and can be updated allowing the patient to be constantly updated.”
“As a clinician, I need to maximise my time; me filling out forms is not in the best interest of the NHS in my opinion. Chief information officers realise the benefit of going paperless.”
DrDoctor held a panel discussion that focuses on the opportunities and challenges around demand management
Dr Hussain Gandhi and Dr Andrew Foster presented online meetings made easy in primary care
“Meetings suck your time and there a lot of challenges with organising meetings. Also, being on call as a clinician is an excellent reason to use online meetings; meetings on the fly. You can even catch up on meetings by using 1.25x speed to get the general content of the meeting before the next meeting takes place.”