Interview Series: Dr Gurkaran Samra, Clinical Informatician, Blackpool Teaching Hospitals NHS FT

In this edition of our Interview Series we spoke with one of our long-standing judges in the Health Tech Awards, Dr Samra from Blackpool Teaching Hospitals.

Could you tell me a bit about yourself?

I work as a ‘clinical informatician’ within the Health Informatics (HI) team at Blackpool Teaching Hospital NHS Foundation Trust.

Alongside my informatics role I work as a clinician in Acute Medicine, as well as being deputy lead for quality improvement with the Medical Education department. I am a GMC Associate, and have worked as a GMC performance assessor for the last 5 years and have recently started as a PLAB examiner too.

After graduating from Manipal University in August 2008, I came to England on 5th November 2008. I started out at Blackpool Teaching Hospitals as a Foundation Trainee in August 2009 and have remained at the Trust since then. After completing my Foundation and Core Medical training, I have worked in non-training roles in quality improvement, research, medical education and health informatics alongside my clinical role in Acute Medicine. I also did a brief stint as secondary care digital lead for Healthier Lancashire and South Cumbria ICS in 2018.

Could you tell me about your journey into your role?

In the absence of a defined career path for clinical informaticians, and with not having a personal planned career objective, other than wanting to enjoy work and do the best I can, the journey to my current role has been interesting to say the least.

I have always enjoyed my clinical role, but have often felt that the care provided to people can be improved if the system within which they are cared for were improved – health informatics being one of if not the most important facilitator of change in healthcare.

I have been fortunate to have been supported by the Trust’s CIO, and have been given the opportunity and freedom to work with the health informatics team – a journey which started 5 years ago with a personal ambition to replace the hand written traditional ward whiteboards, and the need to standardise paper based clinical handover. This ambition was the starting point of my introduction to HI and led to the development of in-house developed applications called BASE and Ward Tracker. These apps record clinical summaries mapped along the inpatient journey and were integrated with the existing in-house developed clinical portal.

Over the last 5 years I have transitioned from working with a couple of HI colleagues (who are now some of my closest friends) during lunch breaks, and from having to do a lot of work late into the evenings in my own time at home – to gradually reducing my clinical commitments from 4 days a week to 1 day a week in order to facilitate a more sustainable working relationship with HI – essentially a transition from a ‘black-ops’ approach to an aspiring formal and recognised programme of work.

This has created capacity for me to become an integrated member of the HI team, and has allowed me to grow into a clinical informatician – working on app specification and design, testing and deployment of in-house solutions, supporting secondary use of data (reporting and business intelligence) as well as contributing to the strategic objectives and plans of the Trust and HI department.

My contributions to informatics stem from a fair understanding of clinical and operational processes, a sound understanding of quality improvement methodology, a touch of geekiness, a stubbornness to improve care and an ambition to adopt a value-based model of healthcare.

The majority of my health informatics learning and personal development has been experiential in nature, supplemented with formal and informal colleague feedback, a personal CPD plan – comprising several self-funded online elearning modules, selective conference/webex attendance mostly facilitated through work, and a healthy dose of Twitter at home.

How has your organisation responded over the past few weeks during the COVID pandemic?

I feel the Trust’s response to the COVID pandemic over the past few weeks has been very similar to most other organisations’ HI response – enabling agile working for staff by upscaling remote access connectivity and increased use of communication tools, supported by device deployment for multi-disciplinary meetings, video consultations and virtual patient visiting.

The HI programme team started daily stand-up meetings aligned to the Trust’s Incident Control Centre function from the week commencing 16th March to ensure effective coordination and execution of tasks. This was supplemented with changing the frequency of HI senior team meetings from twice a month to twice weekly meetings to encourage timely resolution of any complex issues.

Along with this there were a few initiatives undertaken by the app dev and reporting team which I have been heavily involved with these include automated eAlerts of COVID swab results that integrate into the in-house developed BASE and Ward Trackers this saved clinicians from having to navigate to the in-house diagnostics results system to view results. A new ‘COVID Tracker’ was developed which displayed live updates and counters for COVID swab results.

The app facilitated the collection of clinically relevant data for the Respiratory COVID Outreach Team (RCOT) through capture of screening information, notes for daily updates and allocation of patients to different clinical COVID pathways depending on patient status indicators which helped prioritise reviews by RCOT, Critical Care and Palliative care teams.

The app also incorporated a live database for the research team to screen and recruit participants to ISARIC, RECOVERY and GENOMICC trials as well as functionality for RCOT to record follow-up plans on patient discharge from hospital was also included along with functionality for clinicians to record the cause of death.

This application linked to the active directory thus allowing for single user sign on, integrated with an in-house developed clinical portal, a BASE/Ward Tracker, and an eReferral system. The COVID Tracker app was developed in a turnaround time of 3 days from receiving a functional specification and as of 19th April, 244 users have used the app, with 7841 logins and a median of 147 logins per day.

There has been an enhancement to the existing ‘GP-Inpatient’ app for primary care teams to view COVID results and patient status updates for patients registered at their practice who may currently be an inpatient. There has also been an amendment of the existing Respiratory eReferral to help the Respiratory team to prioritise their inpatient referrals.  The reporting team have created automated data extracts for COVID-19 Hospitalisation in England Surveillance System (CHESS) report and several daily SitRep reports as well as creating a 15 minute automated report for the patient flow team to ensure timely identification of any new positive results and transfer of patients to isolation areas. Interactive reports for the ICP, Acute Trust and Community with a wealth of information on COVID related activity. As of 19th April 309 users have used the dashboard app, with 2411 logins and a median of 53 logins per day.

In this challenging time, we were joined by a newly recruited data scientist on 23/03/20, who within the first week of starting created predictive models for daily new positive cases admitted to hospital, COVID deaths per day, COVID mortuary occupancy per day and COVID discharges per day. These models were then incorporated into the BI reports. Aspects of this work featured in a recent HTN article – ‘From Academia to the NHS – thoughts from a data scientist in this time of crisis’.

What are you working on at the moment and what is coming up over the next 12 months?

This week I am working with one of our data analysts to create a report to help the Trust leadership understand and learn from cases of hospital acquired COVID.

Working in an agile manner has meant that the app dev team have continued with ‘business as usual’ despite the increased workload. They are now back to full flex working on the next version of our internally developed EPR which will amalgamate the existing core functionality of in-house clinical apps into a single application to enable better user experience and enhanced functionality of bidirectional ADT with the PAS, a range of patient flow tools, note function for specialist nursing team input and bidirectional communication for ward teams with primary care and community teams.

The new version will enable the dev team to be more agile when responding to change requests for functional enhancements in the future, and will also provide a richer source of data for reporting, business intelligence and for the data science team to initially predict expected discharge dates and then move onto other items in the planned programme of data science work.

Once this version goes live later this summer; I hope we can start working on other modules of our EPR for elective care pathways, stroke and cancer MDTs, enhanced clinical noting functionality, a new version of the in-house Trauma Tracker for fracture neck of femur, and an app for sharing information with patients about their care whilst they are in hospital. All this, plus supporting the deployment of new electronic document management and electronic prescribing systems, as well as looking into an eObs solution and a possible PAS replacement.

Can you tell me about some of the challenges and successes?

One of the biggest challenges is maintaining the pace of development and delivery without reverting back to a ‘black-ops’ approach whilst maintaining user engagement and ensuring user expectations and needs are met. The HI department are trying to overcome this challenge by establishing the required governance processes for a development lifecycle, and by continuing to raise with the Trust’s Exec team the ongoing issue of the importance and need for a the Trust to appoint a CCIO and the need fora clinical team in HI.

The current climate especially with the project team working from home may also prove to be a challenge for the roll out of the next EPR version; bearing this in mind the deployment phase of projects will need to be reconsidered – and I am confident that the teams will overcome this.

Another challenge that comes to mind is the challenge of striking the right balance between local HI capability versus regional strategy. We need to be mindful of the direction of travel of regional teams whilst not delaying local HI development to enable safer and efficient care.

Lastly, more than ever before the challenge and need of sharing data across systems in a safe and lawful manner has been highlighted by the ongoing pandemic.

What’s the best piece of career advice you have ever received?

The best piece of career advice I have ever received is from my Papa; who has always reminded me to do something that I enjoy, and then work hard at becoming the best at it.

What advice would you give to anyone aspiring to work in health tech?

My advice would be if you want to make a difference to the way care is provided – then health tech is the place to be. Also, dream big – anything is possible and ensure you gain professional accreditation. IT is easy – people skills and design thinking are essential.

What’s your go-to entertainment programme at the moment?

These days I am watching a Canadian television sitcom series called Kim’s Convenience, and I am also listening to Ollie Ollerton’s ebook – Battle ready.

Is there anything you would like to add?

Just a couple of points to mention:

A massive thank you to all my colleagues and friends in Blackpool’s HI department for the work they do to improve patient care – you are awesome!

Thanks to Jon and HTN for the opportunity to share some of our work.