Interview, Secondary Care

Interview Series: Hugo Mathias, CIO, SIRO & Director of IT, Northampton General Hospital

Last week we covered a project at Northampton General Hospital where Robotic Process Automation technology is helping plan the care of COVID-19 patients by automatically monitoring oxygen levels and removing manual process.

HTN spoke with Hugo Mathias, CIO & SIRO at Northampton General Hospital NHS Trust to find out more about the project and the more wider health tech work at the hospital. 

Could you tell me about yourself and your organisation? 

My role is CIO at Northampton General, but I’m also the senior responsible officer for the District Transformation Programme for Northamptonshire.

My job is to create a digital NHS, as best we can, with the resources that we have so we can deliver joined-up care. It is very patient focused, managing a transformation around the way people work and getting the best impact and value from technology. I think pre-COVID it would have been an aspiration to move this quickly towards being digital with patients. Now that COVID has entered everyone’s lives we have quickly seen the benefit of digital first. Being compliant with COVID safety has brought a new agenda of safer working, which I hope, will also be convenient with patients.

Could you talk me through the past few weeks in terms of health tech projects and also some of the challenges?

The biggest thing was quickly adapting to the change in information requirements. Though hospitals do exercises and plans for disasters, the planning to get information on a new pandemic condition requires quite a lot of agile working. We needed to create new reports around the new condition which needed new codes, new tests, new terminology to be coded in the systems, etc. Our plans for other possible pandemics like flu still needed to be in place but COVID was new.

The Hospital is very concerned with safety. We need to protect our staff so we can continue to deliver services, we also need to protect the public who visit from catching this at the hospital. We also need to care for patients safely. COVID didn’t take away other illnesses that are also presenting, it just stole the attention, so we still needed to manage all our patients care safely. To do this we needed beds for the COVID patients, so we worked with Partner organisations to move as many as we could to safe care in the community.  Patients needed to be cared for away from the hospital where we can, so outpatient appointments needed to be able to be video consultations where possible and non-essential attendances needed to be cancelled and managed. Technology was needed to drive this management of change.

Staffing the hospital also became a challenge. Some staff needed to be shielded due to prior conditions, some needed isolation where they may have been exposed and some were sick, all at a time when demand is higher than normal.

With COVID there’s now a huge focus on technology. My first big challenge was information and sharing it quickly with the right people. We built an incident room with all the technology in 2 days. We had laptops on order and the government gave us extra funding to buy further equipment we needed, however, with every other business also sending staff home and needing laptops we were competing for laptops, which luckily vendors helped by prioritising hospitals.

Then the task of enabling our people to work from home became a focus. We are a ‘one site’ hospital. We have VPN, but does the VPN have sufficient bandwidth for so many to work from home? Did we have enough telephone lines to cope? Normally staff would talk on our internal exchange. We had to up the number of telephone lines, up the bandwidth, and buy more VDI licences to enable faster working.

There was a whole raft of challenges, and I have to say, I’m proud of my team that they stood up to the challenges thrown at us. I’m also proud that they looked after themselves and practiced social distancing well. Only one person in my team become COVID positive, and that’s only been in the last few days.

There are also social challenges from different working arrangements as working from home can be lonely. We sent out wellness forms and we asked staff their opinions so we can understand how they feel and address concerns while working from home. We do have a lot of work to do. It is not easy working in healthcare, particularly now as there is a some fear of COVID, however what I can do is provide the best working environment through equipment, online security, and checking people are coping emotionally.

I am well aware that technology has become a focal point at the moment as it enables care to function while adhering to social distancing, I am also aware that much of acute patient care is face to face. I need to provide technology to help staffs way of working. Staff shortages and work pressures meant we had to think about what we could done differently, and this is the reason why the robotic process automation stepped in. We recognise that some of our processes can be done through a robot so thought we would be crazy not to explore this.

A perfect opportunity was with the oxygen monitoring. We have many patients that are required to have ventilation. Most COVID patients need some oxygen and we have physical limits on what we can provide. We have two tanks that feed the hospital and we need to load-balance the demand of Oxygen across the wards. I needed to measure the flow from both tanks. The information of the tank volume is either from reading the tanks physically every hour or on the internet. So with the robot we extract readings every hour, we put it onto our servers, we calculate the difference and therefore the flow, and deliver that as a dashboards to site managers.

Do you have any other plans to use process automation technology?

We are setting up an innovation group to look at this, I would like to use it for Referral to Treatment (RTT) validation; we know that RTT is a challenging thing to do partly because it pulls data from many sources and is often about simply correcting errors in data. We’ve built a tool to identify possible errors and if this can automate data correction we will have better patient flow and safer patient pathways. RTT validation is time consuming and repetitive, and ideal candidate for RPA.

Another place where RPA can help is placing data into systems that do not have open API’s.  This saves from the cut-and-paste time-consuming tasks that are boring, so let’s get RPA to do it. I don’t think this will be the answer to all our prayers, but it is a tool that we can do a quick fix while we talk to the vendors and build the back-end data flow and integration. RPA is quick to implement and we can check and test data flow logic before we invest in a truly-integrated system approach.

Also one of the by-product advantages of having a robot enter data is data quality. If people enter data manually then there is typically a 3 – 5% error rate. Cross-checking reduces this error rate but that takes time and involves more costly resource, peoples time. Getting a robot to do the data entry or transferring data by doing the repetitive laborious tasks is what we are now exploring to make happen.

Was the oxygen project the first use of process automation?

We wanted to use RPA before but the high entrance fee and lack of skilled staff held us back. It just so happens that one of our shadow non-execs, Tremaine Richard-Noel, is an expert in RPA. He has helped us step into this arena with the certainty we will exploit it well. I think it is a very exciting time. We have much work to do right now; we have a paperlight agenda to fulfil; we want to be a HIMSS level 7 digital hospital; our scanned medical records needs to be easier to access. I need my staff helping with becoming a digital hospital and using their skills wisely and removing repetitive robotic tasks is a sensible step to take.

What’s next?

I’ve got loads of ideas in my head, how we actually get them working in the end, well let’s see, it’s too early and I’m not going to start counting my chickens before they hatch. RPA is a flexible and agile tool which I think will be useful tool for any NHS trust.

We will share our findings and if we work together and help each other we can help create a truly integrated health system. Our aim is to deliver better patient care, end of. If these tools enable patients to have better care, then that’s what we’ve got to do.