In the HTN #HealthTechToShoutAbout feature series, supported by Highland Marketing, this quarter we cover a range of examples from across health and care. The articles range from digital imaging, clinical decision support, information sharing across boundaries, to patient data privacy.
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Embedding Data Protection
First HTN approached data privacy and cyber security consultancy, IG-Smart Ltd, to ask them whether they were working with any clients that had #HealthcareTechToShoutAbout. Here we focus on some of IG-Smart’s clients that are delivering and developing digital innovations that are transforming patient care. Crucially, whilst embedding data protection by design and by default.
NSHI & Lung Health – Delivering Specialist Respiratory Care Services
Despite the availability of evidence-based guidelines, it is well recognised that there is a wide variation in patient outcomes across the UK which has not improved significantly over time. This has been recognised by NHS England in relation to the management of patients with asthma and COPD.
Motivated by the need to improve patient outcomes, the LungHealth guided consultation software (decision support software) was designed to ‘get behind the consulting room door’ with the aim of providing the most expert, guideline driven advice to healthcare professionals and patients during patient reviews. The software guides practitioners through the review and provides algorithm-driven consultations in line with the most recent guidelines with the software prompting the clinician to consider what the national/locality guidelines would suggest at every step of the patient review.
Lung Health’s technologies (for asthma, COPD and sleep) have embedded disease management guidelines and coupled with NSHI’s specialist nursing service have repeatedly shown improvement in diagnostic outcomes and guideline interventions when compared to standard care (which are shared as academic publications in Thorax, ERJ and the Primary Care Respiratory).
Co-owner of LungHealth, Eddie McKnight, believes that the LungHealth products also provide the NHS with the “opportunity to facilitate remote review solutions, during the COVID-19 pandemic (and beyond) by facilitating the on-going review of potentially vulnerable patients whilst keeping them safe.”
PerDoc – Developing private & secure patient/clinician comms
PerDoc is currently in the process of developing remote consultation solutions that are aimed at “improving long-term health for patients, whilst giving healthcare professionals the insights they need to provide personalised care and support.”
Eager to ensure alignment with GDPR and NHS specific best practice standards (like the Data Security & Protection Toolkit – DSPT), PerDoc commissioned IG-Smart Ltd at the earliest stage in the process, shortly after Founder and CEO Bhavin Garara, conceived the concept.
“Embedding patient data privacy and security into our solutions is of critical importance to PerDoc. Not only because we fundamentally respect patients rights and wish to deliver solutions that protect them, but also because it provides our clients and key stakeholders with the assurance they quite rightly demand.”
Whilst PerDoc’s solutions are still in development, they are worth shouting about because of the proactive approach that PerDoc has adopted towards embedding patient data protection and privacy throughout the software development life-cycle.
IG Smart commented: “Many healthcare tech organisations make the mistake of waiting until it is either extremely costly or too late to make changes or embed controls that may be necessary to ensure patient data privacy and security and compliance with industry specific standards like the DSPT. If you are in the process of developing healthcare tech solutions, don’t fall into the same trap!”
NSHI, Lung Health and PerDoc have partnered with IG-Smart Ltd for external advice and support in furtherance of their missions to continue to ensure that patient data privacy and security remain central to the services and solutions they deliver. IG-Smart Ltd is also NSHI’s and PerDoc’s designated Data Protection Officer, and partner for compliance with the NHS Data Security & Protection Toolkit.
The Dudley Group sets tech-enabled change in motion
During the COVID-19 crisis, the Black Country trust delivered remote working, virtual clinics and a major rollout of the Allscripts dbMotion™ Solution, and now it is looking to keep up momentum as it prepares for winter and the NHS reset.
The Dudley Group NHS Foundation Trust delivered “four years of change in four months” as it responded to the COVID-19 emergency, and now it is preparing for the NHS reset.
As the novel coronavirus arrived this spring, the trust used the national contracts for Microsoft Teams and Attend Anywhere to support remote working for staff and to pivot from delivering 5% of its outpatient appointments digitally to delivering 60% by phone and video link.
The Dudley Group configured its Allscripts Sunrise™ Acute Care electronic patient record and tracking boards to help clinicians triage and treat patients with COVID-19. And it accelerated a rollout of the dbMotion information-sharing platform that had been planned for the summer.
The dbMotion deployment included the addition of medications information from the IT system used by local GPs and data feeds from the trust’s pathology, imaging and document management systems, so clinicians could access them all in context by clicking the dbMotion “blue button” built into Sunrise EPR.
Chief information officer, Adam Thomas, explained: “We had the dbMotion platform in place, but we really accelerated work during the coronavirus outbreak to support clinical decision-making.”
The Dudley Group has kept up the pace this summer by finding additional platforms for MDT meetings and image sharing. It has gone live with the Allscripts electronic prescribing and medicines administration system in a COVID-secure adult inpatient environment, with training and support delivered remotely.
It is now looking to progress a project to integrate medical devices with Sunrise, building on an initial deployment, and to rollout Allscripts® Care Director across its emerging integrated care system. This will enable professionals to create a care plan that can be shared across care settings in the Black Country & West Birmingham STP.
However, Thomas said the Dudley Group’s bigger ambition is to learn the lessons of the past few months so it can keep up momentum for a future of using the NHS App as a front-end to a patient portal, digital consultations and other digital services.
“There is a lot of talk about a ‘new normal’ and we do not want to go back to normal,” he said. “We need to look at what worked and what didn’t and embed the best of our new ways of working.”
“We also want to start planning to use some really exciting innovations, like AI with imaging, digital radiology and process automation where that makes sense. We want to keep moving forward.”
The trust has a long-standing relationship with Allscripts; it has used the Allscripts® PAS since 2006 and contracted for Sunrise and dbMotion as part of a ten-year Digital Trust programme in 2016.
Thomas said strong digital foundations were one reason the trust could move so quickly this spring. Other factors included the funding available for coronavirus preparations, more streamlined approval processes and willingness to change in the face of the “common enemy of COVID.”
He said the lessons the trust wants to retain include: the benefits of talking about operational and clinical issues that technology can solve, rather than “IT issues”; the need to positively engage the board and a new cohort of clinical leaders; the benefits of agile working and collaborative relationships with employers.
Richard Strong, vice president and managing director, EMEA, Allscripts, said the Dudley Group is a good example of how the pace of health technology deployment changed during the pandemic.
“The work the Dudley Group has done has not just helped staff and patients through the crisis, it has put it in a much better position to move forward with the information sharing and integrated care agendas that the NHS wants to pursue in the coming months,” Strong said. “Allscripts is absolutely up for continuing with the collaborative, rapid working that will entail.
Improving infection control by minimising paper in hospitals
Digital transformation and data driven collaboration has risen to the top of the NHS agenda during the Covid-19 pandemic. Day to day challenges, such as minimising the use of paper documents as part of infection control procedures and supporting staff working in different environments, highlighted the importance of high quality digital data.
Bedfordshire Hospitals NHS Foundation Trust has been using Viper360 interoperable clinical record – both within the hospital and at home for several years to provide both clinical and administrative staff with single sign-on access to an array of patient data – from test results to outpatient appointments to consultant letters.
The trust records over 23,000 patient searches each month in Viper360 and, as Josh Chandler, Associate Director of IT at Bedford, explains, Viper was instrumental in supporting clinicians when the Covid-19 pandemic hit in two key areas.
The initial challenge faced by the trust was to scale up to support the demand for respiratory consultants. Within a couple of days, the trust had created a 24×7 on call rota for all respiratory consultants and doctors to provide round the clock diagnostic support for those treating Covid patients. The respiratory team needed rapid access to patient information, both on and off site, to enable rapid assessment and diagnosis and support the hugely challenging workload.
Josh said: “Using Viper360, we were able to immediately provide the entire respiratory team with secure single sign-on access to key patient information as well as all test results, enabling clinicians to work effectively either within the hospital or from home, as required.”
“In response to staffing difficulties and infection control procedures, the decision was taken to limit the volume of paper moving around the Trust and some clinics stopped requesting and receiving any patient paper records. For clinicians who had always relied on paper records, often several inches thick, to support patient consultations, this was a huge challenge – not least for those who were working in unfamiliar departments, with previously unknown patients, covering for staff who were either unwell or had been redeployed elsewhere.”
“Clinicians needed to be able to get to know the patient within a few minutes – and Viper provided a single source of information that enabled them to get an overall picture of a patient’s experience with the Trust very quickly.”
“Clinicians could check cardiology history, track blood results – including any outstanding, and see recent in- and out-patient visits and the relevant consultant. With immediate access to any letters generated by various systems, including discharge, the clinicians were able to achieve rapid insight into the patient history.”
“Feedback from the clinicians was extremely positive – with many confirming that, despite the extraordinary changes in working practice, there had been no degradation in the level of care they were able to provide.”
With the Trust now embarking on an Electronic Document & Records Management System (EDRMS) project to digitise all paper records, this cultural shift and confidence is key. As he says, “You don’t get many chances with clinicians if a system is inadequate or limits their ability to deliver care, they will not use it. The ability to provide immediate access to patient information using Viper has provided clinicians and consultants with the experience of a paper-free patient consultation and that has helped to transform behaviour and confidence in IT.”
For a demo of Viper360, speak to an interoperability consultant on 0845 680 3249 or email firstname.lastname@example.org.
Coping with rising demand: How radiologists are fighting back with tech
Even before the coronavirus pandemic, radiologists have been facing year on year rising demand. University Hospitals North Midlands NHS Trust is one trust that has been using technology to respond. The trust has been transforming pathways and providing its professionals with rapid access to crucial diagnostic images, since going live with an advanced picture archiving and communication system from Sectra. Staff detail how this is improving their working lives and how they are innovating with the technology to improve the patient experience.
From ambulance or landing pad to scanner in minutes
Located just off the busy M6 motorway and treating patients who can be airlifted from as far away as North Wales, the Royal Stoke University Hospital deals with high volumes of patients every day.
The hospital, part of University Hospitals North Midlands NHS Trust, or UHNM, was recognised for having the best survival rates of any major trauma centre in the country in a 2017 independent report. Today, the role of the imaging department is key to continuing to get patients appropriate care quickly.
Within minutes of landing on the tarmac or leaving the ambulance, trauma patients can find themselves under a scanner that can capture detailed diagnostic images from head to toe in just seconds.
And as soon as a scan is complete, the trust’s radiologists and reporting radiographers are on the case, using a sophisticated picture archiving and communication system – or PACS – to interrogate the images and to inform a detailed diagnostic report that is fed to hospital clinicians in as little as 20 minutes, allowing appropriate clinical decisions to be made quickly.
Dr Suchi Gaba, a consultant musculoskeletal radiologist, says: “It’s a major trauma centre here. That is one of the reasons we are so busy. A great many patients who come to the hospital will have some radiological procedure, whether that’s an x-ray, MRI, or ultrasound, for example. Radiology is at the heart of the hospital and it makes a huge difference if you have good systems and good IT set up.”
The diagnostic backbone
It’s not just trauma patients that keep diagnostic professionals busy. In usual circumstances, the UHNM imaging department sees more than 9,500 patients – capturing and reporting on a wide range of medical imaging from simple x-rays to more complex CT and MRI scans.
“This makes us one of the busiest NHS imaging departments in England in terms of patient throughput and the volume of cutting-edge machines,” says Dr Marius Grima, consultant paediatric radiologist and clinical information officer for the children’s, women’s & diagnostics division. “But in terms of radiologists, our number is small compared to other places.”
The PACS, implemented by medical imaging provider Sectra in 2017, has been key in enabling radiologists to cope with a 10% year on year rise in demand.
“The PACS is the backbone of our department and we have been using it in innovative and extensive ways to help our patients.” says Dr Grima.
Notifying cancer patients more quickly
One of those innovative approaches has been to transform how quickly patients are notified if they do or do not have bowel cancer, by drawing on functionality in the PACS and transforming pathways.
Dr Ingrid Britton, consultant gastrointestinal radiologist, says: “We can now identify patients with colorectal cancer whilst they are still on the scanner. Previously the radiographer would perform the scan, and then place imaging in a queue to be reported by a radiologist, before the report would be sent onto a multi-disciplinary team.
“Now, when radiographers see something during the scan, they alert the imaging team immediately, and using a simultaneous viewing feature in our PACS, radiologists can immediately look at the imaging from their own location and report as the image is generated, before notifying the referring clinician the same day when a patient is positive.”
Patients are also being notified more quickly and discharged sooner when they don’t have bowel cancer. Traditionally if a CTC scan, or virtual colonoscopy, doesn’t show signs of cancer, imaging joins a queue to be reported, before going through an administrative process that can take three to four weeks. A pilot programme at the trust has seen this reduced to 16 days, simply by the radiologist sending a letter from the multi-disciplinary team (MDT) to the patient when the radiologist can see from the image that the patient doesn’t have cancer – something not traditionally done.
Dr Britton explains the trust’s approach has resonated with the national Getting It Right First Time programme. And she believes it’s the fact that the technology “just works” that has given her and colleagues the capacity to stop worrying about IT and to focus on transforming the patient experience.
“If a patient knows straight away, they have faith in the service,” she says. “Getting this right from the beginning gives the patient confidence. This wouldn’t work with a system where the technology doesn’t load quickly enough.”
A big difference in breast care
Breast radiologists are equally as impressed. “The PACS has made an obviously huge difference in breast,” says Dr Seema Salehi-Bird, a consultant radiologist in imaging and breast care. “We can more easily look at every aspect of a mammogram systematically,” she adds. “Imaging is now just there. We can more easily annotate areas for colleagues to look at. And we no longer need to work across three specialist systems. All of this has made our work far more streamlined. We can more effectively present information to surgeons, allowing them to make important decisions, and in MDT meetings we can bring up relevant images at the click of a button.”
Improving data integrity and strategic innovation
Innovation with the PACS continues to pick up pace. Martin Dale, the trust’s PACS manager, says that, since working with Sectra, the increased stability and functionality of the PACS has seen a significant reduction in firefighting that has freed up more time within his team to focus on strategic work. This includes moving more diagnostic specialities into the PACS, bringing in artificial intelligence and a more flexible approach to responding to clinical needs and service improvement strategies.
The team are now much better equipped to deal with routine problems like data errors and have even been able to commence a project in resolving legacy errors not easily visible in previous solutions. Since bringing in the Sectra, the team have been able to significantly enhance the data integrity of the system; eliminating duplication and reducing misfiled studies, with a big focus on a rapid response to errors and education of users (whilst cases are still fresh in their minds).
“We are adding more power to the solution,” he says. “We want to bring in tools that add value, where the radiologists no longer waste time with things like measurements, which are just done by the system.
“Radiologists come back from conferences with ideas about how we can move forward – and we can accommodate them. We used to have to say ‘no’, now we can say ‘yes’ which is not only better for the service, but has really improved what we take away from the role personally.”
Dr Grima says this willingness to do things extends to the trust’s relationship with the technology provider. “Sometimes a CT scan might supersede an x-ray,” he says. “We wanted something in the PACS that identifies when this happens, so that our reporters can report on what is actually going to add value to the patient’s care and save a lot of time.”
Within weeks of describing the idea to Sectra, the company started working on a solution. “Talking directly with the technical person helps,” adds Dr Grima. “If we identify an area that can be developed, they take it on board.”
Improving working lives and the next generation of radiologists
Implementing the PACS has improved working lives in many ways. Radiologists now have the ability to work from home, and they are connected across multiple sites through a single PACS.
Whether an image is captured at the hospital in Stoke, in the community, or at UHNM’s County Hospital in Stafford, it can be quickly accessed and interrogated by professionals regardless of their location.
Chat functionality, which operates in a similar way to consumer instant messaging, is also allowing staff to access second opinions from colleagues who could be located miles away, very quickly.
Radiologists are also saving time in preparation for MDT meetings, adding in reports and images to lists within a few clicks.
Julia Astbury, a reporting radiographer who has seen a progression from working with film, through to a range of different PACS, says: “It’s easier to use than other systems. It’s easy to negotiate and access a history of images, and connects me to colleagues across different sites.”
The future generation of radiologists is also realising benefits. Dr Shaun Neal, a trainee radiologist, says: “If it wasn’t for the speed the of the system, we wouldn’t be able to keep up with demand. The chat function on Sectra is also fantastic. If you have any questions you can send a link to the image you are looking at to a consultant who can check it. This works really well for junior trainees.
And staff are using the system to equip future radiologists through teaching. Dr Zafar Hashim, a consultant neuro-radiologist at the trust, says: “I’ve used several PACS and Sectra allows me to create teaching files and anonymise images very easily. We use Sectra workstations for our courses and I can build teaching files when I’m sitting at home. We no longer need to download images and place them on a separate computer for teaching. It’s now so easy.”
It’s not about the IT
Ingenuity demonstrated by healthcare professionals at University Hospitals of North Midlands is what technology in the NHS should be about. It’s not about IT. It’s about how people can use it to deliver better patient care, and a better patient experience.