In our latest interview in the series, we sat down virtually with Dr Tamara Everington, Haematology Consultant and Chief Clinical Information Officer at Hampshire Hospitals NHS Foundation Trust.
Can you give me a brief introduction of your role and background?
I’m a Haematology Consultant and my role involves conducting medical and research work in haematology and I am also the Chief Clinical Information Officer and Lead for Clinical Change Embedded in Digital.
What digital projects are you currently working on at your trust?
Three years ago, we were a largely paper-based organisation, and over the last three years we have made a massive leap by joining the Global Digital Exemplar (GDE) programme, in partnership with University Hospital Southampton NHS Foundation Trust, and the core of our patient records have gone digital over this time.
We are currently designing something called ‘Intelligent Electronic Clerking linked to Intelligent Ward Rounding’ to completely replace paper processes. This essentially does a number of things: firstly, it provides information which can be carried over day-to-day throughout the admission episode and into the discharge summary, so there is a continuity of information which can be updated as progress is made. Secondly, it links into our core patient management systems so that the responsible consultant can be updated, any specific risks to the patient can be identified such as blood clots or altered mental state, and also upfront you can highlight any potential issues which might require the patient to stay in hospital for longer.
From a clinical helpfulness point of view, it also does things in ward rounding such as informing the clinician if the patient has been prescribed antibiotics, how long the patient has been on that medication, and asks the clinician to review them; we are essentially trying to attain a strong control over our ‘anti-microbial stewardship’ – the right antibiotics at the right time, and not an overabundance of antibiotic treatment which may breed resistance.
The collateral advantages from this, which are not immediately visible, is that data can be reported out of the back-end; this provides us a much-improved back-end data stream to support managers in what they do day-to-day. Direct audits can also be conducted. So, for example, junior doctors do not have to scroll through reams of paper to find out processes – instead they can access real-time extracts from the record.
We strongly believe that introducing this new joined-up solution will bring us a step change improvement in keeping our patients safe and ensuring that, on discharge, their GP has good visibility of their needs for ongoing care.
What digital projects are on the horizon?
We have a number of projects on the horizon; one of the most significant change projects is bringing in a new solution for our emergency department. Across the country emergency departments have stand-alone systems supporting ED. By and large ,they are not integrated into the core hospital record and do not have capability for integration with the outside world.
What we are trying to do right now is achieve a much better join-up of care across our community, so that care is seamless and in the most appropriate environment. One of the difficulties has been the process from a GP needing to send a patient to hospital via ambulance crew to emergency department, to in-patient team – there are a lot of parts to this process which currently require printouts being handed to each department in the pathway.
So, in partnership with a company called ‘Think Shield’ (who have helped us with our architecture for a number of years), we have designed a new system for our ED which directly links into our core central patient record, and provides us the ability to link to the outside world; we therefore have visibility of what is coming into the hospital prior to arrival, and their onward journey thereafter.
Historically, hospitals have tended to do things internally for themselves, although as we’ve moved into an era of ICSs, we have tried to do things more collectively. With this in mind, we are now on the brink of launching at Hampshire Hospitals our Integrated Maternity Record with a system called ‘BadgerNet’ and this is in partnership with providers across the region.
This system is truly innovative. Our past processes have used backend electronic systems in collecting data on maternity with paper notes and electronic notes in the hospital – the pregnant mother has previously carried around her own paper notes. BadgerNet brings together all of those elements into one centralised electronic record, which is continuous and integrates into the newborn record.
The design of the system is really good at guiding midwives and obstetricians in best practice in care – there is in-built decision management for support. For example, an expecting mother with diabetes will need specific requirements and the system allows for the best care outcomes possible. Also, with the expectant mother carrying around her own paper record – which she would have to hand back in at the end of pregnancy – she’ll now have her own electronic record to keep and can add information such as pictures, which makes the process more personalised and fun.
Future pregnancies can also be added to the same record, which creates a timeline of birth. This is also a safer process too, as all the information is joined up.
What learnings have you acquired from projects that you have been working on?
In the past we have focused too much on delivering the technical; a huge amount of effort is spent on sorting out system integration and technical delivery aspects. Then, when it comes to reality, it doesn’t really work or get embedded because we haven’t thought through the implementation enough and, in particular, the significant amount of change management which is required for people to work in different ways.
A system can launch which does not meet the needs of the end user and therefore is not well adopted and gets discarded – our digital evolution is littered with problems like that, where ultimately the design is not user-friendly.
In the e-clerking and e-ward rounding project, we involved end users right from the beginning. In the design and in the discussions we’ve brought in experts from across the hospital to tell us, for example, if they are looking after a patient with frailty needs, what does the clinician need to see, what documentation have you currently got, and what can we do with the record that will support you in providing specialist care.
So, you design in partnership with the end users so that when the system is launched, no one gasps that it’s such a large change and it doesn’t feel new or imposed.
Do you think that there are issues with a general unwillingness to embrace digital?
Something I started doing when embarking on this project was writing a regular blog to try to tell the story of what we were trying to achieve. Instead of just giving a list of detail, I would tell stories and link to everyday life so people could understand the direction we were moving in; this might have taken the form of a moral from a children’s book, for example, and extrapolate that into what we were trying to deliver.
If you capture people’s minds with ‘why’ you want to make a change, then making the change is much easier because they actually understand it and hardly anyone is opposed. Then, when there are people opposed, they are probably the most useful because they have picked up on a practical problem that you didn’t previously recognise. The opposition is actively helpful.
This story-telling is really important for patients, too. One of the benefits of COVID was a rapid growth in people’s understanding and use of technology to keep in touch. We need to use this learning to help patients move forward in having the information they need at their fingertips to really own their own care.
What projects have you been most proud of over the past year?
We have learnt a lot from COVID over the past year; we have significantly moved from face-to-face consultations to remote consultations. This has meant that we have managed to continue 70% – 80% of our out-patient activity even through difficult times.
This means we are in a much better position as we try to pick up on patients that would have otherwise been pushed to one side due to COVID. The most significant change we made was the facilitation of our wards in electronic working in an end-to-end way. For example, many hospitals have done digital observations; we tried it originally and found that it’s all very well doing the observations, but then you end up manually transcribing them into systems, sometimes systems which are separate to other systems.
The end-to-end way deliberately integrates upfront observations; say if I’m in a bed, the nurse will come and check my blood pressure on this special machine, the machine will look at all the observations then the nurse can add in additional ones, the machine then calculates a warning score and guides the nurse in escalating care.
The nurse can then push the save button to save the observations and the observations do a number of things: observations are saved into an electronic observation chart (where previously the chart used to hang at the end of the bed) which is electronically viewable on a number of different systems.
It also transmits information to a touch screen electronic whiteboard on the ward in a central location which highlights to the lead nurse where an escalation is required. It will also flag it through the central systems with our critical care outreach team who can also be alerted to a deteriorating patient.
It can also alert the site management team who are observing what’s going on ward by ward, which allows for preventative measures in terms of staffing levels and resource levels.
The system also monitors oxygen levels in terms of consumption and also likely consumption over a period of time; this allows for optimisation of oxygen usage, particularly when oxygen can be wasted and has provided us with real-time visibility of oxygen levels.
At the end of the day, these digital innovations are all about delivering outstanding care for our patients and supporting our teams in working efficiently together to enable this.