From the Heart and Chest

Welcome to the electronic patient record. Press F5 to resolve any marital difficulties that you may be experiencing. Press F6 for a full cooked English breakfast. You do not need to press any keys to undertake your normal work duties, as these will be performed automatically…

Tools and the people who use them

I was interested to read a recent blog post made by Annie Cooper about #NHSChangeDay, for which she’d visited some people in Hull to see what they were doing with telehealth.

In the post [anniecoops.com], she argued that the reason that telehealth is controversial, and the whole systems demonstrator programme does not seemed to have ‘worked’, is that it is viewed “through the wrong end of the telescope.”

The focus tends to be on the technology when, in fact, telemedicine is actually all about human interaction; not just between users and staff, but between different types of staff, who all need to be using the right skills to make a success of a project.

Our team feels the same about our electronic patient record system. It’s all about delivering better patient care and, in order to do that, our solution needs to meet the needs of our end users – the ground floor clinical staff.

That applies whether we are talking about the most senior consultant in the hospital or one of the healthcare assistants. We are all equal when it comes to both the challenges and the opportunities that the EPR affords.

However, as my opening paragraph so subtly alludes to, they also need to bring something to the party. Their job hasn’t changed as a result of implementing EPR, but they have been given a fantastic new tool to allow them to do their work to an even higher standard than before.

Drilling and caring

Everybody needs to know how to use that new tool. Imagine working for years as a hole driller with a mechanical  hand turned drill. Suddenly, you are given an electric drill.

Your job hasn’t changed – you still drill holes for a living. As long as you read the manual and know to plug the drill into the wall (or charge the battery, if you prefer) then all that has really happened is that your job has become much less strenuous.

I was going to say that as hole drilling is piece work, you will also have become more productive and your pay will increase. However, this analogy is meant to refer to the NHS, so I don’t want to stretch its plausibility too far.

Conversely, though, if didn’t understand how to use your new shiny tool, what would happen? You might resort to manually turning the whole drill to get a hole, use a hammer to hit the drill and punch a rough and jagged hole, or just abandon the electric drill for your old mechanical one.

If you are reading this then you, like me, are passionate about the possibilities of IT enabled healthcare. What I am struggling with this month isn’t so much issues of training or change resistance, but something deeper.

How do we as a community get the right message out there – it might be IT enabled, but it is still healthcare. We might be working better, faster, more efficiently and to a higher quality standard, but we are still working.

EPR on Speed

A little over a year ago, I visited Bronx Lebanon hospital in New York. What I saw there is what I still refer to as "EPR on speed" – intelligent IT processes that actively drive clinical staff to work to higher standards without in any way removing clinical freedom.

Being America, a lot of it is driven by ensuring maximisation of revenue by complying with standards and pathways. And I am not precious about what drives the change – capitalism driving IT to drive better healthcare works for me.

Anyway, the Bronx has a large Hispanic population, so much so that all patient leaflets that the EPR outputs can be printed in either English or Spanish.

Now imagine that the organisation decided that so much of its healthcare was delivered in Spanish that it would be more efficient if all care processes were performed in Spanish and all documents were output in that language.

At the change-over, it couldn’t be reasonably expected that every healthcare professional in the hospital would have polished Spanish skills. However, as the organisation moved forward, every individual who delivered or oversaw healthcare would need to become fluent.

Indeed, their ability to utilise the Spanish language would be a major metric by which their value to the organisation was measured. 

In this analogy, the need to be able to speak Spanish in order to do your job is self-evident. I feel the same is true of using technology to deliver IT-enabled healthcare; it’s just that, for some reason, this is a little bit less self evident.

Think revolution

Senior leaders debate whether the change programmes they are delivering should be classed as evolutionary or revolutionary. For me, done right, there is no question that IT enabled healthcare is a transformational revolution.

It’s possible to make paper-based processes electronic on a like-for-like basis, but that misses a massive opportunity to work in a truly different way.

Indeed, this is why I prefer the term ‘IT enabled healthcare project’ to ‘electronic patient record project. Saying: "We just completed a project to electronify our patient records" is clearly an evolutionary approach and that, in itself, implies a conceptual approach that can severely limit the scope of the benefits you can deliver.

I take back what I said at the start of my piece – the job has changed. Not perhaps in what people do, but certainly, fundamentally, in how they do it.

Dr Johan Waktare

Dr Johan Waktare is a consultant cardiac electrophysiologist at Liverpool Heart and Chest Hospital, specialising in interventional procedures for heart rhythm disorders. He is the clinical lead on the trust’s electronic patient record project, as well as being a clinical lead for IT and the trust’s Caldicott Guardian.

A self-confessed IT geek, Dr Waktare has always been interested in computer hardware and software. His status was cemented when, several years ago, the IT helpdesk agreed to replace a user’s PC rather than look at it – after hearing that he had failed to repair it.