From the Heart and Chest

I’ve made my New Year’s resolutions. Have you?

After a rather busy year work-wise (getting our EPR live!) I have decided to "get my life back".

Within a day or so of the New Year, I had booked tickets to two concerts, booked my place on both the Liverpool half marathon and the full marathon, and arranged to get together with some old friends to enjoy our mutual hobby of photography.

However, have you seen what I did there? I haven’t actually done any exercise yet; nor done anything socially.

What I did with the first two actions is spend some money to give me the incentive to follow through on my laudable aims for the New Year.

I have noticed that it is a common strategy for me to employ. If I’m not doing much photography, I buy a new lens to "inspire me" to go out and try it and, in so doing, take more pictures.

My thinking is that (a) I will enjoy the new bit of kit and (b) I will be shamed in to using as I have spent money.

Spend, spend, spend

Similarly, have been known to buy more running gear if I’m not getting out and running regularly. Who am I kidding? All you need to do running is a pair of trainers, some other clothes, and the drive to step out of your front door.

Do you think this kind of thinking was what went wrong with the National Programme for IT? The idea that if we throw a lot of money at healthcare IT, then we will a really good outcome?

We certainly managed to spend a lot of money, but we don’t seem to have that much to show from it.

In running terms, we put in a couple of decent showings in some 10k races, but we certainly didn’t win a marathon. Most would say we didn’t even finish the race.

In fairness, significant thought and planning went in to NPfIT. While it is self-evident is that there was a failure of strategy, and that probably relates to the depth of the strategy, it was more complex than my personal foibles in self-motivation.

When all is said and done, NPfIT is also in the past. You can’t change the past – just learn from it. Are we doing things “right” now or just “differently” with stringent tests on value for money to receive a share of the pot? Only time will tell, but it feels more positive overall.

A time of predictions

The coming of a New Year is also a time for predictions. EHI joined in by publishing ’14 predictions for 2014’ over the festive season. For better or worse, I was asked to contribute.

But when the piece came out, I was particularly struck by the comments of Emil Peters from Cerner. “2014 will see a growing gulf between trusts with a clear strategy to 2018 and those yet to identify a credible path to paperless,” he said.

This resonated because it emphasises that the investment required to deliver improvement isn’t just a financial one. It’s also a matter of investing time and the right human resources in creating the right vision and strategy.

Back at work

Back at Liverpool Heart and Chest Hospital, our first major upgrade to our EPR, which we term our “cycle of change”, has been successfully delivered.

I am very proud of the entire team, which went in overnight to make the changes. This minimised the impact on patient care and on clinical staff by taking the system down during the small hours rather than during the day.

The upgrade itself went like clockwork, and although we encountered some issues in the days following, it was a big pat on the back for all.

Even so, I have been reflecting on how much there is still to do, and how much stuff we wanted to get done but haven’t yet delivered.

Often this is because of a dependency outside our control. For example, we need to create a separate test version of our patient administration system in order to safely do some work.

This is taking time, but it is critical to be able to test everything thoroughly before we deploy it into our live clinical systems.

From the end user’s perspective, though, until something is in the system for them to use, it means nothing. Whatever the hold up, whether it’s down to a dependency beyond our control or not, if it isn’t there yet, then it isn’t there yet.

Small changes, big impact

One of the things that has been gratifying is seeing people start learning to harness the power of the electronic patient record.

A colleague of mine produced an audit of chest drain care documentation at the trust. He’s a chest surgeon and deals with the sharp end of poor chest drain care, so he has a vested interest!

The fact that he did this kind of audit isn’t big news. But the fact that he just decided to sit down at a PC on a Sunday for two hours and do it over a mug of coffee is.

No planning needed, no pulling notes, no audit staff, and no preconfigured report written – just some insight and initiative.

We are starting to get some nice reports inside the system, but the beauty of the EPR is that for many things you don’t need them. Also, reports are great for quantitative data, but healthcare isn’t just about that. Qualitative evaluation always has a place, particularly when it comes to direct patient care.

Getting people to use the system better, whether it be by harnessing its potential (as above) or by correcting user error in how they use the system, is a great improvement strategy. You make things better with no development in the EPR.

A lovely example is something that I have just worked with other team members. Being a heart hospital, we do lots of ECGs or heart rhythm recordings.

They are one of few things that we currently have to scan into the EPR (our Nurse Technology Fund bid is being hurriedly written, like others!).

Some tests may include 20 – 30 individual ECGs, and a cardiologist colleague was understandably frustrated at having to individually rotate each one to one of his patients. Guess what – it takes no longer to scan them at source in the correct orientation as the wrong one…

The wisdom of Woody

At the end of the day, for me it is all about delivery. This can be stated many ways: “He talks the talk, but does he walk the walk?” and so forth.

But my personal favourite is a rather obtuse way of expressing the sentiment from Woody Allen. His response to a question of his legacy was “I don’t want to achieve immortality through my work; I want to achieve immortality through not dying.”

Therein for me lies the fundamental difference between talking the talk and walking the walk.

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.