Rewired Reflections – Empowering the frontline with involvement and education
Back from another hectic and vibrant Digital Health Rewired event, and there is a lot to reflect on. The major themes we have seen in recent years of the digitisation of healthcare and, how best to educate and empower the frontline/shopfloor with technology continue. There were more nurses, midwives and allied health professionals (AHPs) in attendance, and many more conversations about involving the frontline in digitisation projects, and it feels as though we are moving in the right direction, albeit it is still somewhat patchy progress.
With the Phillips Ives Nursing and Midwifery Review due to be published soon (the Review will provide evidence and inform strategy to ensure that nurses and midwives are given access to the education and skills required for safe, effective digitally-enabled practice), a key theme at Rewired was how do we educate and train the workforce to take advantage of new technology, whether that is nurses already well into their careers, or those in training that need to use the latest health technology so that they can hit the ground running when they reach the ward or clinic.
Putting clinicians at the centre of digitisation
Echoing what we’ve said many times before, one of the stand-out quotes from the conference was that for technology to be most effective for the clinicians on the frontline, any digitisation project needs to be clinician led, operationally enabled and digitally supported. In that order!
This sentiment was echoed by Dr Crystal Oldman, chief executive, The Queen’s Nursing Institute, in the keynote session Milestones in Digital Nursing. She made the point clearly that what nurses want is to be included in the decision-making process when it comes to implementing new systems and technology.
And they have a lot of to offer. Only by listening to nurses, midwives and AHPs will system designers truly understand the significance of the right connectivity, compatibility and interoperability across multiple clinical systems. With trusts that are understaffed, under resourced and facing long waiting lists, the importance of systems that enable the sharing of information once to everyone that needs to see it in order to deliver top quality care can’t be over emphasised.
In short, every new technology project should put clinicians at the centre.
Training, and culture change
We heard plenty of examples of the importance and also the challenges of providing training to a workforce that is extremely busy in a high pressure environment.
Northern Ireland is rolling out a fully integrated health and care system as part of its Encompass programme. The new system will digitally enable the delivery of fully integrated health and care for the citizens of Northern Ireland. This will provide tremendous benefits to patients when all their care providers have access to the same, up to date information. However, finding ways to train people was a challenge when everyone is so busy – It’s difficult to get their attention, but it needs to be done in order to see user adoption.
Another example from Guy’s and St Thomas’ NHS FT (GSTT) and King’s College Hospital (KCH) who in October 2023, went live with the largest EPR project, the £500m project Apollo. Prof Ian Abbs, CEO, GSTT, and Beverley Bryant, CDIO, GSTT and KCH shared their experiences and lessons learned in a well-attended keynote. It is fair to say that while the project has been a success, they did not anticipate the sheer amount of technical and cultural change that would be required. Again, bringing the frontline along was a challenge due to workload levels.
Artificial Intelligence – We could, but should we?
There is great excitement around artificial intelligence, and how it might be used to help healthcare delivery. From reading x-rays and radiography scans to analysing large datasets to developing new treatments, there are many avenues where AI could contribute to better patient outcomes. Dr Jessica Morley, postdoctoral researcher, Digital Ethics Center, Yale University posed some interesting questions about the use of AI. We could use it, but should we?
Dr Morley explained how AI might be biased or skewed. How different datasets may not always be applicable to everyone, data gathered from healthy people may not be so relevant to ill people, and it may not be right to treat individuals based on data from large groups of people.
There is still a long way to go with this potentially game-changing technology, but we certainly need to have strong elements of control and oversight, and we need to think about how that can be achieved.
Extra funding announcement - £3.4 billion for Health IT
In the Spring Budget, Chancellor Jeremy Hunt announced £3.4 billion of new investment in NHS digitisation. Naturally, this was a topic of great debate, particularly in the keynote sessions. The national aim is to move upstream, towards prevention and deliver more place-based care. One area debated was how to close the EPR gap, so that all trusts have electronic patient records, ensuring that the NHS meets international benchmarks on digital patient care.
However, as is so often the case, it is not necessarily the EPR itself that equates to success, although it certainly needs to be good. It is the clinicians’ experience of the EPR. So if the WiFi signal is poor, it will be difficult to use any online systems, resulting in an extremely poor experience, no matter how good the underlying EPR is.
Matthew Taylor, CEO, NHS Confederation made the point that any technology investment should be viewed from the point of view of the frontline. Will it deliver benefits to clinicians and therefore their patients? And, while any investment in tech is good, it needs to have the proper infrastructure to support it. It’s no good trying to access the latest clinical systems on creaking 10 year old desktops.
Mobile device usage increases – but not without challenges
Another technology trend that started in earnest during the pandemic and is still going strong is the uptake of mobile devices. According to the survey we ran on our stand 72% of healthcare organisations asked are using mobile devices in a care setting. Yet only 17% have badge tap/single sign-on and 6% said that they use the same login for everyone. The majority (70%) are able to access the EPR from the mobile device, and nearly half (45%) are able to access other clinical applications too.
Unmanaged and uncharged devices were the biggest challenge, followed by small or onscreen keyboards that make logging in particularly arduous.
A similar theme around the use of mobile devices was the importance of understanding the issues that you are trying to solve, and to involve the frontline workers in any digital transformation project.
Digital identity – the power behind the throne
Throughout all discussions around the efficient use of technology, the importance of digital identity for fast, efficient access to the EPR, for enhancing the clinicians’ experience and making the technology almost invisible and for keeping patient information safe and secure was more in evidence than ever. Centralised efforts to bring the NHS Staff App/Passport are gathering momentum and all the focus groups were well attended.
As healthcare looks to ramp up digital, transforming data into intelligence at all trusts, and as we explore the possibilities of artificial intelligence, digital identity will be a key enabler – the power behind the throne.