I recently attended a clinical multidisciplinary workshop on frailty and the topic of technology was raised. The main aim of the workshop was to agree a data set about an individual that would form a document called the Comprehensive Geriatric Assessment (CGA). The information required appeared to already be gathered by different organisations but not always shared which led to a lot of duplication.
During the workshop, there was a suggestion for a technical solution to this problem (an IT system that would extract relevant information from each health system and create a dynamic document). However, this idea was quickly dismissed as too hard and could never be solved by technology. An alternative suggestion of using a paper-based system was then advocated as this was much more achievable.
This got me pondering about how in 2018 can we be advocating a paper-based solution with all its potential issues (keeping it updated, no remote access, potential errors, counter to NHS drive for paperless care) and so quick to dismiss technology. I can think of 3 main reasons for this view by clinicians.
1. Health clinical systems have a PR problem
Despite the revolution that technology has brought to our lives (e.g. internet banking, online shopping, booking a place to stay with Airbnb or ordering a ride with Uber) healthcare lags a long way behind. Staff tend to have a poor experience with health systems with constant friction for even the most simple task. It feels like they have been designed without appreciating how clinicians work. This can be compounded due to the fact that the majority of systems are created overseas (mainly USA) and require ‘retrofitting’ for NHS use. There is also the issue of delayed or failed IT deployments in the NHS. These factors lead to an erosion of trust for healthcare staff and so they display little confidence in technology to solve problems and make their roles easier.
2. Health clinical systems don’t embrace sharing
Clinical staff don’t work in isolation – to care for patients they need to interact with colleagues both inside and outside their organisation. However, health systems don’t have easy tools to allow this to happen. Features for working within an organisation (i.e. sending tasks) do exist but true collaboration is lacking with no easy way to export data outside of the clinical system/organisation. It seems the designers of these systems expect the staff to be working in silos with no need to share or receive information from other sources. While a systems provider could be concerned about information governance and the issues of confidentiality this could be countered by designing the UI to only allow appropriate sharing. This closed approach makes meaningful sharing incredibly difficult for staff and so in many cases isn’t done.
3. Lack of clinical clarity
Creating a shared document requires clinicians to be clear what information they need and to make sure that any information that they do record occurs in a standard way. Too often professionals disagree about what data to use (e.g. what clinical scoring system) or where it should be recorded which can prove a challenge to design an appropriate system. For example, in the workshop, the fire service described a piece of information they find useful is how cluttered a person’s home is (as this can be a source of risk). As a GP this is something that I wouldn’t normally be interested in and have previously thought was irrelevant.
In the Future
Moving forward if we can produce well designed and innovated software which meets the needs of clinicians we can help solve issue 1. If also the software has the potential for sharing embedded within its structure this will negate issue 2. Issue 3 could then begin to tackled by staff being exposed to the information being recorded by different clinicians and organisations (such exposure can lead to discussion and shared understanding). At the workshop, there were several health colleagues (including myself) who will now be more mindful of the state of clutter in peoples homes. I hope that in the future such workshops will focus on how to work more collaboratively around improving patient care and just assume the technology will take care of itself.