OPINION: Top 10 Tips To Meet The Digital Challenge
Written by Dr Paul Shannon, Consultant Anaesthetist in the NHS and Medical Director at CSC
Following health secretary Jeremy Hunt’s recent challenge to the NHS to ‘go paperless’ by 2018, doctors and hospital executives are going to need IT tools to coordinate care electronically.
Care coordination is essential to avoid duplicate treatment and to prevent medical errors. Whether it is a GP, hospital, other healthcare provider or local authority, they are all at different levels of implementing IT. In fact, many are still manually posting or transporting health records to other members of care teams, which can take days. Even if a patient moves from one doctor to another down the corridor in a medical building, the patient may have to carry records in a paper folder rather than their being accessed or transmitted digitally.
For healthcare providers to properly exchange information and coordinate care, it should be in “near-real time”. A phone or fax machine may not be good enough but there are numerous ways that the NHS can rise to the health secretary’s challenge >>>
#1. Make more use of existing, national tools that are already up and running
a. NHSmail is a secure, encrypted email service that can be used instead of ‘inhouse’ email systems. It means that secure emails containing patient-identifiable data (PID) can be safely sent anywhere within the NHS. NHSmail 2 is coming soon, which will have even more functionality. There’s really no need to send letters and faxes to colleagues anymore!
b. Choose and Book (CAB). About 60 percent of all first outpatient referrals are now done through CAB. Make it 100 percent to get the most benefit. Consider the other functionality within the application such as the ‘Advice and Guidance’ section to avoid inappropriate referrals.
c. Summary Care Record. A surprising amount of useful clinical information can be found here. The more it’s used, the more useful it becomes.
#2. Automate the discharge summary. It’s virtually impossible to attain the NHS standard of discharge summaries to GPs within 24 hours without using electronic systems. A good electronic patient record system should permit electronic discharge summaries to be sent to GP systems easily.
#3. ePrescribing. This is a high-impact patient safety issue; no more problems with doctors’ notorious handwriting. ePrescribing can be ‘standalone’ or integrated into an EPR. It may be best to start with a gradual roll-out in enthusiastic areas, rather than a ‘big bang’ approach. Once the benefits are seen, clinicians will clamour for it in other areas.
#4. View results electronically instead of printing out paper. Get into the habit of accessing pathology and radiology results without printing out paper and consider using a Single Sign On tool so that you don’t have to remember multiple passwords.
#5. Exploit ‘departmental’ systems to the maximum. For example, if your trust has a theatre management system, see if you can use it to record the clinical record. A relatively easy start is the surgical operation note. But, make sure that any ‘bespoke’ systems can talk to others using Health Level 7 standards.
#6. Don’t duplicate. Paper records are not more valid than electronic ones, so you don’t have to do both. If you’re told to write paper records and create electronic ones, someone’s missed the point. One Consultant I heard of confiscated all the pens of her trainees when they came to her clinic.
#7. Know your ‘business continuity’ policy. Inevitably there will be times when electronic systems are not available, so you need to have robust alternatives in place just in case.
#8. Develop a ‘portal’ mentality. This means automatically pulling information from multiple sources into a single area. There are various ways of achieving this, but make sure the patient is the ‘context’, that is, you only view information about one patient at a time. This is an important patient safety factor in order to avoid confusion.
#9. Find out about your trust’s IT strategy. Your IT department needs your input. Do you have a clinical lead for IT, or even a chief clinical information officer (CCIO)? Could you do it? You don’t need to be a ‘techy’ or have a Master’s in Informatics; this is about improving patient care, it’s not an IT project.
#10. Enjoy the digital revolution. The NHS is ‘data rich but information poor’. In the era of ‘big data’, find out ways of exploiting data for patient benefit and/or professional development. For example, how do you compare against your colleagues, other trusts, international best practice? Annual appraisal and revalidation requires individual, practitioner-level information, and nobody wants the bottom of the league table.
Dexcom: changing the lives of people with type 1 diabetes
It is estimated that 9.3% of adults around the world are living with type 1 diabetes, which amounts to a total of 463 million people. A further 1.1 million children and adolescents under the age of 20 are living with the condition.
Unlike the more prevalent type 2 diabetes, where the body still produces insulin and symptoms develop slowly, people with type 1 diabetes need regular insulin injections or pumps, and must monitor their sugar levels frequently.
In recent years a number of remote glucose monitoring systems have become available that patients can use at home. These work with a sensor, usually placed under the skin, that measures glucose levels every few minutes. This information is then transmitted wirelessly to a device like a smartphone or tablet, which can then be shared with their clinician.
British actress Nina Wadia's son Aidan, 14, has type 1 diabetes, and has been managing his condition using Dexcom, a glucose monitoring system used by patients all over the world. Here Wadia explains how Dexcom has improved their lives.
As a parent of someone with type 1 diabetes, what is your day-to-day life like?
Being able to take a breath, think and pivot constantly without getting frustrated becomes an essential mindset because sometimes it feels like each day is determined to be different from the day before. Whatever worked yesterday is going to misfire today.
Which areas of yours and Aidan’s life are most impacted by diabetes?
The one thing that you have to fight hard to reclaim is spontaneity, especially when it comes to food and exercise. It’s only when this is taken do you realise how essential each one is. You can be flexible and there are no real limits, but only in the sense that a great athlete can be flexible without limits because they’ve trained super hard to be that way. So we’ve all had to become athletes when it comes to being spontaneous.
How has Dexcom helped you and Aidan?
Dexcom has brought future science fiction to real life today. The continuous glucose monitoring system is tiny, sits discreetly on his body and gives him a ten-day breather between sensor changes, so it's goodbye finger-pricking seven times daily.
Dexcom is totally active at a grass roots level and for Diabetes Awareness has pledged to donate £2,000 if #DexcomDiabetesStories and/or #DexcomWarriorStories is shared 200 times! I’ll be sharing more on social media and would love to hear how other families are winning their fights.
Maybe most importantly Dexcom is trying to introduce a reimbursement programme for type 1 diabetes patients which will give greater access to modern, life changing hi-tech. I want to spread the word on the importance of accessing it through this campaign.
If you compared your life today with how it was before Aidan was using Dexcom, what has changed?
It's always working, which lets him take his mind off diabetes for longer stretches. It also lets me get off his back. We both receive alerts so I no longer have to pester him by asking him what his number is, and especially importantly, I don’t have to wake him at night to prick his finger if I’m worried. Dexcom gave us back our sleep!