Opinion on NHS's changes causing us to embrace the digital library
Written by Alyssa Clark
Wayne Sime, director of library services at the Royal Society of Medicine explains why the NHS changes mean that medical librarians should no longer fear digitisation and why the time has come for them to truly embrace the digital library.
When I joined the Royal Society of Medicine (RSM) in 2006, a year before the Kindle was invented and four years before the iPad dominated the tablet market, the RSM’s library was a very different place.
Footfall was low, books and journals could take an age to locate as library staff and members needed to use card catalogues to retrieve items. Librarians could often take days to deal with more complex requests and often when they were able to provide the information, books from the historical collection were found in varying states of deterioration.
Fast forward just a couple of years and despite gradually replacing hardcopy books and journals with electronic versions, the wide reaching impact of commercial eBooks and tablets meant that our members, mostly made up of busy junior doctors and senior clinicians, were becoming frustrated that clinical reference material was not more readily available in a digital format to help them in their daily role. In addition, the RSM was reputed as the largest provider of Continuing Professional Development (CPD) training in the UK and it was our duty to ensure that members could find the training materials they needed in order to continue practicing.
As with virtually every other aspect of their lives, members wanted content to just ‘be there’, with no blockages or difficulties. Whether that was in the hospital setting on the ward or even at home while doing research, medical professionals needed information as quickly and as easily as possible.
So what next?
However, we faced the same challenges and questions as the many NHS organisations looking at the implications of digitisation. Would the building still be needed if almost everything was online? How would the role of the librarian change? Was going electronic really affordable?
With the library one of the major reasons our 21,000 members joined the RSM, irrespective of our concerns, the demand could not be ignored. We knew that it was imperative that we did not just become a medical archive and a new strategy was developed, which made digitisation a key strategic priority.
The outcome has been astonishing. The implementation of electronic resources, including recent products such as Clinical Key, which has seen more than 3,000 journals including the Lancet titles and around 1,500 books accessed directly online, has increased the footfall through the library dramatically. In fact in 2006, 16,000 people came through our doors, and this year we are expecting over 30,000 visitors. Not only is this a record number of visitors for the library but also satisfaction rates for the library service are at an all-time high.
Keeping pace with change and demand
But why has providing information electronically had such a positive effect on the organisation? The amount of information that clinicians need access to is constantly changing and increasing. The vast amount of clinical trials, patient data and new drugs available combined with patients who are much more informed about their conditions, means that clinical reference material is becoming much more complex and readily available in greater quantities.
Clinicians struggle to keep on top of this using books and journals alone and often if they are not provided with an easy option, they will turn to the likes of Dr Google as a last resort. This can be problematic for clinicians in identifying whether the information they come across is really trusted and whether they feel confident that they are using the right information to make decisions, which may ultimately affect a patient’s life.
It is because of this that medical librarians are becoming even more relevant and important to clinicians. Many clinicians struggle to find the answers that they need and require training and assistance in searching databases to find research evidence to answer clinical questions. In many ways, the librarians’ role is increasingly moving towards becoming a trusted advisor, providing the collective ability to integrate services and practices into teaching and learning processes.
One day a medical librarian might help a doctor to find guidance for treating a rare condition, the next a manager might ask for evidence to support a staffing decision. Either way the role of the medical librarian is vital in helping to obtain and translate research into meaningful knowledge to ensure decisions are made based on the best and most up to date evidence possible.
Medical librarians on the NHS frontline
Digitisation is also changing the role of the medical librarian and extending their remit beyond the walls of the physical space, moving the information to the clinician’s workplace as opposed to waiting for them to come to the library - something that many healthcare professionals may increasingly struggle to find time to do. Librarians have the opportunity to become part of the frontline, which can be incredibly rewarding in seeing how patient care has been improved as a result of their role.
We see that digitisation is simply a way of enabling medical librarians to cope with the increasing demand on them to provide more information to the people who need it most, often using less resource. This challenge is likely to become even more prevalent as the financial strain on our NHS continues.
As for the expense, we are reaping the benefits of using electronic resources. Our librarians are able to use their time more effectively as there is far less laborious searching for information. Although we continue to grow our content, we no longer have to worry about where new books and journals will be housed and are able to provide our Members with enhanced working spaces. There will be less need to replace older books that are in poor condition and we are providing far greater access to our members at the same cost to them, as multiple people can view clinical reference material simultaneously.
By the beginning of 2014, we expect all of our journals to be electronic. We anticipate footfall continuing to increase and have no doubt that the library will continue to evolve as the NHS faces more challenges and technology advances. For now, we are confident that the changes we are making are supporting the medical professionals of today in the best way possible.
About the Author
Wayne Sime, director of library services at the Royal Society of Medicine (RSM). In his opinion Wayne explains why the NHS changes mean that medical librarians should no longer fear digitisation and why the time has come for them to truly embrace the digital library
How UiPath robots are helping with the NHS backlog
The COVID-19 pandemic has caused many hospitals to have logistical nightmares, as backlogs of surgeries built up as a result of cancellations. The BMJ has estimated it will take the UK's National Health Service (NHS) a year and a half to recover.
However software robots can help, by automating computer-based processes such as replenishing inventory, managing patient bookings, and digitising patient files. Mark O’Connor, Public Sector Director for Ireland at UiPath, tells us how they deployed robots at Mater Hospital in Dublin, saving clinicians valuable time.
When Did Mater Hospital implement the software robots - was it specifically to address the challenges of the pandemic?
The need for automation at Mater Hospital pre-existed the pandemic but it was the onset of COVID-19 that got the team to turn to the technology and start introducing software robots into the workflow of doctors and nurses.
The pandemic placed an increased administrative strain on the Infection Prevention and Control (IPC) department at Mater Hospital in Dublin. To combat the problem and ensure that nurses could spend more time with their patients and less time on admin, the IPC deployed its first software robots in March 2020.
The IPC at Mater plans to continue using robots to manage data around drug resistant microbes such as MRSA once the COVID-19 crisis subsides.
What tasks do they perform?
In the IPC at Mater Hospital, software robots have taken the task of reporting COVID-19 test results. Pre-automation, the process created during the 2003 SARS outbreak required a clinician to log into the laboratory system, extract a disease code and then manually enter the results into a data platform. This was hugely time consuming, taking up to three hours of a nurse’s day.
UiPath software robots are now responsible for this task. They process the data in a fraction of the time, distributing patient results in minutes and consequently freeing up to 18 hours of each IPC nurse’s time each week, and up to 936 hours over the course of a year. As a result, the healthcare professionals can spend more time caring for their patients and less time on repetitive tasks and admin work.
Is there any possibility of error with software robots, compared to humans?
By nature, humans are prone to make mistakes, especially when working under pressure, under strict deadlines and while handling a large volume of data while performing repetitive tasks.
Once taught the process, software robots, on the other hand, will follow the same steps every time without the risk of the inevitable human error. Simply speaking, robots can perform data-intensive tasks more quickly and accurately than humans can.
Which members of staff benefit the most, and what can they do with the time saved?
In the case of Mater Hospital, the IPC unit has adopted a robot for every nurse approach. This means that every nurse in the department has access to a robot to help reduce the burden of their admin work. Rather than spending time entering test results, they can focus on the work that requires their human ingenuity, empathy and skill – taking care of their patients.
In other sectors, the story is no different. Every job will have some repetitive nature to it. Whether that be a finance department processing thousands of invoices a day or simply having to send one daily email. If a task is repetitive and data-intensive, the chances are that a software robot can help. Just like with the nurses in the IPC, these employees can then focus on handling exceptions and on work that requires decision making or creativity - the work that people enjoy doing.
How can software robots most benefit healthcare providers both during a pandemic and beyond?
When the COVID-19 outbreak hit, software robots were deployed to lessen the administrative strain healthcare professionals were facing and give them more time to care for an increased number of patients. With hospitals around the world at capacity, every moment with a patient counted.
Now, the NHS and other healthcare providers face a huge backlog of routine surgeries and procedures following cancellations during the pandemic. In the UK alone, 5 million people are waiting for treatment and it’s estimated that this could cause 6,400 excess deaths by the end of next year if the problem isn’t rectified.
Many healthcare organisations have now acquired the skills needed to deploy automation, therefore it will be easier for them to build more robots to respond to the backlog going forwards. Software robots that had been processing registrations at COVID test sites, for example, could now be taught how to schedule procedures, process patient details or even manage procurement and recruitment to help streamline the processes associated with the backlog. The possibilities are vast.
The technology, however, should not be considered a short-term, tactical and reactive solution that can be deployed in times of crisis. Automation has the power to solve systematic problems that healthcare providers face year-round. Hospital managers should consider the wider challenge of dealing with endless repetitive work that saps the energy of professionals and turns attention away from patient care and discuss how investing in a long-term automation project could help alleviate these issues.
How widely adopted is this technology in healthcare at the moment?
Automation was being used in healthcare around the world before the pandemic, but the COVID-19 outbreak has certainly accelerated the trend.
Automation’s reach is wide. From the NHS Shared Business Service in the UK to the Cleveland Clinic in the US and healthcare organisations in the likes of Norway, India and Canada, we see a huge range of healthcare providers deploying automation technology.
Many healthcare providers, however, are still in the early stages of their journeys or are just discovering automation’s potential because of the pandemic. I expect to see the deployment of software robots in healthcare grow over the coming years as its benefits continue to be realised globally.
How do you see this technology evolving in the future?
If one thing is certain, it’s that the technology will continue to evolve and grow over time – and I believe there will come a point in time when all processes that can be automated, will be automated. This is known as the fully automated enterprise.
By joining all automation projects into one enterprise-wide effort, the healthcare industry can tap into the full benefits of the technology. This will involve software robots becoming increasingly intelligent in order to reach and improve more processes. Integrating the capabilities of Artificial Intelligence and Machine Learning into automation, for example, will allow providers to reach non-rule-based processes too.
We are already seeing steps towards this being taken by NHS Shared Business Service, for example. The organisation, which provides non-clinical services to around two-thirds of all NHS provider trusts and every clinical commissioning organisation in the UK, is working to create an entire eco-system of robots. It believes that no automation should be looked at in isolation, but rather the technology should stretch across departments and functions. As such, inefficiencies in the care pathway can be significantly reduced, saving healthcare providers a substantial amount of time and money.