(BJ-HC/ Vox Pop) – There is still a feeling in some quarters that caring does not involve fiddling about with either paper or computers, says Adrian Byrne, Director of Informatics at University Hospitals Southampton. This has been compounded by a lack of suitable offerings from the tech community. These have both contributed to the slow adoption of technology by nurses.
In 2014 University Hospital Southampton (UHS) received £870k from the Department of Health's Nursing Technology Fund for a patient acuity monitoring system, making mobile devices for capturing observations available across 57 wards to 3000 nurses and midwives. Can you describe your experiences with this project?
We chose this project for two main reasons. If you look at where data can drive a change for improved safety and outcomes then acuity management is where it’s at. Also it is one of the areas where you can see a direct relationship with nursing and the data right now, so it is ideally suited for this kind of bid. It should not be just about giving any group of staff a bunch of handhelds and telling them to get on with it. We chose to work with our critical care system vendor as that is where we want all of our vital signs data to sit.
This involved some development work for the mobile platform. As a result the project is live and a success but is not yet fully rolled out, to the extent we could measure the impact on staff. General feedback from nursing is positive, but it’s like anything else: everywhere you go you find another little quirk.
Right now one of the areas is assessing fluid balance, which has not to date been a part of the national early warning system, but has been a part of the UHS process for some time, and is a difficult area. The single vital signs chart for the whole trust is popular, vindicating the strategy, and we have this launching from the core EPR.
How does this single-project funding fit into a wider digital transformation programme?
Nothing here is done in isolation. Our whole thing is integration, and open data. We use an Intersystems' ESB extensively and make sure our clinicians and data do not get locked into one system.
We now plan to do some wider engagement of nursing and other allied professions with the technology environment and have an initial event planned where we will be showing developments and new technologies and trying to find out what our staff think are the things that will change their working lives — phones, small tablets, watches, wearables for staff and patients and so forth.
As recently as 2014 a study identified increasing paperwork as a serious concern for nurses. Why have nurses been generally been left behind in technology adoption/digitisation even with previous massive projects such as the National Programme for IT?
There are a number of reasons that nurses have been “left behind” or at least why that perception exists. I do not think, even now, that informatics is high enough on the training curriculum agenda. There seems to be a feeling in some quarters that if you join up to be a care professional then that does not involve fiddling about with either paper or computers, even though the former seems preferable!
In reality, though, I always think this is more about the offering that is made by the tech community rather than any culture of non-adoption. From the basic infrastructure like ward-based screens and wireless networking, through to application software that is not built for the specific use cases, I don’t think we have yet delivered the things that do transform their lives. In fact they haven’t even been possible until relatively recently. Now we must get on and do it. I retweeted something the other day “All applications should be API driven, small, composable, reusable. Monolithic applications should be dumped”.
What are the key factors in adopting technology that can truly benefit nurses, improve efficiency more widely and improve patient outcomes?
Be data driven. Make your systems useful, useable, and they will be used.
What are Southampton's current digitisation/transformation priorities?
We have a whole programme of upgrades for paperless working. We do not necessarily aim for HIMSS levels but they will be equivalent. An EDMS programme this year will see us having the ability to start taking some of the work out of form filling side of things, as when they become electronic over time they will become more intelligent. Our patient online programme, My Medical Record, will see patients doing things for themselves and we are already seeing the impact of this. The aim is to release more time to care.
Adrian Byrne is Director of Informatics at University Hospital Southampton NHS Foundation Trust and has spent 15 years building an electronic patient record at the Trust. He is also chair of the Health Chief Information Officer Network. Under Byrne’s leadership of the Trust, it has been recognised as an IT leader in the NHS and in 2016 was chosen to be a digital centre of excellence by the Department of Health — a Global Digital Exemplar.