Digitising the NHS - a slow old business
The long journey to a smart patient wristband
“I never want to hear another story about digital transformation in some organisation.” That line from one journalist in a recent panel for PR people about covering life sciences stories really struck a chord - any. business or organisation that is not undergoing ‘digital transformation’ isn’t likely to be around for long, so it really isn’t a story.
And yet I was struck in a recent conversation with a major NHS supplier that the slow pace at which the health service is adopting some digital technologies does merit examination. Wayne Miller, head of healthcare for Zebra Technologies, was telling me how his company had transformed something very simple but very important, the wristband that every patient gets when they enter hospital, into a digital product.
While the wristbands used to feature the patient’s name handwritten in an often indecipherable scrawl, since 2008 Zebra has been printing them and adding a barcode so that they have added functions and will look identical across the health service: “It doesn't matter where the nurse or the doctor works or was trained. They look at a wristband and it gives you the same data.”
That data will include the patient record, and can be updated with details of the drugs they are being given and whether they’ve been administered on time. Wayne gave me an example: “We would scan your wristband and then get all your patient notes up on the screen, and it would say Rory requires blood pressure at 11 o'clock and requires two paracetamol at 2 o'clock..”
The information can be read and updated by being scanned with a bespoke smartphone made by Zebra. I wondered why doctors and nurses couldn’t simply use an app on their own phones. Miller said Zebra’s devices were more durable and unlikely to smash when dropped, had swappable batteries, and there were security advantages: “If you use a high street device, they're quite prone to being stolen. And if there's any data on it, you've got the GDPR breach risk.”
The devices have been used for years by delivery companies - minutes after our conversation had ended, I found myself at the door signing for a parcel on the screen of a Zebra smartphone.
Wayne Miller says this relatively simple technology can play an important part both in boosting NHS productivity and in improving patient safety, generating more data on work patterns within a ward and triggering alarms if someone hasn’t had their medication on time.
But, as I found when I wrote about the drive to create registers of medical devices implanted in patients, simple scanning systems used by delivery drivers and supermarket workers for years have been slow to arrive in hospitals.
“The journey is still not finished,” says Wayne of the move to “smart” patient wristbands which began 14 years ago. “I still go into hospitals now that haven't done it, through either lack of knowledge, lack of support, or willingness to drive it through.”
Now, there are plenty of exciting tech developments afoot in the NHS, many involving using AI to do everything from predicting emergency hospital admissions to triaging millions of eye scans. But perhaps hauling the health service out of the era of paper records and illegible wristbands and into the 21st century should be a greater priority.
There is an interesting (and very sad) article on the BBC today which feeds into this. A patient with Coeliac disease was fed Weetabix in hospital and subsequently died. The inquest has noted that although their condition was in their notes, there was no warning sign above their bed which could have alerted carers.
https://www.bbc.co.uk/news/uk-wales-61836866
Any data collecting system has the potential to complicate care. Smart wristbands are a wonderful idea, but two problems strike me immediately:
1. The carer needs to carry a device to scan the wristband and be able to easily read the output. In an ideal world, the output should be A4 size so that there is enough immediate information available at a glance rather than scrolling through on a small screen where info can be easily missed. This is additional equipment that either must be carried by every carer of whatever level, or be at every bed, or have enough at the nurses' station for carers to use. Whichever, they must also have secure logins so that the carer only sees what they have authority to see and not the entire medical record including personal and irrelevant data. (For the system to work properly, it must have access to the full database).
2. There is a "Too Much Data" risk. I have seen this so many times over many years as IT has taken over the data-collection/data-storage/data-analysis role from paper records. Because it can be customised so easily, managers and designers have a terrible habit of adding form field after form field till not only is the input long and laborious, but the analysis and data output is huge and unwieldy.
In the paper system that IT should replace, you have a chart at the end of the bed that is easy to read, update, and always with the patient. It only includes relevant information. You can put additional notes above the bed for important warnings, and you can add additional notes to drips or other equipment that are attached to the patient and their care.
It is an efficient system because these notes are between the carer and the patient - they are right there in the way where they are most useful. And for tired, pressured, and overworked staff, the lack of knowledge and training needed to just read them is welcome!
So, the smart wristband/scanner/display solution not only has to store all relevant and urgent information, it must also be as accessible and immediate as all those paper notes that no longer exist. It is possible to do, but not easy. For instance, you might have multiple displays situated at the right places to catch the eye, but this is now a lot of equipment that all must be connected.
But the tech solution must also do one more thing - it must never go out of date. Paper records are a complete pain when it comes to storage and so forth, but they have one peculiarity - the only interface is the human. And humans don't go through hardware and software changes.
If the tech solution, which no doubt has an interesting price tag, goes out of date (or even out of fashion) in a couple of years, the NHS suddenly has to either cough up huge amounts of money to replace it, or risk being accused of running a system that is years out of date with all the problems that go with that, like security issues.
(People were very quick to lambast the NHS when they got hacked and subjected to ransomware, but their systems were out of date mostly because of the substantial on-going costs of keeping it up to date).
Sorry, I am playing devil's advocate here, but in my experiences with the earliest days of bringing IT to the NHS back in the 90s, there were either no devil's advocates, or those who brought genuine worries to the table were branded as nay-sayers and ignored.
I saw that in businesses too. I can think how many internal corporate videos I worked on which were all about explaining some shiny, new IT system to a jaded staff who had never managed to get the last shiny, new IT system to do the job they used to do with post-it notes!
However long the journey to the smart patient is, the time should not only be spent on innovation but on learning from the old systems that were often created by the staff themselves who actually dealt with the patients on a day to day basis.
A most interesting article, Rory, which may be about to come 'of age' given the prospect of AI systems linking NHS primary care records, EPR and organ donation. The benefit of a digital wristband is that the patient wearing it remains the focus of care, whilst accessing their virtual-cloud of historic and current health data.