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April 24, 2006

Winning Ways: transforming healthcare using IT

I am a big fan of Idries Shah’s tales of the Sufi wisdom of Mulla Nasrudin. Here is one of my favourites:

One night a neighbour found Nasrudin down on his knees looking for something under the street light: "What have you lost, Mulla?"

"My key," said Nasrudin.

After a few minutes of searching, the other man said: "Where did you drop it?"

"By my house."

"Then why, for heaven's sake, are you looking here?"

"There is more light here."

A veteran of a Hospital Process Redesign, I remain an advocate of transforming healthcare with IT. So, I enjoyed consultant vascular surgeon Simon Dodds’ book Three Wins, which recounts his experience at the Good Hope Hospital, Sutton Coldfield, UK of developing the Leg Ulcer Telemedicine (LUTM) Service.

Leg ulcers mainly affect the elderly, and the annual costs of treatment are in the region of £600m. The high cost is mainly due to the need for redressing by community nurses.

LUTM is a secure electronic clinical-record system that allows the storage and processing of colour images. Community nurses use LUTM software to monitor the colour and size of ulcers from the digital images. Measurements over time can assess the effectiveness of treatment and allow future management to be planned. Nurses can also refer a patient to a specialist, transferring images at the same time.

Furthermore, a randomized trial showed using the LUTM system reduced the time from referral to attendance at an outpatient clinic and improved rates of healing at 12 and 24 weeks.

Impressive stuff!

Simon’s approach to change is closer to the “harder” end of systems-based change methods. I would like to have read more on the human dynamics of process changes, which I have found to be the most challenging.

He does spend time explaining how Belbin’s roles apply to the various stages of transformation and explaining Maslow and Herzberg’s theories of motivation.

However, as someone who sits uncomfortably between a Plant, a Shaper and a Monitor-Evaluator by Belbin’s reckoning, I am sceptical of categorisation as a tool.

I am similarly uneasy when it comes to theories of motivation. Herzberg’s theory is attractive in its simplicity, but his conclusions were based on samples selected from engineers and scientists, and, therefore, may not be applicable to the kaleidoscopic variety of workers in the NHS. I like models of motivation as a starting point, but to treat everyone as an individual.

The study shows impressive improvements in patient care, but I would be interested in hearing from Simon if he thinks the well known Hawthorne Effect* may have played a part, because it would have been impossible to blind nurses to the fact they were using LUTM.

But enough management speak. Despite my reservations on how well the method would apply on a large scale, Three Wins is a book for inspiration and practical application.

Simon Dodds and team have spread their light on a specific area of the NHS and systematically improved it. Other areas remain in darkness. But the key is out there for those who look for it: systematic soft change underpinned by hard IT.

*The Hawthorne effect - an increase in worker productivity produced by the psychological stimulus of being singled out and made to feel important.

April 21, 2006

NPSA Patient Wristband Specification

The National Patient Safety Agency (NPSA) is developing a standard specification for patient wristbands in the NHS in England and Wales. This second phase of work follows from earlier guidance issued in November 2005 and reported in this FHIT entry.

In Right Patient, Right Care the NPSA has already noted that mismatching patients and care is a serious and costly problem. It can be caused by patients not wearing a wristband, or by wearing one that provides unreliable identifiers. Between November 2003 and July 2005 the NPSA received 236 reports of patient safety incidents relating to missing or unreliable wristbands.

The NPSA's work is closely linked to other initiatives, such as:

  • Blood transfusion safety;

  • Medication safety;

  • Research into bedside checking of patients and care; and

  • Work with NHS CFH and Informing Healthcare.

You can read the full briefing sheet download file.

April 16, 2006

Commanding Voice: combining telephony and wireless

vocera.jpgNow I am a sucker for a cute gadget, especially one finished in black and silver that combines telephony and wireless. No surprise then that I spotted the Vocera badge on Telindus' stand at HC 2006. Vocera's system combines software with the badge to integrate PBX, pager, cellphone and push to talk.

The badge packs a radio, speaker and microphone and uses voice activation commands—like “crash team” or “Gina”—to connect you to the right section or person. The software integrates the different technologies and manages security by voiceprint.

By promoting improved communications and making an organisation more responsive, Vocera seems to offer plenty of benefit, while at the same time being unobtrusive and easy to integrate with normal hospital, ambulance or clinic operations.

A good example of a well-devised device integrating care with IT.

April 09, 2006

Connecting for Health: awaiting the winds of change

Connecting for Health faces the winds of change.Political and technological winds of change whistle through NHS Connecting for Health's National Programme for IT (NPfIT). They may erode the notion of a single, comprehensive, monolithic system serving GPs and acute, community and mental health care settings and deposit the spores of innovation, clinical inspiration and supplier diversification.

At UK's Healthcare IT Conference in March 2006, several speakers—including Richard Jeavons NHS CFH's Director of Service Implementation—recognised the need for a refresh and a new operating model.

Further, the white paper Our health, our care, our say has signalled NHS structural changes by emphasising primary care and its delivery—though it makes little of IT's part in this.

However, in my article Making NP Fit I argue for a clearer vision of future care based on centralised information and devolved innovation. For instance, NPfIT—which was specified in 2002—makes little provision for telecare and wireless technologies. Such omissions risk obsolescence.

In Switch on to IT Benefits I also argue technological innovation and clinical inspiration are linked. NPfIT has failed to inspire a critical mass of clinicians—a likely fatal flaw. One way to repair that is to engage an influential few clinicians in the transformation of care with IT to inspire others.

In a recent assessment in the UK's Sunday Times Paul Durman paints a bleak picture of NPfIT's Local Service Providers suffering the financial consequences of failing to deliver. Nonetheless, NHS CFH rebuts suggestions that LSP contracts will be renegotiated.

While that may be the case, a re-scoping of LSP deliverables and the introduction of greater choice of IT systems suppliers seems inevitable.

As a long-time supporter of the need for a multi-disciplinary patient record, I sincerely hope the winds bring real change and drive Connecting for Health's NPfIT back on course.

April 05, 2006

Kiosk Care

Has healthcare gone kiosk mad? Or is this good marketing?

An entry on Healthcare IT News describes kiosks in pharmacies, in combination with an Electronic Medical Record, enabling nurse practitioners to provide routine care to walk-in patients.

This application has a good fit with the recent UK healthcare white paper: Our health, our care, our say: a new direction for community services that shifts emphasis from secondary to primary care.

The UK's E-Health-Insider website in Kiosks have potential for patient feedback describes a study using them to gain patient feedback in diabetes and orthopaedic clinics. Even older people, it seems, do not feel intimidated by them, especially if there is a host nearby to help us out.

Wired News describes a similar application this time remotely monitoring patients. It reports that home telecare reduced emergency room visits by 29 percent and admissions to hospital by 37 percent.

Recently my bank implemented new paying in machines. Very nice touch screen jobs offering options, reading the value of the cheque and printing a receipt.

What used to take me about five minutes with a (admittedly) clunky old system now takes twenty-five, because I wait for the hosts to help baffled customers. As Sam Goldwyn said: we improved it worse.

But I am being cynical. Remote monitoring—maybe with kiosks—is part of the future.

April 02, 2006

Quantum Computing: bigger than the NHS IT project?

Picture of a surgeon and diagnostic images.The £6bn NHS National Programme for IT (NPfIT) is the biggest computer project ever, if some healthcare pundits are to be believed. I have news for them. Mine may be bigger.

An article in 25 March 2006's New Scientist describes how quantum mechanics may be harnessed to create computers millions of times faster than today’s supercomputers.

Conventional computers use on and off states to represent 1 or 0, physically manifested as a difference in voltage or electrical charge. Quantum computers use quantum bits, or qubits. Qubits can exist in a state of 0 or 1 at the same time. Only when someone tries to measure its state will a qubit settle on one of the values. This means that you get roughly two calculations for the price of one.

But that’s not enough for the weird quantum mechanical world. Quantum computing also uses entanglement. When qubits are entangled, they become linked, which means one is in a state of 0 when the other is 1. Or both can have the same value.

Using such quantum cavorting, a computer could calculate with many numbers simultaneously. With only a few hundred entangled qubits it may be possible to represent more atoms than there are in the universe. Now that really is big.

Quantum Computers may help healthcare to:

  • Sort huge numbers of data;

  • Calculate statistics for large populations; or

  • Recognise complex patterns and images.

Researchers say a practical quantum computer may be less than 10 years away. Since NPfIT completes in 2010, a combination of that, wirelessness and the convergence of clinical and information technology could leave the systems it deploys about as up-to-date as a slide rule is today. Maybe size really isn’t everything.