What can we do to help our healthcare professionals?
Healthcare professionals need more effective use of IT and so do their customers.
I rarely watch TV but by chance I walked in part way through a very interesting ITV programme last Thursday ‘Dr Google: Does DIY Diagnosis Work?’ presented by Dr Oscar Duke.
Dr Duke was reporting on recent guidance from the Royal College of GPs trial encouraging patients to visit their pharmacist or use the internet to self-diagnose to ease the burden on the NHS. Dr Duke discovered this self-diagnosis coupled with purchasing medicines on line could lead to patients putting their health at risk.
The government is driving online services within the NHS but as one healthcare professional pointed out on the programme, there is much to be done to ensure the basic IT infrastructure in the NHS is fit for purpose. I can’t help feeling that this going to be a case of treating the symptoms rather than identifying and treating the cause.
“My experience highlights a number of challenges healthcare professionals and their patients face, challenges that could be easily overcome by IT.”
Before I go any further I must declare that I am a big fan of our NHS and have the utmost respect for the vast majority of the healthcare professionals I have come into contact with. I have spent a fair amount of time over the past four years in and around hospitals and rehabilitation centres with several members of my family.
My most recent experience of the NHS (there were many in 2017) was over Christmas 2017 and like all my other experiences left me with a whole range of emotions from extreme frustration, to extreme gratitude. The lack of effective systems especially during the initial engagement just confirmed to me that our NHS is broken. My experience highlights a number of challenges healthcare professionals and their patients face, challenges that could be easily overcome by IT.
“It defies logic that we were being referred to a hospital in north London while sitting outside an empty and open hospital on our doorstep.”
My daughter was suffering with a fever on the Friday evening before Christmas. The next day her temperature was getting higher and we called 111. As she had no other symptoms we were reassured that having a high temperature was natural and it could last as much as a week, and advised to monitor her condition.
By Christmas Eve my daughter was very poorly and after a lengthy call to a 111 agent came to nothing we took her to a local Urgent Care Centre. When we arrived at 3pm we were told there was a five hour wait to be seen. We were also told that as a contracted out service there was no requirement to meet the NHS Constitution of a minimum of 95% of patients being admitted, transferred or discharged within four hours. So we moved on to our local NHS cottage hospital to see if they were open.
When we arrived at the cottage hospital the waiting room was empty. We were told the doctors could see our daughter but we would need to call 111 to get a referral. We called 111 again from hospital car park. After going through the entire list of diagnosis questions for the third time in two days, we were referred to an Urgent Care Centre 10 miles away in north London.
Things were getting fairly heated by now as my daughter’s health was deteriorating. It defies logic that we were being referred to a hospital in north London while sitting outside an empty and open hospital on our doorstep. We were told they could not refer us to the local hospital because it was not on their system. I could hear “The computer says no.” in my mind, but that at least explained why the waiting room was empty.
“We then established that the ambulance had been sent to the hospital that is not on the system.”
We went home and see if we could get a doctor to visit. To put this in perspective, my daughter is wheelchair and bed bound so it isn’t as easy as it would otherwise be with a fully mobile person. We even called a couple of private internet doctor services, but one told us we were outside their catchment area and the other said my daughter’s symptoms were outside their remit. We then received a call from an NHS doctor as a result of the last 111 call to tell us he had dispatched an ambulance. He said our daughter needed to be seen urgently and we should expect the ambulance within an hour.
Having waited some time, the ambulance still hadn’t arrived so we decided it would be quicker for us to take our daughter to A&E. We tried to cancel the ambulance through the 111 service but were told this isn’t possible and were advised to call 999. The emergency services operator told us the ambulance had arrived some time ago but we were not there. We then established that the ambulance had been sent to the hospital that is not on the system. We had informed the 111 agent that we were sat in our vehicle in the car park of the hospital when we called.
“The doctors, nursing team, porters, radiographers and other people we came into contact with were simply amazing…”
We rushed our daughter into A&E where she was seen by a triage nurse within 15 minutes and was sent for a blood test within an hour of arrival. We then waited several hours in the A&E waiting room and were apparently lost in the system. We were being told regularly that we were next to see the doctor but with no indication as to the wait time. We were then informed we were in the wrong location and should have been waiting in Majors. Once in Majors we were again told that we were next on the list to be seen by the doctor but they could not say when as the system that allocates patients to doctors was down.
The doctor eventually arrived and my daughter received excellent treatment. My daughter was admitted to a ward soon after suffering with a very serious condition that needed urgent IV antibiotics. The doctors, nursing team, porters, radiographers and other people we came into contact with were simply amazing, extremely thorough, and leaving no stone unturned in my daughter’s care.
Despite the excellent care given by the professionals they, and my daughter, were consistently let down by a lack of information continuity along the care chain. My daughter has regular medication. I mentioned this and provided a medication list for the doctors in A&E. We were told the ward staff would prefer to provide and administer the medication themselves. However, once on the ward we were told they didn’t have the required medication and we should bring our own from home.
“Medical history plays a significant part in any patient’s care so this information should be readily available to the health professionals.”
During my daughter’s stay over Christmas the nursing staff were constantly telling her to drink more water. They were not aware that my daughter is on a strict water intake regime having suffered a brain injury through drinking too much water in 2014. Having to keep explaining the situation is unnecessary and stressful. Medical history plays a significant part in any patient’s care so this information should be readily available to the health professionals. My daughter has special needs and cannot reliably convey an accurate account of her medical history, nor is she able to tell anyone her medication requirements. Without effective information systems how do other people in a similar situation cope if they don’t have someone to represent them?
On Christmas Day we were told the hospital would be checking records from a previous occasion two or three months ago when my daughter was treated at the Urgent Care Centre. However, on Boxing Day we were told the records were not accessible outside normal office hours because the Urgent Care Centre was contracted out and their records were not available on the NHS system. The ITV programme mentioned a trial in my neighbouring borough of Bexley where patients can book GP appointments and view their medical history via an app. This is far removed from my recent experience where doctors do not have access to vital medical records to enable them to do their job effectively and efficiently.
“…it must be even more frustrating for the healthcare professionals tying to do their jobs under extreme time pressure as well as having to deal with anxious and irate patients.”
As frustrating as this is for patients and their families, it must be even more frustrating for the healthcare professionals tying to do their jobs under extreme time pressure as well as having to deal with anxious and irate patients. Clearly, our healthcare professionals are not being supported as well as they should be. This entire experience could have been and should have been so much smoother.
How much better would our NHS be if it were to provide a personal healthcare experience? It doesn’t what device I access Amazon from as soon as I login I know I am going to get a personal shopping experience. When I check my car in for a service into any of the main dealers, as soon as I give my registration number the service centre has access to my vehicle’s service history. I am convinced a combination of the Internet of Things and machine learning technologies would make life a lot easier and much less stressful for healthcare professionals and patients.
“We must find a way to manage the patient experience throughout their healthcare journey.”
We must find a way to manage the patient experience throughout their healthcare journey. That way every aspect of their health can be taken into consideration such as lifestyle, diet, living and working environments, from childhood through to the present day. How powerful would that be?
There are some amazing and almost futuristic uses of technology in key areas of medicine and healthcare. Surgeons can operate on patients from their PC from the other side of the operating theatre and maybe even the other side of the world. People with acquired brain injuries and spinal injuries are being given a better quality of life and sometimes being given the ability to walk and even climb again through a range of bio-mechanical and neurological implant technologies. Cancer diagnosis and treatment strategies have improved significantly as a result of technological advancements.
“…our overall healthcare experience is falling way short of what we should reasonably expect in 2018.”
Machine learning and AI are enabling advancements in the diagnosis developing from precision diagnosis to predictive diagnosis which could have a profound impact on global health. But for all of these developments and the benefits they bring, our overall healthcare experience is falling way short of what we should reasonably expect in 2018. If we cannot find a way maintain continuity of healthcare from the first call through to successful resolution of the problem then we are falling at the first hurdle.
The investment required will be significant and the ROI will be beyond the term of any political party, but the NHS should be above politics. We all have a responsibility to do what we can to maintain our NHS. The government and the NHS have the responsibility to ensure the money going into the NHS is spent wisely and the organisation is operating efficiently at every level. In 2007, management guru Sir Gerry Robinson discovered the NHS to be riddled with practices that defied belief. One of the challenges he identified back then was related to clerical and reception staff lunch breaks misaligning with the doctors and consultants so there were times in the day when doctors were free but there was no one to assign the patient in the waiting room. This problem still exists. One of my family had to wait several hours because the reception timetable did not match the doctors’ availability.
“What other reason do we need to invest in technology to help provide effective and efficient patient (customer) experience management?”
There have undoubtedly been some improvements since Sir Gerry’s investigation over ten years ago but I don’t think anyone would argue that there is still significant room for improvement. I appreciate the NHS cannot be changed overnight, and I am a simply a user of the service. But, if we start with effective management of the patient experience through state of the art systems with machine learning, over time the majority of the inefficiencies will be identified and they can be worked on individually. Further down the line the information gathered will enable a wide range of predictive interventions such as staffing, medication, supplies, food and anything else hospitals have to buy in to support their patients.
What I am referring to here is familiar to anyone working in a customer service role. Online shopping sites invest in machine learning to continually improve our customer experience and retain us as customers. If we suffer a poor online shopping experience, they may lose us to a competitor. If we suffer a poor experience within the NHS it could ultimately cost us our life. What other reason do we need to invest in technology to help provide effective and efficient patient (customer) experience management?