To wake myself up in the morning I have a quick scroll through the Times app on my phone to get a briefing on the daily news. It’s only Wednesday but my Fitbit is telling me that I am averaging 3:39 hours of sleep a night which seems about right. I swear, the flickering lights of screens take more and more sleep from me in terms of waking me up and putting me to bed. Right now I am studying an MSc full time, working weekends at the hospital and spending 2 days a week writing code for a financial tech firm in central London. Thankfully my commitments will be reduced in two months time which cannot come soon enough as I can feel myself age daily. One story today struck a nerve which has prompted this post. Clinicians are having to rely on social media apps to send patient scans in order to bypass the “backward” IT NHS systems. This stuck with me on my way to work because it has been the goal crushing reality for many doctors who have contacted me asking for advice on their tech projects.
There is one thing we have to acknowledge in order to give context to this story. That’s the nasty, sledgehammer side to NHS management. I know an ED charge nurse who had been one for years. He was good, trusted, respected, and always dependable in a crisis. However, one day, out of the many years of good service, he had been involved in a drug error. The result, his drug administration privileges were taken away from him and he had to retake the course. For months he was unable to help when drug administration was involved. Any rational person would think, this man has been practicing for years and has a good record. Let’s investigate and see what the situation was around the error. It’s not that it’s his ability to distribute medication that caused the error, otherwise why has it happened after years of service and being promoted. Was he being pulled in multiple directions at the time or overworked? If an experienced nurse made this error what systematic changes should we make to prevent less experienced nurses making drug errors? Sadly no changes were made and the charge nurse was scapegoated. All this did for other nurses was give them an incentive not to report drug errors. Now, let’s think of our IT colleagues. If they approve a project that you’ve coded and it goes well, they will receive little praise. You and your team identified the problem and solved it. However, if something goes wrong and there is a security breach, or it messes up the system, they are likely to receive the heavy-handed approach from management. Because of this, they have an incentive to avoid innovating and inhibit new projects that are not dictated to them from management. Considering this, the general golden rule I tell clinicians who want to start a tech innovation project is: avoid the IT department. This means avoiding the main hospital computer system. At a loss on where to start? Here are three areas you can focus on to get started.
excel and data apps
As long as the data does not have patient information, this area is the simplest packing a large punch. You also do not have to integrate with any systems as all systems have a function where you can export the data into Excel or CSV files. NHS staff are terrible at processing and analyzing data. Combining this with the explosion of data with the NHS going digital there is more data than clinicians and managers know what to do with. All you need to have is a working knowledge of a high-level language like Python, an understanding of a few modules that can open data files and some knowledge of the field that you’re analyzing. This is where I got my first taste of applying code to solve problems in the NHS. If you have a math background this will give you an edge, however, if you don’t this won’t block you. I have helped people out by simply processing and cleaning the data. Getting a script to produce PDF reports based on the data in an excel file is way more useful than you might think. You may have to show people in order to demonstrate how this works, however, you can get around this by downloading a dataset from my downloads page and playing with it. Once you’ve created a quick demo you can show others the uses and they will be lining up for your help. My first feel of creating change came when I produced a 3D probability distribution of the number of patients plotted in bins depending on the time they came into the department, and the time to assessment.
As you can see there is a time where the department got flooded with patients and this delayed the time to assessment. The result was that we managed to get extra funding for staff in that time period.
Staff organization apps
Again because there is no patient data you do not have to go through IT. This can be a number of things such as protocol managers, reporting minor issues with a new pathway that’s being implemented, communication and much more. What’s good about this is that there’s something for everyone’s skillset. You can go from a really low skillset like developing a form interface on an excel file so staff can quickly and easily input data on something you want to monitor which can run on the desktop of a trust computer, to something high end, like developing a full web platform to manage workflow for the medical team. Here I interview James Bird, a matron who used Microsoft access to build an app where charge nurses can report issues quickly, allowing him to get a full picture and a list of the issues that occurred in the shift [link]. Part of his success was down to him not trying to fuse his app with the hospital computer system.
Build your own web platform
This is hard, but one of the best options. As web frameworks become more powerful you can effectively code a whole software suite in a web platform and run it on your own server. However, if you’re new to this I warn against jumping in at the deep end and chasing this unless one of the people in your team is good at programming. Al, o you have to put in a lot of work before you start to see results. A lot of doctors come to me asking for advice with the desire to develop a web application even though they have never developed anything in their life before. My advice is to develop something in the previous two areas covered first. With web platforms there is an organisational challenge as well as a technical one. The advantage here is that it’s the most lucrative. You can have a login structure where you can charge people to use your software etc. Again the success I have seen from this approach is that it bypasses the hospital computer systems. You can connect with other systems at a later date if your platform is successful with a rest API structure.