While IT is transforming UK healthcare practices and procedures, a significant proportion of the NHS relies on outdated paper-based processes, which are wasteful, inefficient and putting lives at risk. Unquestionably, the time is ripe to fully exploit IT in the NHS, argues Dr Paul Shannon.
Back in 2004, the National Patient Safety Agency described the risks that arise from our complex healthcare system, warning: “evidence shows that things will and do go wrong in the NHS; that patients are sometimes harmed no matter how dedicated and professional the staff.”
To err is human and we can see examples of this every single day in every single healthcare setting. The common types of individual human error are lapses and slips; that is, errors of omission (I forgot to do something I should’ve done), and commission (I did something I didn’t mean to do).
The root causes are many, including such contributing factors as fatigue, distraction, lack of knowledge, poor communication and even deliberate wrongdoing.
Electronic systems don’t suffer from many of the frailties of humans. Where they can replace tedious, repetitive, high-speed and complex tasks currently performed by people, they can improve safety. Electronic systems are logical. Steps can be made compulsory: no cutting corners or skipping items by mistake.
There are many examples where there is evidence to show improvement in patient safety; here are just a few: electronic cross match of blood; electronic monitoring and voice prompts to enhance hand-washing, thereby reducing nosocomial infections; prompts and pauses.
A prompt mandates or reminds the user to do something, e.g. Kenyan HIV compliance: vital signs monitoring. A pause introduces time for reflection or confirmation: “Do you really want to do this?” Cutting out that human element – or even prompting us to think a moment – can and does save lives.
With the best will in the world no doctor or nurse can know everything. They’ll have strong points and weak points in their knowledge and skills. They have good days and bad days, like the rest of us. Health IT can help direct care and ensure that the patient stays on the right track, that he or she receives all the appropriate care in a timely manner: right thing, right way, right time.
Again, illustrations are plentiful. Enhanced communication across care boundaries can, for example, provide integrated care – vital for things like safeguarding – and also helps to overcome the fragmentation of care delivery.
Formal clinical decision support is also hugely useful, for example, with programmes such as ePrescribing improving the quality and safety of patient care. Informal support such as Medline – and even Google – is also proving its worth. Electronic systems are also great for tracking patients along pathways of care, improving hospital care planning from well before admission to long after they return home. They can also help in implementing care bundles, groups of interventions which, when implemented together, have a synergistic effect on a disease pathway or patient outcome.
Having the necessary information about a patient is essential to good clinical care. Having that information at your fingertips, when you need it, and easily accessible, helps avoid pitfalls and promotes bespoke decisions. The patient feels valued, listened to and at the centre of your attention.
The full recording of clinical observations (such as vital signs and early warning scores) facilitates medicine’s reconciliation and enhances continuity of care. After all if the notes are consistent and trustworthy, then they will be trusted by the next clinician who treats the patient.
Electronic systems are terrific at discovering the source of problems because they allow data to be captured automatically. Coding systems, such as SNOMED CT and ICD11, aim to overcome ambiguity in language by providing terms that have defined meaning. If information is captured it can be investigated, analysed and presented in meaningful ways.
This provides the possibility for remembering and learning from mistakes (retrospective analysis), providing a real-time picture of how things are (current status, dashboards), and how things are likely to be in the future (prediction).
A few examples of how this is working in practice include: automated adverse event detection can spot medication errors and infection risk; automated critical incident reporting makes it easier to flag when things go wrong; data mining can identify complex correlations and novel associations that would otherwise never be seen; population surveillance can aid with establishing the safety of products or interventions – such as vaccine safety – and also monitor the spread of infection or progress of epidemics.
There are many more examples benefiting all aspects of healthcare, ranging from supply chain management to making sure patient information is recorded properly to save the same questions being asked over and over again.
The use of electronic systems in healthcare is already embedded into everyday practice. It would be inconceivable to contemplate providing modern healthcare without such essentials as patient administration systems, picture archiving and communication systems and theatre management systems.
In many parts of the NHS, however, paper-based and manual processes still dominate. The time is now ripe to exploit healthcare IT fully in the NHS in order to reap the patient safety benefits. These systems, properly implemented, can provide the step-change in patient safety we need.