Dr John Payne, consultant transplant cardiologist and clinical safety advisor at InterSystems, outlines what should be provided to patients who expect digital health services as standard.
Digital transformation (DT), put simply, is the step change improvement of operations and services through the use of digital technology. But thinking of it as merely going paperless or inputting information into a computer is to grossly underestimate its potential.
People now do their banking and food shopping online. They pay for goods and services digitally, with contactless or through their mobile phone. And they expect their health services to work in a similar way. In fact, most people think they already do – whereas the reality is that in most hospitals that’s not yet the case.
Safety first
You could say that healthcare is behind the curve when it comes to digitalisation – compared to other industries – but with patient safety of the utmost importance, the adoption of digital systems such as electronic health records (EHRs) in healthcare is not only about taking advantage of the benefits – which include easily-accessible and legible records, a joined-up, user-friendly system, less wastage and better measurement – but weighing up and countering any associated risks as well.
In such a highly-regulated industry, where processes are carefully scrutinised by clinical governance departments, safety in digital systems is something that must be looked at very closely by the industry – not only in the UK but around the world. The bigger the digital footprint, the more healthcare systems are dependent on their digital system. If there’s a bug in the system, this could put patients at risk – they could be prescribed a dangerous dose of a drug, for example, or a vital screening appointment could be missed. But, with the right protections in place, EHRs can open up a whole host of benefits for both clinicians and patients.
Digital systems in action
EHRs are now being used by various health boards in Scotland, for example. Most run on one central system, with other systems attached. Secretaries can use it to book appointments, doctors and nurses to look at medical histories and important treatment information such as drug allergies, and managers to pull data and write reports. In order to uphold the highest standards of safety, a Clinical Safety Management System (CSMS) has also been put in place that follows NHS Digital guidelines.
EHRs are helping to increase transparency, which improves both the quality and safety of services because it’s much easier to access information, but also to measure progress, which can then be done on a more regular basis. Digital systems also encourage standardisation across the board, so that processes can be simplified and there is less variation in the quality of services in different areas. Information from outside healthcare – social care, for example – can also be linked in to records, so that healthcare providers can get a more holistic view of their patients – a doctor is able to see whether a child is on the vulnerable register, for example.
Putting the right protections in place
However, the expansion of digital footprints and an increase in dependence on such systems can leave hospitals, healthcare organisations and ultimately patients, more vulnerable to the risks and hazards associated with them. Suppliers of these systems are responsible for designing safe, reliable, easy-to-use systems to reduce such risks. But purchasers responsible for system implementation and use also have an important role to play in their safe configuration and in making sure that those using the system are appropriately trained. Supplier and purchaser activities that reduce risk and ensure the system is safe – and is used safely – come under the umbrella of a CSMS, a recognised framework through which organisations can manage the risks associated with software systems.
Building a CSMS includes formal acknowledgement of the known hazards associated with the system – known as the hazard log. For example, if a doctor prescribes a medication for the wrong patient because they were not working in the correct patient record when they started typing the prescription. In acknowledging such hazards, suppliers and purchasers can reduce the risk of them happening. In this particular case, a patient banner – designed by the supplier to be clearly seen – with the patient name and unique identifier, would reduce the risk of this occurring. Similarly, increasing doctor awareness of this potential hazard in staff training can reduce the likelihood of it happening. Both suppliers and purchasers need to build a CSMS. Whilst most suppliers already have this established, many healthcare organisations are realising only now that the benefits of digitisation are associated with a risk that must be proactively managed in this way.
The future of healthcare
As we have seen with the temporary hospitals that have sprung up this year to care for COVID-19 patients, if we are to treat people efficiently and effectively, the digital build in a healthcare organisation has become just as important as the physical one. In hospitals like the newly built Louisa Jordan in Glasgow, the expectation was that patients who came into the hospital would already have some information associated with them that could be viewed by healthcare professionals electronically. In this way, doctors and nurses wouldn’t have to rely on relatives or the unwell patient themselves to get a past medical history.
Digitalisation is happening across every industry and people expect to be able to access digital health services now too. By being aware of the risks these systems pose and managing them effectively, we can leverage the benefits of digital systems in healthcare to improve the overall safety and quality of care we offer patients.
