In early July, the special independent look at data use by Google AI subsidiary DeepMind took a pause to offer an astonished review of just how bad the UK’s National Health Service use of technology really is.
The digital revolution has largely bypassed the NHS, which, in 2017, still retains the dubious title of being the world’s largest purchaser of fax machines… Many records are insecure paper-based systems which are unwieldy and difficult to use.
The panel noted that in response, doctors have been voting with their feet and turning to their own shadow IT solutions, making extensive use of WhatsApp and similar consumer services to cope:
Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes. They may use SnapChat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.
It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue.
Fast forward to mid August, and we can see some evidence of how at least one go-ahead NHS IT leader is responding to this mess.
That’s in the shape of a major tech refresh at Cambridge University Hospitals NHS Foundation Trust, led by its Chief Information Officer Zafar Chaudry.
He confirmed to diginomica/government that a big driver for his just-announced move to the Office365 world was just that problem:
Clinicians will use personal texting or WhatsApp if they feel they need to – and they told us they wanted to stop.
Chaudry also admits that many of his 13,000 users had also grown highly frustrated with what they saw as the limitations of their personal communications systems, too:
Doctors hated having to delete emails from their in-boxes to get back space, and they also couldn’t believe they couldn’t access their work email accounts from their personal devices, either.
Largest healthcare Office365 for business site in England
To be fair to Chaudry and the rest of his IT team, they have had other fish to fry. Cambridge is three years in to a complex bedding down of a major EPR (electronic patient record) platform, Epic, which as been both occasionally problematic and also very high profile.
Now that that system is stabilising, he says, he finally has time to address the productivity and communications issues that were also very much on his to-do list.
We have been operating on very old versions of software, like the 2003 version of Exchange and Office 2010. I wanted to clean all that up and get us into this century, but I also wanted to help our clinicians start to be more productive, too.
That’s happening by the Office365 move, claimed by Microsoft to be the largest healthcare implementation of the suite in England, and which brings in not just more modern mail but other collaboration and comms tools such as s Skype for Business, Yammer, Microsoft Planner and Microsoft Teams.
Let’s hope it works: Chaudry cheerfully admits a pre-switch user survey found a depressingly high 90% of his users ‘hated’ their comms.
But it does look as if the corner’s being turned here. Alongside the software uplift, Chaudry has also switched on Wi-Fi in all clinical areas and replaced 5,500 older computers with 6,750 new ones and 500 laptops. At the same time a Trust-wide network refresh has also plugged 800 new mobile and handheld devices to Epic, a big start in allowing clinicians to record patient information in real-time at the patient’s bedside, he claims.
How precisely will all this help address the kinds of problems that lead doctors to SnapChat pictures of injuries to colleagues in a desperate attempt to get some advice, though? Chaudry says it’s all about reassuring them that all they need is now in one place:
If our users know that there is at last one single, secure platform that has all the information they need in one place, and which is protected by a very high and reliable service level agreement, then they will stop using text and WhatsApp and use what they know works.
Proof is in the pudding, they say: and even a few weeks in, Chaudry says the turnaround is really happening.
From that 90% unhappiness level, I am now hearing that just being able to better synchronise email has had a big effect, with some colleagues telling me they’ve won back 30 minutes a day. That’s 30 minutes that they’d much rather spend with patients, so that’s a really big win.
At the same time, Cambridge has learnt some lessons from its EPR experience, and Chaudry, who came in after the Big Bang Epic rollout and all its problems, is determined to be much more cautious about tech.
Asked if what he was doing was ‘digital transformation’, for instance – a key marketing message out of Microsoft when it comes to what its customers do with all of its technology these days – he’s refreshingly realistic:
Transformation’ is, generally speaking, an over-hyped word, in both the NHS and Vendor Land. I try not to be over-influenced by what someone’s written in a nice White Paper, so what I’ve done instead is to ask them to show me transformation, not just talk about it.
In this case, he says, that was borne out by Microsoft being willing to engage “at ward level” with his users to offer proof of just how useful a more integrated comms approach would look like. That, plus the offer of 1Tb level OneDrive storage space to remove that email purge issue for good, seems to be working at ground level, he states.
We have more to do with Epic optimisation work, so we are all about pragmatism here. But I can genuinely see users with their EPR open on their tablet, using Instant Messaging and Skype to talk to colleagues, the cloud to share content… and I think that’s a place we definitely want to go.
Image credit - Image sourced via the Trust's Facebook page