When health tech ‘magic’–isn’t. Roy Lilley and his several times per week newsletter (NHSManagers.net, subscribe here) are really must reads for our UK readers dealing with the foibles of the NHS and NHS Digital. Billions have been poured into digitization of records and equipping district (community) nurses with laptops and access to apps that connect them to patient information. All of which is apparently, a flop for the money spent.
The Queen’s Nursing Institute (QNI) has published a study, Nursing in the Digital Age 2023, via its data gathering and analytics area, the International Community Nursing Observatory (ICNO). It obviously should be microscope-read by NHS Digital, but also by US developers (and in other countries) with clinical users. (Oracle Cerner, Epic, and 00’s of EHRs and workflow apps–take notice).
Mr. Lilley outlines the level of failure here–from his article:
- 5 yrs ago; 32.7% reported problems with lack of compatibility between different computer systems… in 2022 the figure had risen to 43.1%.
- 5 yrs ago; around 85% of respondents reported issues with mobile connectivity… in 2022 this figure was around 87%.
- 5 yrs ago; 29.5% reported problems with device battery life… in 2022 the figure was almost 53%.
The overall take of the QNI study is that nurses are highly digitally literate and embrace technology at scale, but in practice, the apps and the hardware have become impediments as the workload increases. For non-UK readers, district nurses travel a lot, often working from home–akin to home care or rural nurses in the US. Points from their executive summary:
- Hardware–battery life, weight of laptop, old laptops, ergonomics not only from weight but also when working in cars. Safety and confidentiality issues lead many nurses to take the work home, leading to delays.
- Software–connectivity, authentication, multiple platforms, little integration, repetition of data entry, and poor connectivity and software design leading to interrupted workflows.
- Some scheduling tools cause workload issues, such as over-allocation of work, unmanageable workloads and loss of personal autonomy.
- Systems design–impersonal, designed to act as a barrier to interacting with patients.
- Duplicative workload–repetition with dual entry on paper and into platforms because of poor connectivity and software design
- The use of electronic health records (EHR) and similar platforms was mixed in terms of productivity gains and work capture.
Another issue: “Moving technology-enabled care (remote monitoring) to the community appears to have shifted work from the hospital to the community”, meaning an increased workload on nurses where specialists or non-nursing staff could do this.
Mr. Lilley summarizes as a service what both the hardware and software should be accomplishing:
Just ten simple things:
- Who is the patient,
- where have they come from.
- See their record, have they been sick before and…
- What we did we do?
- Anything in their history that’s a red flag?
- What do we do to fix them up this time and…
- Record how we did it.
- Figure out what worked,
- What did it cost and…
- Do we want to do it again.
Both Mr. Lilley’s newsletter and the study (PDF) are must reads wherever you live. Especially if you are a software designer.
No wonder nurses are single-day rolling striking!
(He also has an interesting take on ChatGPT, AI for copywriting and reporting, which we will take on next week….) Hat tip to Editor Emeritus Steve.
An interesting sight…
For me, the following sentence tells the real story, “ The absence of nursing leadership in this space might account for the non-engagement and poor design experience”.
We have been involved in implementing digital systems into the acute sector of the NHS continuously since 2014 and have found this simple fact – good nursing leadership has a direct impact on implementation. Where we have solid leadership, we get amazing results, where we have weak leadership, we experience lack of engagement and the implementation becomes laboured and protracted with nursing staff saying the technology doesn’t work.
Fix this one thing and watch digital health take off and deliver the results everybody needs…
“…good nursing leadership has a direct impact on implementation. Where we have solid leadership, we get amazing results, where we have weak leadership, we experience lack of engagement and the implementation becomes laboured and protracted with nursing staff saying the technology doesn’t work.”
From your post to Oracle’s and VA’s ears in their seemingly endless difficulties in implementing Oracle/Cerner Millenium!