I'm Hamish, a Junior Doctor in the NHS, I'm frustrated with the technology we use and how this affects our patients
Let's Fix It
Let's fix the list.
Believe it or not, when you're in hospital it's highly likely that your doctor is keeping a record of your progress in a Word Document or Excel Spreadsheet. These are updated and printed daily and carried around the hospital. When new results are reported or when new tasks are made, these are written on to this paper sheet and then updated at the end of the day.
As archane as this may seem, it has turned out to be a highly efficient and effective way of holding patient information. There are certainly significant drawbacks of this system:
- The most obvious, but perhaps the most significant for a variety of reasons, is that these lists can be lost. Naturally, this represents serious patient confidentiality concerns. Lists have been found on footpaths, buses, trains, in the canteen and many other places besides. Confidentiality is one of the keystones of medicine, but we are often forced to risk disclosing patient information because there is no other safe or effective mechanism in place to manage this information. As well as the risk to patient confidentiality when these lists are lost, the entire day's tasks and progress can also be lost and takes time to collate and rebuild.
- Though updated by hand throughout the day by your doctor, these lists are essentially static. Your care is shared by a team of doctors, and often other teams also, information cannot be easily disseminated to them using these lists. The NHS is the world's largest user of Pagers and they remain the principal mechanism to contact colleagues to update them of important changes. Encrypted messaging apps, such as WhatsApp and Telegram are used more frequently, but there remains concerns that these also post confidentiality risks. There is no internal NHS instant messaging system. As information is shared slowly, patient care may not be updated as quickly.
There are many commercial systems available for managing patient information in electronic lists which are encrypted and carried on smartphones. The NHS hasn't bought into these systems because they are prohibitively expensive - both in set up and maintenance fees.
Minimally Viable Project
As I'm learning, the best way to start with a project like this is to identify what elements are absolutely essential to the user group. This minimally viable project is then deployed with feedback sought for the existing features as well as any feature requests.
The essential features are:
- Encrypted and secure, with access only granted to authenticated users
- Storage of patient demographics, presenting complaint, relevant background, blood results, progress and tasks