Technology
hospital, make it less likely that they will need to reattend, and free up beds for new patients more quickly.
Improving the flow of patients Digital CDS isn’t necessarily new, but neither does a standard exist, nor is it as sophisticated as it should be. Having used many different EPR systems in my time, I’m pleased to say that digital CDS is something that has long been central to the development of Sunrise (an electronic patient record provided by Altera Digital Health). Working closely with clinicians on the design has enabled them to improve patient and clinical experience, and position us to think about the wider impacts that digital CDS can have on systemic challenges like the backlog. Currently, in most EPRs, CDS is essentially
branches of logic. Situation A will take you to intervention B or C. However, the intervention that the clinician chooses will vary from hospital to hospital, if not ward to ward. If we focused on making CDS more intelligent, enabling it to make suggestions on real patient data, then we hold the potential of reducing these kinds of variations altogether, as the suggestion is based on both information provided by guidelines, and intelligence provided by the data. This will then contribute to a better flow of patients, improving their health and enable discharge to a more appropriate care setting as soon as it is safe to do so. In the future, I would like to see CDS capabilities enhanced with artificial intelligence. An EPR should be the single source of truth when it comes to patient data, and the possibilities are almost endless when it comes to how we make use of it. For now, we’re focusing our attention on embedding CDS in bespoke ways, so that it complements the needs of individual hospitals and departments. We’re seeing that, by doing this, staff are more welcoming of the digital change, as they can see proof points that the system has been designed for them. Naturally, the only way of being able to do this at scale is to introduce standards around digital CDS. If there are no standards in place, the way this data is used will vary and we run the risk of it causing more problems than it solves. With millions of data exchanges happening every day, it’s essential that the data being collected is of the highest quality. For me, free text is ‘dumb’ data, with very little that can be learned or replicated from it. By instigating standards, we can ensure that things like CDS are as powerful as they can be. For me, this would mean all data being inputted through drop-downs and tick boxes, with very little free text. By standardising the data that is entered, it can be more easily analysed, trends are more identifiable and more intelligent
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recommendations, backed up by a treasure trove of patient data, can be made.
Part of a wider system CDS is not a standalone solution to the backlog. We’re all aware that there are many moving parts; clinician burnout, COVID-19 cases, health inequalities and poor population health to name a few. Rather, we need to encourage a culture that gives us the freedom to ask, ‘Can this be improved digitally?’ so we can transform as much of the system as possible. As clinicians, we need to raise our expectations on what we want from technology. As suppliers, we need to understand the problems that face the front line and build solutions that are going to help solve them. To do that, the clinician must be at the centre
of any digital change and given the flexibility to configure the solution in a way that suits them and their department. We saw this in practice at Bolton NHS Foundation Trust when the Acute Medical team developed medical lists within their EPR. It streamlined their clinical workflows, improved patient flow, and reduced the length of stay in hospital. It’s these kinds of configurations, in combination with an intelligent CDS system, that can ease clinical burdens, free up beds, and make a real impact on the backlog. As such, there is a great responsibility (as there should be), on suppliers to develop and implement technology that works for clinicians and benefits patients. Clinicians are burnt out. The last thing they need is a badly implemented piece of tech that is difficult to learn and doesn’t deliver the basics. That’s why we supported Medway NHS
Foundation Trust to execute a pre-emptive training programme ahead of their EPR going live. It meant the Trust was able to recognise benefits from the EPR straight away, utilising features like digital CDS. Technology systems are there to support us, and its only right that we put high expectations on just how assistive they can be. The things we expect from our personal
devices, we should be able to expect from our EPRs. My smart phone is intelligent enough to suggest different apps for me to look at depending on the time of day, why can’t my EPR do something similar? That’s my vision for the next phase of electronic CDS, an intelligent web of knowledge and insight that enables not just the right decisions, but the best decisions, in the fastest time. By streamlining and modernising simple systems like CDS, we are in a far better position to tackle key challenges like the backlog.
CSJ About the author
Dr. Constantin Jabarin is chief clinical information officer at Altera Digital Health UK. He has 23 years of clinical experience, is a graduate of the University of Wales College of Medicine and continues to practice as an emergency medicine physician at a senior level. He also has extensive experience in clinical IT, working as a director for DocCom (later known as Careflow), System C, and as CCIO for The Great Western Hospital, Swindon, during which time he oversaw the initial steps of the paper-light process rolling out digital across the hospital. Constantin strongly believes in the importance of presenting a flowing clinical solution that works for all clinical users, in addition to supporting non-clinical leads. Dr. Jabarin also has a large amount of experience running his own pre-hospital events company, where over the years has acted as chief medical officer of Castle Combe Racing Circuit, medical director of the Bath Half Marathon and Cardiff Half Marathon, as well as being a trackside doctor at the British Grand Prix at Silverstone. He now continues to support Festivals by providing medical support as a doctor at Glastonbury, Reading and Womad.
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