Rapid improvements in digital technology, along with financial pressures on nationally funded healthcare, have provided healthcare professionals and health organizations with the opportunities and the incentives respectively to seek new ways of working. The UK’s National Health Service (NHS) is a prime example of this. The application of mobile technology and the steady transitions to digital medical record-keeping are both rooted in their potential for cost savings.
Challenges to new tech
Within the NHS, two elements hamper the implementation of novel technology: the questionable veracity of source data, and the lack of interoperability among the many electronic health record systems (EHRs) currently in use.
There are multiple and varied objective data items involved in clinician-patient interactions. The simpler examples of these include patient demographics and date/time of encounters, or specifics such as tests requested, results recorded, actions initiated and drugs prescribed. More complex variables can relate to the technical specifications of procedures performed or equipment used.
The coding systems used to capture much of this information are arcane and antiquated. The input of these data points into ‘the system’ is most often performed at a clerical rather than clinician level, conferring another level of inaccuracy at best and error at worst.
The profusion of in-house and corporate-driven EHRs is a significant barrier to data interoperability. While most clinicians have – regrettably – become inured to this inefficiency, the frequent impossibility of two-way communication between systems creates even greater challenges for the health data innovator. Technology is hamstrung by the inability of the pre-existing parts of the puzzle to communicate with one another.
Devising a clinical photograph tool for diabetic foot wounds in a London teaching hospital, for example, necessitated access to four different system interfaces to correlate blood test results (CERNER), ultrasound arterial scan findings (IRRIS), angiographic pictures (PACS, Picture Archiving and Communication System) and previous clinical correspondences (OpenText) prior to annotating the relevant summary into the mobile image.
The lack of reliable data input and the failure of system interoperability compromise the ability of enthusiastic doctors to get the most out of their working hours or use the plethora of clinical information to its full potential. This situation has encouraged a few clinicians to develop workaround solutions.
A common pattern is for a doctor to first devise a new, relatively labor-intensive method of recording, organizing and analyzing a relevant set of data items. She or he then seeks to develop an algorithm or digital tool that simplifies and/or automates the steps involved. Digital skills, investment in a freelance developer or the assistance of third party industry partners contribute to further progress.
Medopad, a secure mobile app that integrates details from the hospital’s patient database into an interoperable tool for the capture, storage, dissemination and retrieval of clinical images, resulted from a group of like-minded clinicians and digital health innovators working collaboratively in an iterative manner.
The clinical need was a tool for taking and uploading patients’ pictures securely using a mobile device. These images required aligning with the patient’s clinical identifiers before sharing and storing the end product within the official hospital record. The concept arose from the clinician, the technical support was outsourced by the NHS trust and the expertise was – eventually – provided by a hungry startup.
The net result was the creation of an elegant product that surpassed its original scope on two counts. By integrating with the Trust’s ports for both PACS and EHRs, the novel tool facilitated seamless access to the same patient’s angiographic images and clinical correspondences from within the app. Additionally, by incorporating remote networking, it has made all three of the above data components securely available to the clinician beyond the bounds of the hospital.
Should doctors be devising their own solutions?
The practice of clinicians investing time, energy and finances into developing innovative data management solutions is a reality. The question of whether they should be doing this independently is worthy of healthy debate.
Those in favor of clinician-led technology growth would argue that care providers are best equipped to guide the development of novel platforms customized to the secure, accurate, ergonomic and reproducible management of specialty-specific information. Doctors who engage meaningfully with their clinical data require little persuasion that existing systems are suboptimal and that the work of digital healthcare innovation and inter-system integration has barely begun.
The opposing view is that the existing frameworks are adequate and that better compliance from healthcare practitioners with regards to their own data input is the solution. This standpoint is heavily influenced by the assumption that the data collection tools and repositories are fit for purpose. Scientific minds seek to clarify conundrums by applying the available evidence, but when the implication is that the available data is intrinsically flawed, which way does one turn?
Clinicians are beginning to haul themselves onto the bandwagon of global interest in codifying electronic clinical data. Alongside this, the concept of patient-owned data blocks is gaining traction and many technology startups are focused on digital health innovations targeting the customer rather than the provider. Companies such as Medopad appear to take a two-pronged approach, allying their interest in patient-monitoring apps to their partnerships with innovative healthcare providers to create novel data solutions.
All of these new roads require important safeguards:
- an adherence to encryption and handling standards for clinical data storage and transfers
- definition and wide acceptance of ethical patient consent practices for the clinical sharing of information
- institutional support for clinicians who invest their intellectual property and energy into these developments
- a demonstrable willingness from large corporate and public health organizations to integrate data systems and facilitate interoperability between
These are challenging objectives to meet. In the long run, though, the benefits would be ubiquitous. After all, who among us can say they will never be a patient?