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Having missed both #dhss20 and #DHrewired20 this year, I need to improve my digital health CME. Lockdown 2.0 seems like a good time to propose #CCIOHomeSchool
@ayesharahimCCIO @rijan44 @DrPeterMarc @NHSCCIO @DrGarethThomas @drdavidhaider @simonirving74 @runNGman @sar_cam @bottomDoctor @robblagden @comparesoftware @NHSDAalumni - how about it. Pick a topic each day, argue the case and solve all #digitalhealth problems by March?
I'll lead with clinical communications. Big news splash 14 months ago but (and please correct me) headlines and intent > legislation. In theory, however, only 11 months to go.... https://www.gov.uk/government/news/health-and-social-care-secretary-bans-pagers-from-the-nhs
Support and some funding has come via @NHSX in the form of the clinical communications procurement framework https://www.nhsx.nhs.uk/key-tools-and-info/procurement-frameworks/clinical-communications-procurement-framework/
Vendors need to provide secure messaging, image sharing, calls and staff directory via links to the http://NHS.net address book (not sure how sites not yet using http://NHS.net for email work).
There's not a huge amount of published data on the time / opportunity cost of pagers. The Royal Sussex have suggested 3 hours in every 24 are spent answering pages https://www.rcpjournals.org/content/futurehosp/6/Suppl_2/77
They call out the disruption to workflow this causes, but maybe the most important finding was that pretty much half of calls did not require action within 60 minutes
Locally we had found things were much worse for specialist services taking calls from other acute sites with almost a full time trainee being needed to respond to calls for advice (fortunately we fixed that one!)
Data from the West Suffolk deployment of a clinical messaging solution approaches the question from a different perspective but gives broadly similar findings https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383097/
The hardware question initially seems a non-issue with 95-98% of doctors and nurses in a 6000+ person survey owning a smartphone https://innovations.bmj.com/content/1/4/174
However.... I own a car but don't really want to drive my patients to clinic. Getting #BYOD right seems essential if this model is to work and there is clearly work to be done here!
https://www.nhsx.nhs.uk/media/documents/Bring_Your_Own_Device_Guide_v1.0.pdf
https://www.nhsx.nhs.uk/media/documents/Bring_Your_Own_Device_Guide_v1.0.pdf
Critically, none of this get us past the question of if we're doing this because we can (can we??) or because we should. At face value, replacing pagers could be the worst type of digital substitution rather than digital transformation
Here @Wired do a cracking job of summarising the arguments and linking to Tweets that are more entertaining than mine https://www.wired.co.uk/article/nhs-pagers
My take is that we need a considered model that asks what are we communicating (often simple tasks); what is the right form of communciation (some things are urgent); and how this interacts with other systems (removing unnecessary steps in the information sharing process)
I'd argue for three levels of communication
- now
- soon
- someday
Our initial thinking around a draft schema is below. I think it's still too acute site focussed. Now, does anyone want to pick up a thread tomorrow :-)
- now
- soon
- someday
Our initial thinking around a draft schema is below. I think it's still too acute site focussed. Now, does anyone want to pick up a thread tomorrow :-)
