Putting pen to paper

During my time working in tech support for a practice software developer following university, it became very apparent just how poorly understood basic computing technology was at the time. Early print editions of Pulse+IT spoke very much about these themes, with practical articles about scanners, monitors, printers, RAID and UPS all garnering lots of interest.

Eleven and a bit years later, computer hardware is rarely even talked about as an issue, with improvements to processing power, memory and storage capacity, and battery life having been so steady over the past decade that it is unlikely that your shiny new device is the limiting factor in your workflows.

As it was in the beginning, is now, and perhaps will be for decades to come, the ability for the myriad pieces of hardware and software systems used in the health sector to talk to each other remains elusive, whether it be be within a general practice or hospital ward, or from one healthcare facility to another.

In this time I’ve been fortunate to have had very little direct exposure to the health system in the capacity of a patient or carer, but thanks to a fairly nasty bacterial infection, I’ve been following my partner on a healthcare journey these past few weeks.

Having had a sore throat on Monday, and vomiting on Tuesday morning, she presented at a pharmacy with painful inflammation on her ribs under one arm. The pharmacist arranged an urgent appointment with a nearby GP, who sent her straight to the emergency department. By the time I arrived in the early afternoon, she had had chest X-rays and had been seen by multiple doctors – each one more senior than the last – and by midnight they had admitted her without a definitive diagnosis.

I don’t recall seeing a computer during the many hours I was in the emergency department that day, but given my professional interest in such things, I did find doctor number five’s comment to my partner – “you’ll have to start your story from scratch as I can’t read their writing”, pointing to the day’s worth of notes the previous doctors and nurses had made – worthy of a chuckle.

The next morning I was called to the ICU, where she had been transferred, and by 10am surgical consent forms were being signed in preparation to stop the spread of what the doctors suspected, correctly, was a nasty case of necrotising fasciitis. Is there any other kind?

Following her surgery, my partner was hooked up to barrage of infusion pumps and monitors, all exporting their data via a sophisticated eyeball-to-hand-to-pen interface, onto the largest piece of paper I’ve encountered since Pulse+IT was in print. The integration even supported pictures, with doctors and nurses able to see at a glance trends in temperature (or perhaps it was heart rate, or blood pressure?) thanks to carefully hand-drawn lines linking hand-drawn dots on the page.

I’m certainly not a zealot when it comes to technology, and if a pen and paper is the most efficient way to perform a task, I’m all for it. But for the same reasons that handwriting was effectively eliminated from GP prescribing decades ago, it does strike me as strange that in a ward dedicated to patients that require around the clock one-on-one nursing, fairly large and potentially unsafe technology gaps are evident.

Two weeks and five surgeries later, I’m pleased to report that things are progressing well for my partner thanks to the excellent care she has received in the hospital. As an outsider looking in, it’s not apparent that health IT has had much of a positive impact on her treatment regime, but nor does it seem the lack of computerisation in what seem like fairly obvious clinical areas has been detrimental to her care either.

Of course other patients don’t always enjoy the same positive experience, so in this week’s poll question we ask: Do you think the continued use of paper in hospitals poses a safety risk to patients? Sign up for our weekend edition or comment below.

Comments   

# Antony Sara 2017-10-07 18:03
Simon
the question you pose is not answerable. Until the technology can carry out the necessary clinical work practice functions as safe as, or better/safer than the paper, then it should not be used. None of the big software products can do the functions at all of an ICU, let alone safely. There are a small number of software products (eg IMDsoft) that can provide the equivalent functionality and safety that you saw of the A2 or A1 pieces of paper. As the software gets better then we can transition from paper to it. some pieces of paper/forms are so rarely used that we are not likely to spend the money to create the functionality in software e.g. the sudden unexplained death in infancy form of 50 pages is used 50 times per year in NSW. What about very complex forms that the big products cannot manage? they will stay on paper until the software can cope. what about consent from external parties? they will be on paper as a written signature for decades...

my point is that we should be focusing on safety and quality and work practice, absolutely not the technology for its own sake. most functions can go to software, and what is not as safe or safer, will/should stay on paper.

happy to have a longer and more referenced discussion as you may wish.

Tony
# Colin Parker 2017-10-10 12:00
As an Emergency Physician I share your frustrations on a daily basis. Unfortunately, as Tony describes, none of the software vendors out there actually have a product that follows our complex workflows and is agile enough to be customised for various institutions. To address this, my colleague and I (practising Emergency Physicians) have developed our own Clinical Information System to address the issues we face as you describe. We are in the process of doing some research as well as commercial marketing of the product. This appears to be another roadblock in that all the Clinicians are positive about the software but getting traction from CIO's and CEO's is proving difficult and navigating complex tender requirements, clearly favouring the larger O/S vendors, is a hurdle that smaller companies cannot overcome.
Yuresh
+1 # Mark Leggett 2017-11-08 09:55
Allow me to refer to the Jurassic era in Neonatal intensive care (the '80s).
As a nurse, we would have an A2 sized form that allowed us to capture 15 min interval recordings for a range of key parameters including clinical observations, ventilator and other tech based inputs, as well as feeding, IV, turns, etc.
I'm a tech junkie, but there was something about the ability to look at a cohort of information and sometimes intuitively 'see' a situation either arising or in retrospect, purely because you could cross-reference a range of inputs and outputs that would otherwise be captured, and potentially presented, in a disparate fashion. The challenge of the technology then, is to provide a similar ability - maybe it's an AI opportunity?

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