Digital report card to capture and share clinical proficiency
Queensland-based intensivist Todd Fraser is developing a cloud-based platform called Osler that promises to allow acute care clinicians to manage and track their credentials for performing procedures, in effect creating a digital report card of their capability and proficiency.
The clinical performance management platform will allow doctors, nurses, paramedics and students to be credentialed in a structured way, enabling supervisors to sign off procedures using mobile-enabled checklists and the recording of competence so individuals and administrators can see what their credentials are.
It also promises to provide immediate access to educational and training resources at the bedside, open up a collaborative acute care community on a global scale and solve some of the inefficiencies that continue to plague the healthcare system.
Dr Fraser, an intensive care specialist at Nambour and Noosa hospitals and a retrieval physician with CareFlight Group, is calling on the the local and global acute care community to get behind the idea by helping to crowd-fund it. It will be cloud-hosted using the power of Salesforce.com, and will be optimised for use on mobile devices.
Dr Fraser’s team has experience in helping different industries to effectively turn data into information, by first digitising it and then using it to improve performance. The idea is both that clinicians can improve their own performance, as can acute care departments.
The plan is to start with procedural data for medical students, residents, trainees, consultants and nurses in acute care units and wards, along with retrieval physicians and paramedics, with a view to extending it to surgical procedures in time.
“At the moment healthcare has only a limited understanding of its own performance, but by encouraging the capture of data, we can start to enable clinicians to do something about it,” Dr Fraser said. “The old expression is 'if you can’t measure it, you can’t manage it', and I think that’s very true.”
While the concept and its application is vast, underpinning it is a way to digitise and improve the credentialing process. Dr Fraser said that at the moment, this is very informal and inefficient. Doctors, for example, can show they have passed their specialist college exams, but after that, they don't have to re-certify in any of their credentials.
Specialist colleges are trying to improve this situation using direct observation of procedural skills (DOPS) standards, but these are often recorded on paper forms and there is no way to share them when a clinician changes institutions.
“At the moment students will be taught at the bedside, they will be observed doing a few procedures and some units try to document that and be as transparent as they can, but that may amount to a whiteboard with some names and ticks, perhaps even evolving to the level of having an Excel spreadsheet,” Dr Fraser said.
“As healthcare practitioners and as supervisors, we are all very interested in maintaining our skills and obviously extremely interested in making sure junior staff are trained appropriately. This can be recorded, but there’s no good way of doing that.
“If you were able to go to a hospital and say I’m Osler accredited, then in time that could come to mean a certain standard of care which is accepted. If you are interviewing somebody and they can demonstrate that they’ve been formally credentialed in a number of procedures then you understand their capability, which at the moment is incredibly murky and very difficult to validate.”
Dr Fraser uses himself as a prime example. He actually got the idea for Osler as part of his work in medical retrieval when he observed how his helicopter pilot was credentialed. Pilots have to perform certain approaches to landing every three months and if they don't, they can't legally perform the manoeuvre until they do another one under observation.
They must keep up-to-date logs and be re-certified every 12 months. A doctor, on the hand, doesn't.
“For me to do a tracheostomy, I can’t tell you how many of them I have done, I can’t tell you what my complication rate is, I was never formally assessed in this, so the disparity is pretty clear. For a specialist, how do you demonstrate that you are currently up to date? There isn’t an easily accessible and competent method, but we feel very positive that this framework can allow this to happen.”
In addition to keeping a log of procedures and credentials, the idea behind Osler is to use its data intelligence to tailor educational resources for the individual's needs. This can then be extended to the whole unit, allowing directors to easily identify skill gaps and support learning in a structured way.
“They may want to upskill or they may want to change the way clinicians perform procedures and maybe focus on two or three individuals becoming responsible for that procedure, or have team members stop performing them completely," Dr Fraser said. "Until you mobilise that information, it is difficult to know what to do about it.
“With the information that you can gather from people’s performance and their experience, who they are, what their career trajectory is, you can start to use that information and to provide them with the information that they need.
“So if you’re particularly strong at tracheostomy, then you shouldn’t need to focus on that. You can provide different levels of learning material depending on their experience. You can develop areas of deficiency and you can enhance team members' strengths.”
The crowd-funding will not only be used to develop the credentialing application, but begin to bring together the vast digital and social educational resources now available. These can then be tailored to the individual and can be accessible immediately at the bedside.
It will have a curated knowledge base providing mobile access to research papers, position statements and procedural and clinical notes, which are sorted and delivered as information specific to the individual.
The platform will also be used as a community resource for acute care, including emergency, anaesthetics, ICU, CCU and acute wards, enabling clinicians to evaluate and benchmark their competencies on not just a hospital or statewide basis but worldwide too, Dr Fraser said.
“To use another aviation example, if you had a problem with an engine on a particular type of aircraft, within about six hours everyone in the world who operates that sort of machine would know about that problem. We don’t have anything remotely close to that in healthcare and I can’t believe we don't.”
To get it going, Dr Fraser needs the clinical community to help out, not just in terms of funding but to prioritise what resources should be included. Institutions and colleges will also be approached, but he wants to get the crowd involved first.
“We’ve got what I think is a pivotal moment in healthcare. I think a lot of people would like to be able to embrace something like Osler, so with the community's support we have a unique opportunity to deliver a solution of high quality and scale, unlike many resources currently available that are narrowly focused and limited in the scope they offer.
“We believe the reason that there is nothing like this is because it hasn’t been properly backed. And if it is backed by the crowd, then that would be a tremendous resource for all clinicians and potentially influence healthcare and patient outcomes quite considerably.”
The Osler Technology website has a demo of the clinical performance management platform and a video outlining the Osler story, and interested parties can register their interest on the site. The crowd-funding project will be launched in the next few weeks, but Dr Fraser would also like to get feedback from individuals, colleges and the hospitals now.
“I’m very excited by this, because I genuinely believe this can make a difference to how we operate,” he said. “I think what will make people respond to this is that it's a practical solution to a problem that everybody faces.”
Posted in Australian eHealth