Digital Health and Inter-operability in the NHS


Choluteca Bridge – 1998. The bridge stayed up but the river moved following a storm! Why is this here? Read to the end and you’ll find out.

First talk of the Interoperability summit based on the talk by Robert Watcher – writer of the Watchter report

Watchter – The four stages of health IT are:

  1. Digitizing the clinical record.
  2. Connecting all the parts
    1. Enteprise system to enterprise system
    2. Third-party apps to enterprise
    3. Patient-facing systems to enterprise systems, and to one another
  3. Gleaning meaningful insights from the data
  4. Converting these insights into action that improves value.

Things get really interesting when you connect things – the intercontinental railway connecting up in the middle was the beginning of great innovation and trade in the US. Traditional enterprise is one set of those tracks (EHR’s, Epic, Cerner etc). The second part is consumer-facing IT (big data, apps, sensors, etc.) When these two combine great things will be possible.

Unfortunately in America, the situation of: ‘No electronic medical record’ in a hospital is now seen as a selling point in the US.

You see, because of huge efforts spent on data entry – the US then digitized the system first without thinking about the people and their work in a deep enough way. This resulted in technical maladaption.

According to Ronal Heifitz there are two kinds of changes in work – adaptive vs technical changes. Technical changes think only about how the technology changes; Adaptive changes consider the people involved and how it might impact them – people are both the problem and the solution all at the same time. Healthcare technology must be adaptive – that is why we have managed to get it wrong in the past.

Erik Byrnjolfsson talks about the productivity paradox of health IT. In industry after industry, digitilization was supposed to bring improvement; however, these changes often actually produced more problems and productivity plummeted. “You can see the computer age, in everything except the productivity statistics”. It takes 10-15 years at least for the productivity to follow.

We are at the beginning of becoming a primarily digital industry.

Solving the productivity paradox: Improve the technology and re-imagine the work itself! Both have to happen in order for success to follow! We need to move towards collaborative charting – this is the only way to succeed.

Features of the Wachter report:

Implementation needs to move at an appropriate speed – staged approach, including global exemplars will be necessary.

We need to give local trusts authority to buy best system for them – and not just follow NP-fit which failed as it tried to centralise everything.

We need to build and nurture the clinical-informatics workforce – we must see health IT as change management, not just a technical project. We need chief clinical information officers and a national lead – currently: Prof Keith McNeil

Interoperability is crucial to success and Leaders must...

  1. Connect the digital pieces, learn to use data for improvement and build decision support.
  2. Build skills, culture, governance to re-imagine the work not just digitise it.

Finally. Why is the bridge at the top of the article? Well the Choluteca Bridge in Honduras was a technical masterpeice. It withstood an enormous storm in 1998 and all the engineers congratulated themselves. Except there was one problem… The river had moved. If we are not careful our digital bridge could look the same. That’s why we need to make the solution people-centric!

Ten Top Tips for Clinical Entrepreneurs in Media Land #NHSClinEnt

Based on a talk to the #NHS Clinical Entrepreneurs by Vivienne Parry – Science writer and broadcaster.

1. People like:

  • Royals, celebs, cute dogs, drama.
  • Something new, surprising, quirky, counter intuitive.
  • Conflict.
  • Human stories – personal journey’s.

Make of this what you will – but these are the things media-land tend’s to look for.

2. Have things to hand:

Great pictures, top factoids – a nugget that is unforgettable – quote on, quote off.

3. Don’t ramble:

Have a beginning, middle and an end to the story.

Typically people start in the middle – without a context (and therefore the story doesn’t work).

4. There needs to be a clear need:

Otherwise people won’t get it. Show me patient’s who have benefited. It needs to be clear and easily understood!

5. Know the difference between good morning and newsnight

One of them is very relaxed and the other is very formal. If you’re sitting on the couch with Piers Morgan you don’t need any training. Newsnight you do! Always watch the show before you go on it.

6. News and features are really different animals.

On the news they will not tell you to comb your hair. If you look like a mess they won’t tell you. Features you’ll have makeup etc – apparently this is essential.

Know the style of the programme, magazine or paper. Know what makes a good piece for each.

7. Rate journalists

Pitch to the ones you like and are in sympathy with. The ones you resonate with are the kinds of ones you should approach yourself as the interview is likely to work much better

8. Horizon scan – what’s coming next?

Understand what events make news. – If you’re the top ligament guy you may need to wait until Wayne Rooney busts his ligament. Then is you’re chance to pounce.

If you don’t get anything – don’t be disappointed. Everything has a time to shine and it may not be dictated by the factors you consider most important.

9. Media people live in a totally different time-zone and world!

They will have to meet their deadlines. It needs to be now (tomorrow is not ok). The average online journalist has to get a story out in 24 minutes! Return those calls fast. Now or never – return and leave a message if you can – at least they will remember you.

It is not an oral examination. Don’t use acronyms or jargon. Use and practice analogy in your area. Simple analogies that people can get win the day.

Establish what the journalist knows. If you don’t ask them to repeat it back they will fill in the dots otherwise and get it wrong. If you think they didn’t get it ask them to repeat what you said and explain it back. If they can’t do that then you need to go over it again. Same with quotes, ask them to quote them back to you.

Re-frame the questions: ie. Is this available in the NHS? If not then say that’s a very good point, we need to raise awareness of this and try to get it into the NHS nationally!

Check: Is it live or recorded? Studio or OB (outside broadcast)?

10. Lights, Camera, Action…

News? Feature or documentary? Documentary you’ll get lots of time setup etc, feature in the middle, news they really don’t care – if you look a wreck they won’t tell you. Who am I on with? What to wear – don’t wear black or white? No small checks, patterns, strong colours, not fussy, no dangly earrings and brush your hair!

You need makeup – DO NOT refuse it! You will regret it.

Never look at the camera – look at the interviewer. When you look away from the camera you lose trust! Also, don’t flap around.

People often look at the monitor – this is because they suddenly get distracted by being on television. Say what you want to say. Write down 3 things that you absolutely have to say in that interview. Note: (The interviewer might distract you with some other irrelevant questions – just say what you need to say!)

Understand that the interviewer won’t have read your departmental briefing or any of your papers. The researcher may not have told the presenter much. If you have something to hand and can, do your innovation in a speedy way or use 5 quick and easy phrases. Help people out if you need to, and don’t ever get angry.

Be relaxed. Breathe out, smile.

Be authorative: stillness, clarity of message, sincerity. Breathe out – then you have a very lovely sexy voice to the voiceovers with.

To be authoratative – STOP! Be still and then speak – you will come across as a very serious person to be taken seriously. Make your message crystal clear.

Be interesting – record yourself and then mark out every word you think should be significant in bold. Vary speed and tone of what you say, use limited hand gestures, smile. Make it sound like a ham Spakespearean actor – on screen this comes across well apparently… Vary the tone and the speed!

If you have a tic – train it out!! They can be very off-putting.

11. Bonus – When dealing with print and radio:

Understand deadlines, ask journalists to read back quotes, offer to look at the science copy but don’t alter grammar or style.

Always say yes to radio – has enormous reach and is a great way to practice.

Ask ‘is it live or is it recorded?’ Who are the other guests?

You don’t need notes – you’re the expert – (if you need to, write it on the palm of your hand, don’t wear bracelets, don’t bang the table [apparently people do].)

Practice with your auntie and try it with kids – but don’t start with 14 year olds.

Start with local radio and TV (great practice).

Pour yourself a large drink and watch yourself back! Note things down in a notebook. Change the things you can. In a mirror remember you are looking at a mirror image of yourself. On TV you see the reverse! Unless you watch it you will never improve.

Ask your mum to keep cuttings and records of phone numbers and who you have spoken to. Use a contact management system to keep records of your contacts.

Further hints… Be committed

Passion, Enthusiasm and Knowledge are key!

There is always that moment when the mouth is moving and the brain has stopped. Just stop talking: I’m really sorry that was rubbish can I start again. Short soundbites are all they want – they will cut out any ramble.

That concludes her whistlestop tour of media training for the NHS clinical entrepreneurs.