In the Clinical Safety Officer part of my portfolio of work my remit is to assure health IT as safe at the point of manufacture or during deployment. However, this isn’t a post just about Clinical Safety or the DCB0129/0160 regulations, but my reflections on wider health system safety in relation to Health IT.
I think that there are several key attributes that the IT used in the delivery of healthcare should be considered against.
- Health IT should be supportive
IT is there to help the people using it. To provide information, to analyse data, to highlight abnormal results or patients that need review. However, this is often not how it works. All too often the systems or products that are used add to the burden; they might slow down access to information by requiring a user to log in to a different system or open another browser window; they might not connect all the available information; the IT may require additional steps in a process that weren’t required in the manual process, for example a requirement to add coding or a requirement for additional unrelated information; or IT can just be clunky, adding additional clicks in a process that don’t provide any benefit. Safe health IT will not do this, it supports a user to provide better care, it allows clinicians to spend more time with their patients and less time in front of a screen. It doesn’t cause the sort of frustration that makes a user cut corners, miss steps or add inaccurate information just to get to the next step. It provides all the relevant information in a way that is accessible, highlights anomalies or areas that need addressing and provides relevant prompts or the information a user needs at the time of use.
2. Health IT should be easy to use
Following on from above Health IT should be easy to access, and not involve logging into multiple systems or downloading an app onto another device, or remembering multiple usernames and passwords which are difficult to rest if they are forgotten. Health IT needs to be properly integrated with the other systems or processes it is designed to work with. Integration allows a user to use each software component for its purpose, and for data from each use to add to the full data set, rather than increasing siloed information that is then not accessible to others who are interacting with different parts of the system. It should be intuitive and have inbuilt, readily available support/ help sections – no-one has time to go back to the user manual if it isn’t there. The IT should guide a user through whatever process it is being used for which again allows the user to spend less time wrangling with IT and more time doing their job.
3. Health IT should be clear about its purpose, its scope and its intended use
Who is the health IT designed for, what is it designed to do and is it being used for that purpose? Do the users have the correct levels of access to do what they need or want to do? If the IT contains software as a medical device, AI or machine learning is this clear? Is it clear if any guidance provided is the local policy, generic guidance or a personalised output for the patient based on inputs to the system? If the answers to any of these questions is not clear, or not clear to the end user I am not sure that the Health IT can be safe. In order for a product or system to be used properly the user needs to understand what it has been designed to do and how they should interact both with the IT itself and any outputs it provides. If there are different levels of user access is there the potential that someone who shouldn’t be able to can change the safe parameters around a patient care? If health IT meets the requirements of the medical device regulations and has a medical purpose does the user know what it is and what implications that has to any care being provided? Is there a tendency for users to blindly accept the output because it’s what it says on the screen? Thinking about a remote monitoring system where a patient is entering health data for review would a user know to question the data that is entered?
Where an IT system or product is clear about who should use it, how they should use it and in what circumstances it is easier for it to be used safely.
4. Health IT should not be the purpose of health IT
Building an app or a platform should never be the primary purpose, however this does sometimes appear to be the case. Supporting, improving or digitising a process that could be done more efficiently, with better integration to other systems or to allow users to access information in the moment are good reasons for developing health IT. This comes back to being clear about the user, the use case and the scope of purpose.
I also think we need to think carefully about how we innovate and improve health IT. I think it is too easy to think that what is needed is new fangled, hi-tech, requires AI. Often a simple digital solution is what is needed and what can make a difference to patient care. Let’s get primary care and secondary care records integrated removing delays caused by letters not getting from one part of the system to another; lets get all trusts working on properly integrated electronic patient records that, for example, let a clinician send a prescription from outpatients to pharmacy electronically; lets get smart automated coding built into those systems…. I am sure there are lots of other bits of very basic functionality that are currently missing (for example Dr Raj Kohli, MD https://www.linkedin.com/posts/drrajkohli_digital-nhs-pharmacy-activity-7014034847891341312-SpWL?utm_source=share&utm_medium=member_desktop)
Our health system is under massive strain at the moment, there is a shortage of all healthcare workers. Health IT can help to support both staff and patients but I believe any system or product needs to be considered against the wider system and how it is going to fulfil the above principles.