Welcome to Synapta! Should we really be focusing on technology support for 'new models of care' or doing what we do now, just much better?

(Dr Mark Greenhalgh) #1

Hi everyone,

Welcome to Synapta!

I’m delighted to actually be able to start sharing discussion topics with colleagues on clinical workflow, pathways and CDS with a Synapta hat on. We’d love you to join us on the Synapta forum.

Since our technology efforts are meant to actually bring benefit to patients, system users or both, I have a provocative question to kick off:

Business transformation heresy?

My ordinary clinical work as a GP would be a great deal more efficient if I could simply make processes of care work even better, which we have already been doing for many years. I mean this in the sense of trying to avoid the ‘failure demand’ and ‘rework’ involved when a significant proportion of activities just don’t function the way we imagine they should or we think they do.

I am comparing this with technology support I have been working on for the new models of care we talk or hear a lot about now; where the pathways are different, the roles of the professional staff are unfamiliar, the way we assess and manage problems is phased or staged differently and so on; untried basically. We’re doing this in response to the development of networks, federations and the emergence of ACOs etc, as well as pressure on resources and rising demand.

I have been involved in a great deal of implementation of technology over the years in service of business transformation. It is often anathema to suggest putting in brand new tools to do the same old thing, but would our slick and clever workflow / pathway technology be best used to support short and familiar pathways we already know and could squeeze more efficiency out of?

Mark

Check out our whizzy new Synapta site.

(samanthabhima) #2

Thanks for this post. Ot absolutely chimes with my own thinking. It is an eternal frustration to me as a working clinician to have to ‘revolutionise’, ‘innovate’, ‘improve’, ‘pilot’, ‘systematise’, etc etc. While there’s nothing wrong with all those activities and concepts in general, it would be so much better if I could just get on with what I’m trained to do. I’m trained to take histories from people, diagnose and treat. Anything that could bring those three things to the top of my daily activities would get a big vote from me.

(Dr Mark Greenhalgh) #3

I didn’t particularly mean it to sound too much of an ‘either/or’.

All being well, the technology will help to gently remove the distracting, unproductive error-fixing admin tasks and concerns away, leaving mostly those things we need or wish to do.

At least we are confident at the moment that the things we try to do would probably bring benefit if they happened effectively or else we know they generally don’t do harm.

I wonder if we should focus on how to achieve organic incremental change where possible. ‘Big bang’ feels rather risky and costly.

Sometimes you do need to make the time and effort to put in a whole new infrastructure if it will allow the change needed. But maybe the first thing we should do with that new infrastructure is carry on how we were doing things before and then gradually change from there.

(roland) #5

I wholly agree. The current tools are not up to the job of efficiently enabling the more mundane but frequently used pathways to be easily carried out. So - an excellent idea - to focus on new shareable tools and get these working first, before moving onto the more “exciting” but less frequented pathways.
The Synapta project looks really exciting and I look forward to seeing how it progresses forwards.

(clive.spindley) #6

when talking about technology, i try to be honest, i try to draw a distinction between tools, toyz and data

i feel with regard to how the NHS manages data it is has done a poor job, particularly from the perspective of the people they serve (i can get to all my other data, but not my health data, mad)

#7

You say the NHS has done a poor job of managing data. It is worse!! There are still cases of patients dying because the admitting emergency service was not aware of severe allergy to penicillin or to other drugs, for instance. And there are zillions of cases of poor medical history taking, poor diagnoses pathways and inappropriate prescribing errors leading to unnecessary and costly hospital admissions. We are entering a new age of interoperable platforms and systems. Great! My hospital [I am an elderly patient with long term conditions and disabilities] can now access my GP SystmOne records; so can I [at least a subset] since April 1st. But …guess what: my patient record is full of omissions and errors, to such an extent that it is totally useless to any health care professional in a different care setting seeing me for the first time. So, I am still carrying a paper based booklet, called My Medication Passport, which HCPs photocopy to include contents in my medical records!! And the said pocket size booklet displays colour Post it Notes with alerts, NBs and other info to help HCPs save time when assessing my conditions. And yes I also have a less comprehensive version as an app on one of my tablets, and a treasure of medical records on my laptop. All in a ready state to be used as patient generated data for the day when patients can input and populate their medical records [with safeguards and caveats, of course]. Technology is wonderful. But why oh why are clinicians [(GPs mainly) so complacent about data accuracy??

(clive.spindley) #8

my solution to this, as scary as it may sound, is to empower all patients to manage their health data, or at least to make a start in doing this, this needs to be done at a national level, and if national organisations are not prepared to do this then i personally think what is the point in having national bodies ... by all means talk, but be open and honest and talk when it matters, it's not just the technology that needs opening up

(Dr Mark Greenhalgh) #9

Yes, I agree, inaccurate, incomplete and out of date information in the patient clinical record is a real problem.

Mostly it just wastes everyone’s time, rarely causing serious problems. Because it mostly wastes time and money and usually doesn’t kill or harm patients, it ranks as similar to any number of other problems in healthcare and there is little appetite to address it in the short term; it’s very costly to do retrospectively at scale.

It’s best dealt with over time by gradually taking steps to ensure better and easier capture, validation and sharing.

(Dr Mark Greenhalgh) #10

I would add that the apparent complaisancy about data quality among GPs is simply a recognition that it is no greater a priority than many other issues, all of which contribute to inefficient care.

In practice we deal with it by repetition of collecting it and learning generally not to trust data for important decisions, double-checking etc. That’s what leads to the wasting of time and money.

(tony.davey) #11

OK – as we already know this then can we stop this discussion and start to send productive messages and stop wasting each others time ranting?

(Dr Mark Greenhalgh) #12

Thank you Tony - you’re happy to be more direct than me. :wink:

(Dr Mark Greenhalgh) #14

… meanwhile, back to the topic at hand.

There seems to be a genuinely interesting point about the optimum pace at which we introduce change for end users, especially when we are using new technology to do it.

Instinct suggests that a balance somewhere between the old established ways of doing things and new ways of doing things may be best (although not always appropriate).

My aim is to introduce powerful and endurable system structures (not changing very often) to underpin our systems and have lighter, more easily configurable layers on top. This is the way of more modern systems design.

We may then want to use our fancy new configurable technology to fully support existing users and pathways (so things look similar to what people are used to), but with the capability to evolve the processes gradually towards what we think is better and more efficient.

That would allow experimentation with new models, but also allow a quick ‘reverse ferret’ maneuver if things don’t work and we need to go back to how things were.