Staff Administration System (SAS): A Vital Missing Piece in Hospital IT systems

Reflect on the current state of affairs

  1. Patient
    Who is the junior doctor looking after me at this moment in time? Who is my nurse? Who is my Physio?
  2. Radiologist
    I am reporting a CT Scan on Mr Some Body. There is something not right here, I need to speak to the doctors looking at this patient now. Who is it? How I can make contact?
  3. Haematologist
    I have some really abnormal blood results for Mr Some Body. I need to tell someone in charge of this patient’s care, but I do not know who it is? The contact number on the form is not working.
  4. GP
    I have a vital piece of information I need communicate to the doctors looking after my patient, but I don’t even know where to start.
  5. Nurse
    I need a doctor to see this patient as she is in pain. Doctors change around all the time and it’s 530pm already, who should I call?
  6. Patient relative
    I want to tell the physiotherapist something really important about my dad to help discharge. I do not know who to get in touch with.
  7. Ward Junior Doctor
    I want whoever is taking over my shift to be notified if a patient does not get a CT Scan by 10pm. It is 6pm and I’m going home now.
  8. Site Manager
    I wonder what medical and nursing levels are tonight.
  9. Director of Operations and Workforce
    I wonder if we are deploying the right skill mix of doctors, nurses, physics, occupational therapists. Are we matching the clinical services to clinical need?
  10. Medical and Nursing Directors
    I really need to understand if we are providing safe enough levels of care in our hospital all the time. I need live up-to-date information. I hear concerns all the time but I do not have any data to backup it up to guide decision-making and strategy.
  11. Chief Executive and Financial Director
    The Workforce is our most valuable and expensive resource and patients are the focus of our organisation. I have never had an objective way to bring these two together.

This is a problem

Speak to any nurse, ward doctor, lab technicians, GP or patient (or relative). This is a problem. I have been to 4 NHS Hackdays now and spoken to others attending other health IT events and the following are recurring themes.

  • Bleep Bleep – The problem with intra-hospital communication between professionals
  • Patient Lists – Making Information to the right person as the right time and keeping track of patients
  • Notifications – Making sure important information get to the right person
  • Task Management Software – Making sure things get done 24 hours a day
  • Rota Management Software – Management staffing, leave, ensuring the right skill mix
  • Medical and Nursing Handover Software – Making sure things get done and right information gets transferred (I actually see this as an amalgamation of patient list + task management software)

SAS – The Vital piece of IT infrastructure that is missing

Imagine a hospital EPR running without a PAS (patient administration system) system.

That’s essentially the situation now with managing staff in hospitals. Let’s call this system the Staff Administration System (SAS) for now; I know this is not a great name!

Like a PAS, SAS will form the backbone to any application that requires coordination or communication between staff. For example, a lab system will just have to send a message out a notification application that says, ‘please inform the junior doctor looking after a particular patient about this result.’ The notification system will then query the SAS to find out the right person(s) to send the notification on.

It will be system to let’s every other system know, who is on duty and when, what their grade and skill sets are. For example a rota management system will use data from this system to ensure that there is someone on duty on all time that can perform a cardiac pacemaker or chest drain in an emergency out of hours situation.

Without a SAS every piece of software that does any form of staff management will require its own database that is not coordinated with any other. This is not sustainable nor safe in the long run.

It is not just about the IT

A SAS is not going improve the care coordination for people do not change the way they work. A SAS will require people to login to work and logoff. It will require staff nurses to assign themselves to a particular patient. It requires teams to clearly define their roles and ensure that it is recorded electronically.

Imagine what things could be like

  1. Patient
    Who is the junior doctor looking after me at this moment in time? Who is my nurse? Who is my Physio?
    > I can just look this up on my Patient Information System. It is reassuring to know the names and faces of the people overseeing my care.
  2. Radiologist
    I am reporting a CT Scan on Mr Some Body. There is something not right here, I need to speak to the doctors looking at this patient now. Who is it? How I can make contact?
    > I’ll just click this button on my radiology information system and it will contact the doctor in charge of the patient now and we are connected!
  3. Haematologist
    I have some really abnormal blood results for Mr Some Body. I need to tell someone in charge of this patient’s care, but I do not know who it is? The contact number on the form is not working.
    > Same as no.2
  4. GP
    I have a vital piece of information I need communicate to the doctors looking after my patient, but I don’t even know where to start.
    > I can just login into my portal in my local hospital and click contact the team 
  5. Nurse
    I need a doctor to see this patient as she is in pain. Doctors change around all the time and it’s 530pm already, who should I call?
    > I just click ‘contact the doctor’. 
  6. Patient relative
    I want to tell the physiotherapist something really important about my dad to help discharge. I do not know who to get in touch with.
    > Log in to Patient Portal.. Contact my physiotherapist… Done
  7. Ward Junior Doctor
    I want whoever is taking over my shift to be notified if a patient does not get a CT Scan by 10pm. It is 6pm and I’m going home now.
    > Add a task linked to the patient record to send a notification to the whoever the looking after that patient at 10pm. 
  8. Site Manager
    I wonder what medical and nursing levels are tonight.
    > Let me just look at the dashboard to see the live staffing levels linked to live patient levels.
  9. Director of Operations and Workforce
    I wonder if we are deploying the right skill mix of doctors, nurses, physics, occupational therapists. Are we matching the clinical services to clinical need?
    > Another dashboard? 
  10. Medical and Nursing Directors
    I really need to understand if we are providing safe enough levels of care in our hospital all the time. I need live up-to-date information. I hear concerns all the time but I do not have any data to backup it up to guide decision-making and strategy.
    > I can finally target the training requirements of my staff. I can finally have some data on staffing that I can link to patient level data to try to understand the link between patient care and staffing. This was not possible before.
  11. Chief Executive and Financial Director
    The Workforce is our most valuable and expensive resource and patients are the focus of our organisation. I have never had an objective way to bring these two together.
    > We are not going to able to increase efficiency and quality without changing the way we work. We need to re-design pathways of care and get people working better together as a time. I want to use IT to make this happen. Current IT system don’t understand or manage our most expensive and valuable resource. 

This must happen

IT is only an enabler of new innovative processes for care delivery. Healthcare staff are the key and most important components to these processes. He can we design patient pathways and have no way of digitally representing the staff members that are key components of that pathway. Without this, how can we move forward?

What can YOU do about it?

  1. NHS Trusts. Build your own and share it – Currently NHS England are making funds for projects just like this. I ask that you run it as an open source project and share your learnings and code with others. Make sure you truly understand the care delivery process and reflect it in the design and data structure.
  2. Software Vendors: Build it, make sure it is interoperable with open APIs. Run it as an open source project. Sell it as a service. This will encourage uptake and constant improve to it. Partner with an NHS Trust and work together and access the £260 million fund.

Let me know what you think. Are people addressing this already?

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Why NHS hospitals don’t utilise modern telecommunication technologies. A response to Prof Jonathan Kay, CCIO, NHS Commissioning Board

Professor Jonathan Kay, CCIO for the NHS Commissioning Boards asks on this NHS Hackday Google Group thread:  why so few NHS hospitals utilise modern telecommunication technologies such as the mobile phone, SMS to improve communications within and between medical teams.

Below are my observations:-

  • Communication and care coordination within the hospital is not on the radar on most hospital’s IM&T strategy: PAS, PACS, Electronic Prescribing, Clinical Correspondence (incl. discharge summaries), Clinical Notation (incl. Bedside observations) are.
  • Internal referrals and internal communication is often a problem for junior doctors and nurses on the frontline, who often do not have a seat at the table when it comes to influencing organisational strategy. We are the silent and transitionary workforce (junior docs).
  • Revolutionising communication requires investment on new platforms such as smartphones and other mobiles devices and staff skilled to manage their deployment on a large scale. (I’m not referring to Blackberrys that are relatively simple).
  • Due to points above there aren’t many people selling solutions. Those that exist require both a hardware and software investment. And often, the hardware is tied to the software instead of treating the hardware as a platform, a general purpose computer, that enables all sorts of other possibilities. Examples of this includes things like Wardware, VitalPAC, and various handover software.

I’m waiting for a forward thinking organisation to tackle the issues of intra-hospital communication head-on to solve the bleep bleep (pagers), patient list and guidelines at point-of-care problem that have been discussed in great detail on the NHS Hackday Google Group and on a series of podcast that a few of us junior doctors record: http://thedigitaldoc.co.uk/podcasts

In conclusion, the people that decides how the money is spent is blind to the problem -> resources are not allocated -> No one  steps forward to offer solutions.