EHI Live

Being keen about tech, when I was invited to EHI Live, Birmingham 2014 - I thought why not, I was keen to see what the state of tech in healthcare is at one of these trade shows. 

The theme of the event was two fold, showcasing the latest in EHR platforms and the latest tech approaches for better care. As someone relatively new the challenges of clinical work, it was interesting to see the barriers to implementing change.

CCIO is a group of clinical technology leaders aiming to steer the NHS towards a more connected and usable environment. Dr Joe McDonald spoke about UX and how is a patient safety factor, as professionals time and ultimately stress can be so influenced by the tech systems used daily. This is something I passionately believe in, so it was great it got a mention as one his visions for the future.

One of the most enjoyable presentations was from Iain Hennesy, Alderhey Hospital (Liverpool) as he laid out their vision of better care. Since Alderhey is being completely rebuilt this presented the opportunity to have the newest technology at its heart. I appreciate this event is rare as purse strings tighten, but it was the approach and set up which made the story compelling. The Hospital staff, including management, have bought into a culture of innovation and improvement of services. This has resulted in a disused ward becoming a centre of innovation, support from management and the resources to turn ideas into reality. The results are staggering in their potential, it will be fantastic to follow their progress. The concept of multidisciplinary working was also core value, as he described "hot housing" which is much like a focused hack event.  

The barriers to this are obvious in time, money and access to resources. Overcoming any of these, requires support, dedicated time and an understanding  of the real needs to be addressed. This forms part of the core values to many new start ups strive to abide by, and many do. The pressures for a large organisation to balance costs are huge (non more so in the NHS!) but arguably the potential benefits in efficiency savings and staff morale outweigh this? Taking that leap of faith will dictate the success and failures of health systems to evolve. I believe passionately that giving staff the power to bring their ideas to life is both smart in using their experience and great to foster ownership at work. 

The conference as a whole, it was really interesting to see the themes of Usability, multidisciplinary collaboration and agile testing. These came through in the speakers and in the clinicians/innovators I spoke to at the event. It was great to meet you! As the internet of things matures, and technology moves forward the hospital of the future will be exciting if the opportunities remain to invent. Something I definitely want to be a part of. 

#Heforshe

If you haven't watched Emma Watson speak at the UN here it is: http://youtu.be/Q0Dg226G2Z8  well worth a watch. 

Apart from being a very well delivered speech (despite the obvious nerves - fair enough) its a great cause. Everywhere in the world there is some form of gender inequality from a bygone age where discrimination on look or type was the in thing. 

In my working life, I can't imagine any benefit at all to gender stereotypes in medicine, but its still there. Male nurses and the growing number of female doctors rightly climbing the hierarchies still dominated by guys. 

#Heforshe is a great idea and definitely one to be promoted in the NHS.

Welcome to the real world

Black Wednesday has been and gone - I am still here! 

For all the preparation given to you at medical school, (5 years of cannulating fake arms and saying the alphabet (only to E) in your sleep) there is still a difference when doing it for real. My first shift, I was lucky to have another doctor in the same position to bounce off - we needed it. One arrest and a very slow/less than slick ward round later we had survived our first day and only left 2 hrs late - result! 

Having a pretty difficult first day has it's pro's (can't get much worse) and con's  (many expletives) but it was hands down the most I have ever learnt squished into 11 hours. Any arrest is a challenging and brutal experience in trying to bring someone back from the brink. When the words of "doctor, come now there is an arrest" get uttered I did actually look around and wonder which doctor they were speaking to...yeah I was included.

First thing I learnt is that fortunately you are never alone, the nursing team looked like they had done it 100 times before. The senior reg was able to be the Master of Ceremonies and allocated access and bloods to the new startled rabbits (new doctors).

Second thing I learnt is that even the simplest of tasks really are the hardest thing ever under pressure. That thing called human factors, - the thing that is subjective and almost touchy feely - defined how well the team performed and how I almost failed to label a bottle. Being familiar with people, environment and what you are doing means that you can concentrate on performing at your best. Essentially:

  • the nurses save you, get to know them well
  • practice makes perfect
  • the job will get easier when you are used to how things work

Finally I also learnt that always go back to basics, it is so easy to get caught out and make an error. Being pulled in twenty different directions when doing tasks can be tough to give tasks your full focus, I have been lucky that any slip up hasn't dire consequences. 

Relocating or up rooting

I have moved 300 miles to relocate for starting in my first (permanent) job, I now fully realise why they say moving is one of the most stressful life events you can do. If packing and unpacking isn't laborious enough, the inevitable cleaning that comes with moving into a new property, all make for a very tired new graduate fresh from celebrating. 

Of course I am not alone, the class of 2014 are all starting posts in the next few weeks - so called black Wednesday. The confidence is in the name. Shadowing is definitely the way forward to familiarise yourself with the job.

Making the jump from student to doctor is a daunting one, but you get through with a little (lot) of help from friends/colleagues/nurses. It's never just the jump in responsibility, the equipment, hospital, people, flat and basically everything is new and weird. Perhaps it's no real surprise doctors need support when starting! I think it's great more emphasis has been given to supporting new staff, it would be great to see new and emerging technologies being put to good use. Some of the ones I like are:

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 #tipsfornewdocs is both entertaining and useful covering lots of silly little things learnt the hard way.

 

 Induction App is a cool idea in centralising and crowdsourcing information about your new hospital -'with numbers/codes and useful info



Another new site...

I have made another new site, a seemingly constant turnover of webspace designs on this domain. Most have them have been just a big learning curve with me learning new skills and tools to use. Hopefully this will stay a while...we will see. 

As I move onto a new chapter as a working professional I am hoping my website will start to reflect my professional and personal interests. They will no doubt change as I go along, plus I do wonder how much I will feel like blogging following 13hr shifts. 

2012

How the hell did 12 months pass so quickly? It's been a pretty cool year for sport, drama and news - sure we will all be sick of the celebrity opinions! But I thought I would share my 2012: noun_project_618_256x256x32

From lectures to patients

This year my medical education made the step from endless lectures and tutorials, to being thrown into the clinical environment to put it all into context. Thinking back even to this time last year my learning couldn't have been more different. Now I'm finding my feet on the wards, and instead of chapters its patients that stand out in learning conditions - definitely preferred! I also became a phlebotomist, a part time vampire essentially, which has definitely made me more comfortable on the wards.

Embracing my inner geek

From developing my new website to simply finding new ways of keeping on top of work - I have let technology fill a big part of what I do. I use Evernote, penultimate, Paper and Dropbox as absolute staples with my iPad. My website has had a face lift, which reflects a big part of what I have learnt about design this year. Appreciating infographics, software and the work of friends (namely Mike Crabb) has really changed how I approach putting across information. Hopefully I can translate what I have learnt this year....well if it goes wrong I will have lots of daft pictures, not all bad! Following my research interests this year has been probably my highlight for me this year, I even had a think about the future. In a year where I presented in Boston, performed some seriously cool research and even got published - I couldn't ask for more! But the best thing is I have the research bug again, that seriously excited feeling you get when you try to find your answer. I have tried to explain it...the only analogy I can come up with is it must be pretty similar to James Mays fuzzy feeling in a nice car.

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Following my ideas

I have worked hard over the past 12 months on wardWatch with others in Dundee - what a learning curve. From a crazy idea I have watched my idea grow both in size and maturity with the help of the project team and many others offering advice. For all I probably have a few more grey hairs, it's extremely rewarding to take up the challenge and produce something that could genuinely be a game changer - watch this space in 2013.

Networking 101...by accident

From following ideas and making new ones I have also learnt about meeting new people, often by complete accident - the best kind! I have met some amazing people in Dundee and further afield, with some amazing ideas to boot. Dundee has an amazing wealth of enthusiasm, ideas and a willingness to collaborate that I'm still uncovering the more.

2013...what now?

All very well looking back on whats done - but really it's only worth anything with what's done in the future. I am pretty chuffed with what I have managed over the past 12 months, to be honest I had no idea how much I had done until I started wiriting this post. Coming up this year I have many more placements, hand ins, the scariest time in medical school - Finals and hopefully the best time with my elective. Needless to say I think it's gonna be a big year! On top of that with my wardWatch project still coming along, I'm hoping to Weirdly when I think back to this time last year I had no idea I would do half what I managed this year, makes this year pretty exciting really.

Ideas and networking

Today I had the pleasure of meeting a very enthusiastic clinician with some big ideas on how to improve on medical education. At the end of the conversation I was absolutely electric - which got me thinking

  these cool ideas, what makes them so good? How do you tell a great idea from a bad one?

 

This is a really subjective topic to think about but with clearly objective results...the scientist in me weeps.

That feeling you get when the light bulb flickers brighter is pretty infectious, using those little grey cells so to speak. Some fizzle out as quickly as they arrived, whilst others quickly cement themselves in your mind or others that this could be something worth pursuing.

The kind of ideas I am talking about are when you think of improving something you are involved or interested in. This need to improve your surroundings is what drives change, increases efficiency and ultimately produces new ideas. Your network - the people around you can be pretty influential - certainly in Dundee I am privileged to be around people I am sure have the ability to revolutionise their area. Furthermore - this network is being connected with this buzz for ideas.

Perhaps an idea itself is not what is special per se Perhaps its the making and production, the way you are able to hypothesise its own path, it grows arms and legs

The people you have around you, this network, is a dynamic entity - shaped by what drives individuals and what connects you together. I think the best ideas capture you, the like minded and ultimately the people it affects. The influence the idea has on these groups two way, it also has an effect on this thing that is the idea. If you have the right network around you, this idea turns from "thats cool" - to that speechless moment where you wonder why noone else has had this thought before.

A good teacher...ingredients list?

A good teacher can turn the hardest concepts into the seemingly effortless learning

Everyone has sat in lectures eyes drooping, getting comfy, wondering if the sound filling the room is the lecturer or air conditioning. On the other hand being sat in lectures where you instantly connect with the speaker, following concepts, thinking along the story and walking out wondering what all the fuss is about.

Teaching - current state of affairs?

Good, the bad and the ugly

Lectures - the bad

Most teaching these days is done by PowerPoint - death by bullet points
Essentially there are:

  • loads of slides - so much info you get lost
  • Lots of text - cant listen and read
  • Font tiny - straining eyes or just not bothering
  • (Often) No enthusiasm!

Tutorials - the ugly

Here is a mixed bag in my experience! Either it's a dry discussion, or there are a couple of people who have prepared and they do all the work. The facilitator may or may not know what's going on in the session and might know the answers away from the sheet but rarely expands on the topic.

The two scenarios above are extremes, and the majority aren't that bad. Unfortunately too many are! So what makes a good teacher?

The Good

Good teachers seem to have that connection, they walk in the room and or they start speaking and you are are drawn to what they say. Exactly what causes this is probably a few things such as confidence, charisma, but probably for me its a real enthusiasm for what they do.
If you have a teacher of any capacity pass on information in way that is infectious in its intensity and engagement its almost certain to make an imprint of some kind. Contrast that to the "teacher" who is monotone, forced into doing it as part of their job or by their seniors and its instantly a turn off.

What's you experience of a good teacher?

I can think of several personally - some lecturers, some just people I have met. All had a burning passion for their work, and whether they knew it or not, let it shine through in their delivery. In this day and age of powerpoint slides and screens, its easy to forget what really makes teaching - connecting with your audience however small. Interesting that with technology reaching further than ever before - we are also somehow so much more distant. A conundrum indeed.

Medical Technology...leaving out clinicans

Technology has a growing presence in medical life - some areas faster than others. Interestingly we now have laptops ridiculously thin, the internet allowing more information than ever before, and even recognising pictures taken on your phone - yet some clinical systems look like windows 98...why?

The first time I worked in a lab for a job it used a clinical system to log each sample recieved, it was actually the same interface as MSDOS...from the 1990's in 2010. It's like having a gramophone next to an iPod!

Clinical systems suffer from this emerging problem of a huge amount of data - that needs to be either put in or taken out or both. Take ordering a blood sample, with an ever expanding range of tests you can do it would become a pretty full ordering screen or long bit of paper to list them all! So what happens is to solve this problem systems have pages of multiple tick boxes and drop down menus...eye sore. Not only that its inefficient and off putting.

What I have described there is looking at it from solving the data problem - what about if we look at it another way? - a solution for the clinician

How about designing a system around how a medical professional needs to navigate the information. Imagine software that is designed around the most efficient and appealing way for someone to access key information relevant to them. Ok so it sounds like a corny ad.

Usability is something which is growing in its influence, it's a word that has been around for decades but only recently redefined in technology. If something is easy to use for the purpose it will be a success - such as the iPhone (yes apple fan boy alert). Although it was by no means the first, the iPhone demonstrated that ease of use really does make the difference between a good gadget and a great one.

What's the hold up?

Creating some thing usable is both expensive and time consuming - why go to the hassle when you get something that works at the moment?

If we could apply the same principles to medical technology the results could be drastic. In such a high pressure environment as a hospital, small gains in efficiency add up - even if its just to remove additional stress on staff.

Jobs showed the world that having something that "just works" can change the way we use technology. I think its time for medical software to be given the "iDevices" treatment, and place the needs of the user before making a system that is merely functional.

Patients, learning, stories

Let loose on the wards having been in psychiatry, general surgery, oncology, infectious diseases, neurosurgery and neurology. It's good to see patients and turn conditions learned in text books into a real clinical picture!

Seeing patients is what you remember, there are patient presentations that will stick around but more than that its also the stories.

Today I met a lovely chap referred to a neurology clinic with dysarthria (slurred speech), difficulty swallowing and a cough - all in all just not quite right. He gladly gave a good history and was examined. When he was asked about what might be wrong - he divulges using the bible that is Wikipedia for his symptoms.

He looked pretty sheepish telling the doctor this - which I think is interesting. In an age where we can google anything, it's no small wonder patients will use to it find out something as daunting as a "diagnosis". Now, this information wields a fair bit of power...and like power it can go two ways; either like Jeremy Clarkson - ending up in a cloud of smoke or the Stig navigating the same track in the same high powered car. Sorry for the poor Top Gear analogy

This chap actually took wikipedias finest diagnosis of Motor Neurone Disease and gave him something to think about. Credit to him, he just asked the consultant who said it was something to think about. He then explained he was the sole carer for his wife and it was good for him to plan ahead. I think he was a Stig, he left the room in good spirits and well informed.

With every Stig there is always a Clarkson. For example an MS patient, who has tried multiple treatments with not much success. They search for an alternative, any alternative to google! - and they stumble across an article singing praises of this new drug. When this is broached to their doctor they happily look it up, unfortunately its not licensed. After a lengthy submission on behalf of the patient under exceptional circumstances - it's declined. The patient is naturally crestfallen after built up hopes and leaves a sticky doctor patient relationship.

I really sympathise with patients looking for an answer - presented with a shiny high powered car it looks so hopeful. How do we stop patients heading for a "crash"? Well in short I don't think the medical profession can really - everyone can do what they like!

I think the Internet is fantastic - but is also a double edged sword. This new group of educated patients presents a new challenge in consultation skills. Dealing with the Clarksons and Stigs of the world is probably not going to come up in a communication skills session. However I think it's definitely food for thought next time you look up a medical condition on Wikipedia.

Keeping up online...

I think it's fair to say this website doesn't get much regular care and attention - keeping up with a constant stream of feeds, websites and news can be a bit too much. Take twitter for example, I actually really enjoy getting into conversations and meeting like-minded "tweeters" (notice how I didn't say twits...). The downside is that it can really eat into your time - and as soon as things get busy it's things like social media that are the first to go. I think it can be summed up as information overload, that and being permanently attached to a electronic device probably isn't entirely healthy. I think taking a break from all this information day in day out is a must even if you are really into all these pearls of wisdom floating your way. I took a big step back from everything social media for a few months over exams etc and actually coming back to it has been interesting. See when you load up something like twitter/FB/LinkedIn and you have a million notifications - it is SO off putting! It would be cool to have something that perhaps highlighted the cool bits and cut the rubbish. I am sure there are ways to do it successfully but I haven't found one that suits yet. There is probably much scope for further research into how web are so addicted to being online - Internet addicts anonymous anyone?

wardWatch

It's been a seriously busy few weeks with exams looming and getting myself involved involved in a new project called wardWatch Last weekend myself and 5 others went down to pitch the project down in Manchester and we won our category! I presented along with Mike Crabb. He was all chilled, I was so nervous! Being last didn't help...I have far too much chance to mull over the presentation and the atmosphere. It went ok though and we were well within time, when it can round to questions I was almost relaxed!

The conference itself was really useful for me to explore the business side of an idea, and also meet like minded people interested in healthcare innovation. It was a great experience to present at my first conference, I don't think I will forget it in a hurry. Funnily enough I think I almost over rehearsed for it, which is something I haven't come across before. Maybe next time I will wing it...