Paul Gruszka:

Because Nursing staff know the business.

Nurses generally aren't all that savvy when it comes to technology. They are also known to treat medical devices like dirt!


I have a psychological theory that intellect and empathy tend to counterbalance each other like a see-saw. Nursing is (traditionally) a career that requires people with a high level of empathy which means, if my theory is true, that a high proportion of nurses have weaker than average levels of intellect that explains why so many aren't savvy when it comes to technology. I have joked that nurse syndrome is the inverse condition of Asperger syndrome.


Medical engineering staff in the NHS are often underrated, undervalued, marginalised, invisible to the public and politicians, excluded from decision making, not factored into decisions made by management and medics, and there usually aren't enough of them. Winston Churchill once quoted that engineers should be on tap, not on top. However, considering the advances in medical devices and IT in hospitals then is it high time that technical minds were allowed to get on top?


If there is a conflict between the interests of nurses and the interests of engineers then should nurses always win?

I wrote a really long reply here, then I changed my mind.  For all the relevant commentary that you need to read on the NHS go buy a copy of “This is Going to Hurt” by Adam Kay.  As you read it try and think about how well the author might function if you added responsibility for procurement and delivery of highly complex technical solutions to his existing workload.  Put simply, I would opine that individuals who are, by their very nature, predisposed to help others by putting-up with a never-ending cycle of sleep deprivation and other people’s bodily fluids/waste products are highly unlikely to be either suited to and/or interested in the non-bio side of science.  In fact, I would go as far as saying anyone that was should be scrutinised very, very carefully.

From the US view point Nurses are a significant part of the healthcare system.


We have a higher level nurse called an ARNP-x (where for example x =C which means they specialize in Cardiology).


Many states allow them to practice without a doctor oversight, including creating scripts for medicines.


This solves the problem of doctor shortages.


I have found that many ARNP, (having previously worked for years in hospitals), have a much better knowledge base than doctors.


By the way there are many male nurses in the US, many were previously in the Armed forces.


Peter Brooks MIET

Palm Bay Florida USA

I am in weekly contact with a doctor who works in a NHS hospital and he develops new "plumbing" systems to improves safety in his ICU.


Peter Brooks MIET

Palm Bay Florida USA

I believe some are doing the many NHS staff a dis-service in comments about adopting and using technology. I believe past experiences of 'having technology imposed and one to them without consultation and involvement in the concept and design phase (customer-centric design and development) has manifested many of the technology project failures and rejection. A technological evolution/revolution in healthcare has already begun in parts of the NHS and the wider healthcare sector, needs to spread wider and deeper, but in a way that is empathetic and inclusive. This medical technology evolution needs to build on examples of technology insertion best practice and success cases, to find the win win scenario so that technology is seen as adding value and benefit, not a threat and replicating an inefficient manual system. 
https://digitalsurgery.com/2018/05/21/a-technological-revolution-in-healthcare/ 


This statement in the article above resinated with me "Because of the confusion that VR/AR and AI cause physicians and administrators, they will require intrepid entrepreneurs who are fluent in both technology and medicine to meld these worlds in order to find the most useful applications for these emerging technologies." 


Perhaps technologists need to use less 'geek speak' and engage using the vocabulary of their customers to gain credibility and their confidence, then perhaps technology will become more acceptable and designed better for the NHS?  https://www.health.org.uk/publications/nhs-at-70-what-will-new-technology-mean-for-the-nhs-and-its-patients


Telemedicine, GP appointments by Skype, personal body-worn medical monitoring, auto-blood condition monitoring and treatment, MRI scanners, keyhole surgery, etc, etc are all part of the adoption of technology. However, these are all stovepipe approaches, not within a system-of-systems strategy and technology architecture. Thus, perhaps technologists need to better understand the requirements and needs of their customers before offering and designing systems without user input, and using a spiral evolution approach starting with small quick wins to bud confidence then evolving based on increasing confidence and evidence of value added and cost benefit.  


If the UK military and support to medical centres in conflict zones can use technology to provide remote tele-medicine to battlefield hospitals, it shows the enormous benefits technology can provide, its just a case of how to implement this across the NHS.  https://www.thetimes.co.uk/article/dr-waheed-arian-saving-afghan-lives-over-the-phone-dxknlql9s


With an increasing cradle to grave care customer base, more ageing people with more complex multiple-illnesses, a population increasingly impacted by childhood to pensioner lifestyle issues, the cumulative impact of our food sector, more sedentary lifestyles, etc, etc, the burden is increasing on flat lining technology investment. If the UK healthcare system is not to collapse under the current very manual and low technology healthcare approach, it needs to urgently embrace many of, or similar, current and new technologies we all routinely take for granted at home and work.


As I first commented, why does it take 4 hours to have a high priority emergency actioned in A&E and not use data provided by technology from another part of the healthcare system?


If I can access my personal media, my home, and work information anywhere in the world, why is it so difficult to provide a simple corporate UK healthcare IT system that allows me to walk into any GP, walk-in clinic, A&E department, hospital ward, optician, dentist, etc, and have my medical records instantly and securely available and updated anywhere in the UK, or even the world? Why do I have to waste the time of my GP staff to routinely monitor my bloods, urine, blood pressure, diet, weight, etc, when I can already buy devices that can be 'smart linked' for use at home and accessible remotely? We need to push routine healthcare monitoring, support and intervention out of hospitals to the community care and patients supported by effective technology support that is linked to the UK healthcare system for monitoring and intervention as needed. This will allow hospitals and specialist units to focus on the non-routine and more serious interventions supported by effective technology, personal medical data and smart data to make the 'entrance to exit' journey faster, safer, smarter, more effective, audited and transparent. 


However, we need to understand the barriers to evolution and technology acceptance and NHS staff concerns and turn negative attitude resistance into positive attitude embracement. More technology does not mean less staff, more technology and same, but more effective, staff means a better chance of dealing with the ever growing national NHS population care burden.


The other side of this two-edged sword is that a more technological NHS needs to be supported by cost effective medical technology solutions - whilst we often ask "why are drugs so expensive" and conclude (and there is evidence) the Pharma industry is ripping off the NHS, why is medical technology so expensive?

Peter, excellent point, the UK has a large cadre of 'combat medics' trained for Iraq and Afghan ops, are we using these to maximum benefit as police, fire and medical first responders, paramedics, nurse practitioners, etc to bring invaluable experience and knowledge into inner city hospitals, road traffic and industrial accidents, etc ?
https://www.jems.com/articles/print/volume-41/issue-5/features/real-time-medical-communication-revolutionizes-treatment-and-transport-in-florida.html

Regarding the use of Artificial Intelligence (AI) and machine learning in healthcare- Recently there have been some spectacular failures with the IBM Watson system due to bias during the learning phase.


The human race is not homogeneous and what is applicable to people of North European ancestry does not necessarily apply to people from Asia-- In some technical areas this is referred to as the "Black Swan" effect.


Also obviously differences exists between male and female subjects, or between young and old populations.


Peter Brooks MIET

Palm Bay Florida USA

Whilst a little long, I found this article, especially Table 3, outlines the challenges with introducing technology in the medical world
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686128/ 


Also, an interesting article on how technology could help the NHS if implemented properly
https://www.health.org.uk/sites/default/files/NHS-70-What-will-new-technology-mean-for-the-NHS.pdf 


Perhaps the NHS requires a Smart Medical Technology Introduction Unit made up of medical and technology experts to support front line staff and management design, develop and embrace technology where it makes sense and adds value?

so firstly the statememt "Is technology killing the NHS" is incorrect ! even where it might be having some sort of negative impact saying it is kiiling the NHS is simply just an attempt to grab peoples attention. Instead of making "sensationalist statements like this one" lets look at some evidence.

The KIngs Fund say that Technology has helped the NHS in a number of ways:

• providing and storing information and advice

• administration and transactions – eg, making appointments

• diagnosis – making diagnostic technology available to the consumer

• monitoring – particularly helpful in an ageing population

• relationships – improving communication between the patient, carers and professionals.

The NHS is a cherished and vital institution across the UK - the average life expectancy has increased by 10 years since its introduction – yet it is under intense and increasing pressure.

Occasionally, referrals take longer than necessary, letters don’t arrive, or waiting times are greater than expected.

But this could all be about to change with the introduction of a number of tech innovations that should lead to a more personalised, improved experience for patients, thanks to a new partnership with leading communications company BT.

 

Personal access to health records

In a partnership between the NHS Islington Clinical Commissioning Group and Islington Council , more than 200,000 people will be given direct access to their health records via a digital database early next year.

The initiative is also likely to have a major impact on the way referrals are managed. The current referral process works on a national basis by the local GP writing a letter to a Specialist at an Acute Hospital, who would in turn write a further letter to the patient offering them an appointment. The new system will digitise this process, making it more efficient and streamlined.

Improving the bed blocking challenge

Another big problem for the NHS is what’s known as “bed blocking”. This happens when people are admitted to hospital for a particular issue, which is treated and resolved.

But because they still require some care or monitoring, they’re not discharged, so they stay in the hospital longer than necessary. Assisted Living technology is helping to solve this problem.

Through the use of wearable technology, such as a push button, or fall sensors and alarm pendants worn around the neck, patients can safely go back to their own homes, rather than staying in hospital longer than necessary. This can also be applied to individuals with long-term health conditions, such as diabetes or heart disease.

An individual may have specific health-monitoring equipment at home, which links up to a device that can send the information to a contact centre or a local care authority

For example, a diabetes patient could test their blood sugar at home and the information could be sent to their doctor. This means that if their blood sugar levels are getting to a position where they’re going to become problematic, they could receive a visit or a call to ensure the necessary precautions are taken to prevent further complications.

Less repetition for patients

Currently individuals are having to tell their story over and over again every time they come into contact with a new department, which can be frustrating and upsetting.

BT and their partner Total Mobile have created a service allowing healthcare professionals to work remotely - taking notes and accessing patient information on-the-go.

The Personalised Care Strategy from NHS Digital is all about embracing increasing technology and digital transformation to improve care for patients be it diagnostic, treatment or care in the community.


Technology is not the answer to everything and it's use comes with significant caveats - to say it is killing the NHS is just misguided. The key points according to The Health Foundation are:

Regarding the problems of introducing new (expensive) technology into hospitals I don't think it is any different from experiences within high tech industries.


I worked in integrated circuit manufacturing for over 35 years and experienced first hand, significant changes nearly every year. Some changes were smooth and some very difficult.


In the US in order to get a major procedure up and running (example the Da Vinci robotic system) a local hospital will borrow a doctor from a major center (example major Cancer hospital) for a couple of years to provide "hands on" training of  local doctors on it's operation.


Peter Brooks MIET

Palm Bay, Florida USA