Future hospitals: IT

Arguably one of the biggest revolutions in recent decades is the introduction of computer systems and IT that can open up opportunities to streamline healthcare and marshall “big data”; or so we’re told! Afzal Chaudhry is Chief Medical Information Officer of the Cambridge University Hospitals NHS Foundation Trust, one of the first hospitals in the UK to go fully online and paperless. He spoke to Chris Smith...

Afzal - The implementation of hospital-wide electronic patient records are really able to bring benefits in a whole range of domains. If you think about ever increasing high quality care, then the properties of that are that care should be safe, timely, efficient, effective, it should be equitable. It should be patient centered and sustainable. And we know that technology is able to really help in all of those areas.

Chris - How? What does it do that we couldn't do with doctors' admittedly terrible handwriting and paper notes, like we had before?

Afzal - Increasingly medicine has become more and more complex, and there are a whole myriad of interactions that any given patient might have with their NHS in its widest sense. On a sort of daily basis, every 36 hours there are more than a million patient encounters with the NHS as a whole. We know that technology helps with safety. For example, supporting clinicians in making decisions. It can also help in terms of good prescribing, reducing unwanted variation, and it makes coordinated care much, much more straightforward.

Chris - They're very expensive these systems aren't they? The system that you've implemented at Addenbrooke's hospital did cost hundreds of millions. And in that sort of ballpark, you could employ large numbers of staff. So are they actually value for money?

Afzal - It is true that there's a cost to implementing these systems. In fact, the majority of the cost for us at Addenbrooke's was related to infrastructure, making sure that all of the computers were modern, that there was a hospital-wide wireless network and also a lot of work around device integration. So connecting all of our physiological monitors and ventilators to the electronic patient record system. But it is true that those systems do cost money. But the counter to that is that what we're doing with paper-based systems is also incredibly expensive. We used to employ a lot of staff who were managing the paper records, putting in the library, retrieving them. We know that paper records were on occasions lost, and that was really diminishing the quality of patient care. And we also know that across a whole range of domains, nurses, for example, were spending a lot of time trying to track down what it was that the doctors wanted to do, or transcribing information from one piece of paper to another piece of paper. And all of that when you multiply it across the domain of a single hospital and then across the NHS as a whole, is incredibly inefficient and expensive. So I would argue that the cost of not doing this is actually worse than the cost of doing it.

Chris - And Imran's point that actually we should be looking at AI - he's getting at using various ways of marshaling big data. Presumably having everything in one place electronically, very consistently and homogeneously recorded does make doing original research, follow up, side effect monitoring and so on, much easier.

Afzal - Absolutely. So even at Addenbrooke's, which is just one hospital, in any given month we're recording over 170,000 new diagnoses on our patients, about 3.8 million results on our patients. And what you can see is that consistency of data, that accuracy of data, the timeliness of it on a significant number of patients from routine clinical care is immensely valuable. The data, for example, from Israel related to COVID vaccination has proven to be really, really important. There's been one of the really early examples of the success of the vaccination programme. And that really relates to the fact that they have a strong, consistent model of recording information on every patient that's used for the betterment of all.

Chris - If I could write you a cheque that would buy you some wonderful equipment or IT infrastructure for the hospital of tomorrow, what can you not do at the moment that you wish you could?

Afzal - I think really what we want to do is to really invest in supporting our patients. So patient empowerment through transparency and access to their own data. I think remote monitoring of patients, whether in the hospital or at home to get a better understanding of both their physiological parameters and their day-to-day routine. Combined with that high volume of data that we get through consistency means that we'll be able to really move towards a position where we'll be able to deliver more personalised care for patients, based on their own activity, their own physiological parameters, their own clinical baseline. And that means we'll be able to detect disease at an earlier point in time. And that means that often the treatment will be more straightforward and more effective.