It's pretty shocking to hear that even in 2020 and even as the whole NHS battles to fight back the threat of COVID-19, there can be no reception or phone signal anywhere in a UK hospital. And if there is a signal, it can be so poor that time-pressed clinicians cannot call out, making it very trying to get hold of a colleague on another team for advice or exchange information.
Yes, if you have Wi-Fi you can use WhatsApp, NHS team members will tell you. But if you don't have a signal, the only option is to try and make contact via the hospital switchboard, where you sometimes have to wait in-line for 25 minutes. Frustrated at these limitations, some doctors have turned to specialist mobile apps instead.
Induction, for example, is a healthcare platform that claims to be helping over 140,000 clinicians (mostly doctors) combat just these communication and collaboration challenges. It does this by, it is claimed, allowing these specialist knowledge workers to increase their productivity and enhance their communication with colleagues by securely sharing clinical setting phone numbers and ‘bleeps' (a secure and real-time communication solution used in some parts of healthcare), online bookmarks, documents and messages.
The vendor operates in the UK, Ireland, Australia and South Africa, and indeed claims to be the number one healthcare collaboration app in the UK. The company's technology is underpinned by a data integration engine called HealthStream that reads and writes demographic, appointment and clinical record data from both national and global EHR (electronic healthcare record) platforms.
Apart from the main Induction app, the company also markets a patient portal called Zesty and MicroGuide, a way to provide medical organisations with the ability to collaboratively create, edit, and publish their own local medical guidelines in a secure and locally administered environment.
Intrigued by the productivity claims, we asked to speak to some actual real-world UK clinicians using the software on the front line. First up is a Clinical Fellow in Dermatology and Lymph vascular medicine, Dr Bernard Ho. For Ho, a major benefit is the fact that he can access colleagues more easily with the app than relying on his Trust's switchboard, as now he has "literally the hospital phonebook" in his hand.
He also claims that it allows clinicians to filter what is useful to make his jobs easier:
Because there is so much ‘red tape' in the NHS to get anything updated on the intranet, by the time it is updated, the information sometimes is already out of date. The app also allows you to use the same software whilst changing hospitals; given the frequency junior doctors change Trusts, this is definitely one constant that is appreciated.
Ho adds that his dermatology on-calls tend to be regional, so he covers several hospitals out of hours, but that the app lets him "easily contact" different wards directly when going from one hospital to another. He adds that he also sometimes gets queries about protocols and rather than having to wait to go back to a Trust computer to access a readily available PDF, he can do that then and there, allowing better time management.
10 minutes back per patient interaction?
Another convert to this way of accessing information in the NHS is Dr Christian Warner, an Academic Foundation doctor. Again, a key pay-off from the app is an accessible solution to the "bottleneck" of always having to go through a busy hospital switchboard to communicate with colleagues, something Warner says is a long-standing problem of hospital medicine:
There must be thousands of phone calls getting made every day between hospital departments to collaborate on patient care. Without an encyclopaedic memory or a ginormous home-made and printed table, that means you are forced to wait on hold for the switchboard to direct you to where you need to go. Instead, this app gives the user access to the hospital directory in their pocket when making referrals and chasing results, plus allows it to be curated and constantly updated by users.
And as Warner estimates that having instant access to the right number saves him a minimum of 15 seconds on every call, and sometimes 5-10 minutes, that's giving him back considerable time in his working day to do patient work. That's a benefit also noted by a Year 7 Specialist Trainee Registrar in Respiratory and General internal Medicine called Dr Daniel Trushell-Pottinger, who again likes the way that he doesn't have to bother his colleagues on the switchboard so much as he now has a list of hospital contact details allowing him to contact the person he needs to.
But this clinician has found it helpful at the start of the Coronavirus crisis, too, as additional functionality that came on-stream during the COVID-19 outbreak allowed his hospital to rapidly provide hospital guidelines and educational documents to medical staff in a mobile and easy-to-access format. Specifically, documents could be added and updated quickly, including up-to-date PHE/government guidance at a time, he states, when "it felt like advice was changing on a minute-by-minute basis". And as staff got reallocated from non-medical areas, they could have access to all hospital guidelines in one place, giving them the opportunity to refresh their knowledge on areas of medicine they may not have practiced for a while, he notes.
‘No-one ever writes it down’
Finally, we spoke with a London-based Ophthalmologist who preferred to withhold his name from publication. Interestingly, this specialist's perspective was less on time saved using the app as a phonebook or document sharing device, and more as a way to help new doctors fight information overload:
Every year we have new trainees and registrars joining our Trust, and there is a lot of information that they need to be provided with, much of which is not provided in a straightforward format. A lot of these processes are not documented so there is a lot of asking around ‘ How do I do this?' ‘What do I do for this?', and you go out and you learn, and you know by the end of the year… but no-one ever writes it down, so then the next cohort have to go through it all over again.
What this app has done is help me put that vast amount of information in one place that I can access on my phone and at home - particularly useful as a lot of people are working remotely now.
Last but not least, this doctor also told us about the struggle you can face in the NHS finding the information you need. Why: clinical guidance within Trusts are often "buried" in its intranet with millions of other documents and a newbie might not even know that guidance exists. Plus, when searching for specific documents, users need to search exactly the correct name in order for the document to appear, allowing no use of alternative spellings or acronyms.
But, they claim, the vendors have now started to make it possible for key clinical documents to be organised into searchable folders, while a new ‘review' function means there is a named person who gets contacted in a set number of time/months to review the documents and check it is up to date.