Discipline Hopping into Healthcare

Lead Research Organisation: Swansea University
Department Name: College of Science

Abstract

Healthcare IT (HIT) is recognised internationally as a vexing problem: computers ought to help hospitals and healthcare, yet healthcare is complex and computerisation to date has been disappointing, with even large national projects having poor or mixed results. Patient-centred healthcare and patient safety are obvious goals, but these high-level goals are very hard to translate into evidence-based requirements for system specification. The recent Berwick Report (August 2013), which may transform the NHS, does not mention computers or IT at all. At the same time pure technological imperatives like WiFi, the Cloud, tablet computers, mobile apps, social media, and so on drive piece-meal innovation.

The lack of technical integration, the race to keep up (e.g., to computerise existing patient records), the difficulty of applying international standards, the problems of regulation, to say nothing of the tiny scientific literature, all highlight the dire lack of evidence-based, informed thinking, particularly from the computer science perspective.

Harold Thimbleby is a leading researcher starting to cross the boundaries between computer science and healthcare, with a particular interest in human-computer interaction and patient safety. With a strong background in computer science, this Discipline Hopping Award would support his immersion in leading international healthcare environments.

Unlike a simple sabbatical, the EPSRC Discipline Hopping scheme permits a level of resourcing to leverage significant activities, including leading national and international collaborations, as well as running proactive workshops to enhance impact - hence drawing others into the benefits of the planned programme of activities.

The main host institutions are: John Hopkins University Hospital (USA), the Royal College of Physicians (London) - in particular the Future Hospital Commission and Health Information Unit - and the Abertawe Bro Morgannwg University Health Board, a large UK NHS organisation with 0.5M patients.*

Additionally, visits to leading international experts at the University of Pennsylvania and the University of Kentucky are planned (they are conveniently close to John Hopkins University Hospital). Since healthcare is notoriously complex, care has been taken not to embed into just one example, but to learn across a variety of contexts.

Thimbleby's work has already been recognised by the award of honorary fellowships at the Royal College of Physicians and the Royal College of Physicians Edinburgh, but he lacks depth in clinical experience and understanding. The aim, then, of this Discipline Hopping Award is to embed into leading healthcare environments, and to build lasting working relationships with clinicians both worldwide and in the local NHS Health Board.

--------

* Note: The ABMU Health Board is responsible for delivering all healthcare services within the large geographical area around Swansea, with broader responsibilities than in the system familiar in England. It has 4 acute hospitals; community hospitals, health centres, clinics, primary care resource centres, forensic mental health services, learning disability services, and services delivered to patients' homes. It has over 300 GP, 275 dentist, 125 community pharmacy and 60 optometry premises. See http://www.wales.nhs.uk/nhswalesaboutus/structure

Planned Impact

In the long run, Thimbleby's research programme (of which this Discipline Hop is a major step) is motivated by improving patient outcomes and patient safety through improved ICT systems. Improving ICT in healthcare requires a deep understanding of the complexities of healthcare, hence the Discipline Hop. The Discipline Hop is seen as part of a larger ambitious research programme, providing authoritative knowledge and experience that will lead to rigorous and well-informed research with significant impacts in healthcare.

The key impact is of course the Discipline Hop itself, learning new skills and understanding from proactive and diverse engagement with healthcare; and in turn, using the collaborations and connections supported by the EPSRC Hop programme to forge long-lasting relationships, leading to research, insights, and innovation, as well as a unique understanding of how to achieve change - actual impact from the research.

The Discipline Hop includes workshops to broaden the impact beyond just specifically planned 1:1 connections.

National Importance

Healthcare, and modern healthcare appropriately integrated with and supported by ICT, is a national priority, and in fact is a recognised international challenge.

Work in this area is of recognised national importance, and will help contribute to future UK economic success by combinations of:

1. Enabling new and more effective, safer product design.

2. By helping the NHS save costs and improve patient safety.

3. By contributing to research disciplines such as HCI, which historically has had limited direct contact with healthcare (particularly in hospitals) due to ethical and time considerations.

4. By increasing reach. The problems of the NHS are almost overwhelming and complicated (e.g., because of political and funding agendas), so an important part of this Discipline Hop is engagement with international healthcare (represented here by the USA).

5. By working closely with the Royal College of Physicians (RCP), to obtain a high-level strategic view of the activities, and their context within the political structures of the NHS - both up (to the Government Department of Health) and down (to the computerisation of individual trusts and hospitals, etc).

6. Working closely with the RCP Future Hospital Commission, in particular by critiquing and expanding its view with contributions grounded in leading Computer Science. Since ICT is going to be a major part of any future hospitals, this authoritative and 'hands on' contribution will be nationally important. The close face-to-face dialogue to achieve this, as the Discipline Hop allows (rather than the usual textual submission) will significantly enhance its value, both to the RCP and to the PI.

7. The Discipline Hop will considerably strengthen the unique world-leading research activity (including areas of niche capability) that fits with and complements other UK research already funded in the area and related areas, including our EPSRC Programme Grant (CHI+MED - http://www.chi-med.ac.uk - EP/G059063/1) and the ongoing EPSRC Multidisciplinary Assessment of Technology Centre for Healthcare (Match - http://www.match.ac.uk - EP/F063822/1), etc.

6. Professionally facilitated workshops are included in this Discipline Hop to help build up the UK Health IT community; i.e., to ensure this proposal's impact is broader than to just the personal benefits of the Discipline Hop for the PI, facilitating cross-disciplinary and academic/healthcare/NHS interaction much more broadly.

Publications

10 25 50
publication icon
Li Y (2014) Hot cheese: a processed Swiss cheese model. in The journal of the Royal College of Physicians of Edinburgh

publication icon
Thimbleby H (2015) Making healthcare safer by understanding, designing and buying better IT. in Clinical medicine (London, England)

publication icon
Thimbleby H (2017) Interactive numerals. in Royal Society open science

publication icon
Thimbleby H (2015) Safer User Interfaces: A Case Study in Improving Number Entry in IEEE Transactions on Software Engineering

publication icon
Thimbleby H (2014) Processing storage and display of physiological measurements in Anaesthesia & Intensive Care Medicine

publication icon
Thimbleby H (2015) Unreliable numbers: error and harm induced by bad design can be reduced by better design. in Journal of the Royal Society, Interface

 
Description I worked very closely with the Royal College of Physicians and three NHS health trusts on healthcare IT issues. Coincidentally I was also an expert witness in a large NHS IT criminal case, and I saw a lot of the messy detail that is often glossed over.

IT is often seen as a 'quick fix' for healthcare problems, however all examples studied over this project showed that managing healthcare IT is crucial - and often overlooked. There must be an alignment between IT and healthcare, and both, generally, need to change. IT needs to improve, but also IT - improved or not - will not solve healthcare's problems unless healthcare itself matures.

We have published several papers on key research outcomes in Royal Society journals; these are documented wherever ResearchFish permits me to.

Similar problems beset medical apps, not just conventional healthcare IT.
Exploitation Route Much more care needs to be taken over IT (and medical device) procurement, particularly ensuring dependability and safety are properly assessed.
Sectors Healthcare

URL http://www.harold.thimbleby.net
 
Description Incident reporting in the ABMU Health Trust (and Princess of Wales Hospital in particular) has improved, and is now reporting more system problems, as opposed to patient harms. System problems can generally be fixed before harm is caused, so this is an improvement. I have helped the RCP obtain several research grants from the National Information Board (on personal health records (PHRs) and on medical apps).
First Year Of Impact 2016
Sector Healthcare
Impact Types Policy & public services

 
Description Expert witnessing for Princess of Wales
Geographic Reach Europe 
Policy Influence Type Influenced training of practitioners or researchers
Impact I was an expert witness in a large criminal case in the NHS, involving analysing gigabytes of data about alleged misuse of glucometers. My work resulted in the case collapsing (i.e., I proved the evidence was unreliable), and the release of two nurses who had otherwise faced custodial sentences. There is now on-going work with the health trust to learn lessons.
 
Description Working on patient safety and incident reporting
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Working with Princess of Wales hospital following a perventable fatality, incorrectly reported, to improve safety culture.
 
Description Royal College of Physicians 
Organisation Royal College of Physicians of London
Department Health Informatics Unit
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution The Health Informatics Unit has appointed me an Expert Advisor, and are now paying my travel costs.
Collaborator Contribution I have high-level access at the top of the UK clinical environment, with direct contact with statutory bodies like MHRA, DoH, etc, as well as with leading clinicians.
Impact We have collaborated on papers which will appear in Clinical Medicine, and we are writing guidance for all physicians on correct and safe use of medical apps, which the MHRA is collaborating with.
Start Year 2013
 
Description Expert advisor in IT for the Royal College of Physicians 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Made expert advisor in IT to the Royal College of Physicians
Year(s) Of Engagement Activity 2015