21 August 2016

Training for #shanenaz2016: GLENARM

You already know that I'm heading to Nazareth, the largest Arab town in Israel, in November. I'll be joining a fine group of folks cycling to raise money for the Paediatric Unit in Nazareth Hospital.

So today (21/8/2016) I did a training ride up to Glenarm in Co Antrim. The Antrim coastline is one of the most scenic in on the planet, and very accessible. Today's ride was up to Glenarm, the southernmost of the famous Nine Glens of Antrim, with its historic castle and harbour.

Here are a few Virtual Reality images from my trip - same as before - download them to your phone or tablet, and view with Google Cardboard. I think they came out pretty well - what do you think? A truly immersive Antrim Coast experience!

FILE 1: BALLYGALLY VIEW. Yes, Northern Ireland has some pretty variable weather, but it's precisely because of that weather that we can enjoy views like this!

FILE 2: GLENARM HARBOUR. A view over the foot bridge towards the harbour.


FILE 3. GLENARM MARINA 1. Little boats rocking in the gentle breeze.

FILE 4. GLENARM MARINA 2. They're still there and they're still rocking.

Please leave me a comment in the box below - I'd love to know how these make you feel.

Here's the Strava map for my journey - this is a lovely ride - do try it out.

And please sponsor my bike ride for Nazareth! Thanks :-)

17 August 2016

How the Clinical Note has to change

How not to do it.
Everything is wrong about this image of clinical noting in the digital age. White coats are an infection hazard. He's not bare below the elbow, presumably in a clinical area. The device is a big clunky useless piece of crap that's a pain to type on using this stylus. Why is he typing anyway?

So here is the problem. When Electronic Health Records were first designed, their job was to replace and carefully emulate what we had been doing with paper records. The concept was that the paper record was something of a Gold Standard, and our objective was to leverage the benefits of electronic onto this gold standard.

However, as Larry Weed pointed out FORTY FIVE YEARS AGO, there is a deep problem with the way we structure clinical records, and I'll be honest here - in my journeys around hospitals and clinics, and even in my own note-taking (even? Good grief!), our notes are not fit for purpose.

Here's a typical example of a note on a baby on day 3 in the Neonatal Unit (I've made this up, but if anything it's better than most): "Thanks for referral; Hx noted. D3. b38/40 twin 1. Other twin OK. bwt 3.21kg. Meconium at delivery, req resus. Resp now OK; off vent. NG feeds. Dysm features: hypertelorism, small mouth, crumpled ears, clinodactyly V, abn palmar creases, hypospadias. Suggestive of genetic syndrome. DNA for array. Will RV. Pls get clinical images & skel surv."

Now in the context of a busy NICU that's going to get buried in loads more clinical notes very quickly. If do that in an electronic system it's going to take me longer to type in (I could have scribbled that in half the time it took me to type it, even with the abbrevs), BUT again it's going to be lost in the load of other observations, consultations and notes that get added in.

As if that wasn't bad enough, just look at it - there's little structure to it. A computer is going to have to be pretty smart to parse even that highly lucid (in my opinion) text into something it can analyse or search on. It's free text. Furthermore there's a load of duplication there - much of that info is recorded elsewhere, similarly in free text. Maybe I've just jotted it down to persuade some lawyer some day that I've actually read the record (not necessarily understood the clinical case - those are different concepts).

So let's say we ditch the paper (YES!) and go digital - how do we change our practice and train doctors, nurses and AHPs to bring the clinical note up to date?

It's not an impossible task. For one thing, if we can crack the login/ID problem it should become easy to see who has made a note, and when (yes, we're supposed to sign and date/time all notes, but that is often missed, or people miss their IDs eg GMC number). It should also become easy to contact that individual through the secure EHR system. So in that area the clinical note is a good "stamp" to focus at least some clinical care around.

We surely don't need to repeat the basics - that should all be in a summary box every time we open that patient's EHR. But who curates that? How do we turn the mass of data that we generate into a coherent story that outlines the scenario relating to that patient, and that all the professionals AND the patient/family can group around and agree? Moreover, how do we turn that summary into something we can perhaps share with tertiary or supra-regional professionals outside our local (or in Northern Ireland's case, we hope) regional EHR?

And (critically) how do we ensure that electronic notes actually bring benefit, not just to the patient, but to the staff using the system? We need it to free up time. We need it to be a pleasure to use. But I feel that our approach to noting has shackled us to the past in such a way that we have lost sight of the purpose and function of The Clinical Record.

In the digital era we need to actually enter things manually to a computer as LITTLE AS POSSIBLE. Voice recognition is still pretty damn basic, but it's making headway. But my clinical note should be short and to the point. If I need to enter something quantitative I should be able to do that, but I'm not writing a legal document here. I want to construct a digital record that is dynamic and positively contributes to good clinical management and outcomes for my patient.

So like clunky tabs and white coats, perhaps the clinical note itself needs a major overhaul before we start replicating in electronic form the mistakes that Larry Weed pointed out to us all those years ago, but nevertheless persist in our training and practice.

12 August 2016

Virtual Northern Ireland

Have you ever wanted to visit Northern Ireland, but haven't got around to it yet? Now you can get a feel for it in #VR prior to booking your trip(s).

VR panorama: Waterfront Hall & Law Courts, Oxford St, Belfast. *Doesn't lead to Oxford.

I've been playing with Google CardboardCamera - an app that allows you to take 3D Virtual Reality pictures on your smartphone and view them with a Google Cardboard Viewer.

Anyway, the lovely people at VisitBelfast gave me one of their special viewers, produced for the new Belfast Go Explore VR app (check it out on Google Play or Apple Store), so in honour of the occasion, here are some of my own VR shots of Northern Ireland for your Virtual pleasure!

Simply download the file from the link (these are DropBox) - you should get a file ending in .vr.jpg - then add the file into a folder on your Android device called /DCIM/CardboardCamera and then launch the CardboardCamera app. It should automatically detect the files, and if you have a VR viewer such as the one above, you can be magically transported to a mystical world of wonder (i.e. Northern Ireland). Enjoy!

Let me know in the comments what you think of these, and don't forget to sponsor my cycle ride to Nazareth for the Paeds Department in Nazareth Hospital! Spread the word - thanks!