The Problem: Critical information management in health care

Rapid access to critical information is essential for an effective, professional health-care system. Traditional paper-based approaches fail to address this problem, which results in a time-sapping burden of complex information recording and retrieval that is open to possibly fatal errors.

Nurse’s do their best to deal with the current paper based systems that are incredibly still in widespread use in many health-care institutions. Handwritten text can often be illegible and physical copies of patient information must be laboriously moved around. In addition, inefficient telephone and bleeper systems are used for communicating simple messages – not only taking several hours to be passed along, but sometimes forgotten, or even lost altogether in the complex, high-pressure health-care environment.

Where digital systems are in place, the critical human-centred user interface receives scant attention. Software developers may have little understanding of the clinical environment and cognitive situation of users and, therefore, create a data-centred design. Such a design integrates well with databases, and not so well with human needs in a complex health-care system.

The Reaction: Understanding how information flow should work

We wanted to help health-care professionals communicate efficiently and effectively, ultimately freeing them to spend more time with patients in direct value-adding care. A successful two-year pilot project enabled us to gather information, develop and test a communications solution that can save up to 10% of nurses’ time.

Through a partnership with North Wales’ Betsi Cadwaladr University Health Board (BCUHB), we had access to two paediatric wards and three seconded nurses – essential for understanding nurse engagement and, subsequently, software testing.

We also received support from the health boards informatics project management function, which coordinated access to relevant teams across the health board (from nurses to chairperson), and across sector teams and disciplines.

We recognised the need for a paperless system that digitally captures information at point of creation, through an intuitive user interface that carefully considers cognitive situations in dynamic and stressful situations. Drawing on cognitive neuroscience, we created a user interface that takes into account the user’s cognitive situation to optimise the efficiency of information flow to and from the platform. Beyond the interface, all the technical complexities of managing and transporting secure digital information to wherever it’s needed are completely hidden from the users.

We successfully tested our system with NHS staff, in real-life situations.

The Solution: Cybernetic systems that serve human users

Our increasingly complex information-based world necessitates complex IT systems – however, we firmly believe such systems should serve human users and not, as so often has happens, force human users to serve the IT systems.

Our system, our Connected Healthcare Administrative Interface (CHAI™), was originally conceived through an ‘Innovate UK SBRI Challenge’ awarded to Astral Dynamics in 2014. In 2015, Astral created Elidir Health Ltd (Elidir) as a dedicated vehicle for CHAI™ commercialisation and development.

Central to our philosophy is recognising the human-ness of users, with all our human limitations. As such, we design systems that allow humans do what they do best, namely delivering human care; beyond the interface, information technology does the heavy lifting, seamlessly processing and transporting information behind the scenes.

In what we call our Connected approach, we consider the working consciousness of the health-care professional as the primary actor in a complex information ecosystem. The user interface is the boundary between the human actor and the technology components of the ecosystem. As data is digital, we can leverage the many benefits of information ubiquity and digital processing.

How CHAI™ makes nurses’ lives better

CHAI™ is basically a mobile front end to any electronic patient record, processing 80% of the most common interactions.

Unlike paper, inputted data can be instantly in colleagues’ hands (perhaps on the other side of the hospital), and data can be accessed from other IT systems, to eliminate repeated writing (such as the patient’s address) on various forms. The data can also include conversation threads about a patient, and an escalating system of alerts for doctor’s input, thus increasing patient safety.

The simple interface also allows nurses to make quick note of any tasks or reminders for their shift, and alerts nurses when tasks (such as taking observations) are overdue. This automatic notification of urgent tasks (as opposed to hastily written notes on scraps of paper) allows nurses to relax a little and spend better quality time with patients.

Nurses get the information they need, at the time they need it, and where they need it – generally at the patient’s bedside with the patient. Combined with their professional knowledge, the critical information allows nurses to improve the care for that patient.

CHAI™ bridges the gap between data information and knowledge in an easy-to- use, human-friendly system. The data is integrated with internal health-care systems, pushing and pulling data where appropriate.

Why CHAI™ is secure

In addition to being a human-friendly interface, CHAI™ provides essential accountability, with an audit log of every change made by every user to every piece of data. When things go wrong and data is involved, it’s critical to know what happened.

In addition, input of patient data is validated, with error messages warning when data input may contain errors.

From NFC based authentication to state-of-the-art secure software practices, CHAI™ takes care of security, ensuring patient data is accessible only by users involved in the patient’s care.

How CHAI™ works (the technical stuff)

CHAI™ is a modern, single page web application, built using the AngularJS framework. It runs in a large number of browsers. The application speaks to a Java backend, using the Dropwizard framework to provide a RESTful API and WebSocket interface over a PostgreSQL database. All actions are captured and stored using the ELK stack to create an audit trail with fast and customisable search.

CHAI™ integrates with other information stores using standard protocols. Our integration experts can integrate CHAI™ with any information source that provides an API, such as a PAS or LIMS system.