This is why I, a ‘Geeky Gynaecologist’ went to Harvard Medical School at the age of 53 to do a year-long Certificate in Safety, Quality, Informatics & Leadership. And why you need to keep learning too.
My inspiration to engage with disruption comes through raising two kids (now in their early twenties) and supporting their technological engagements, as by default I was the financier! As an accredited educationist, I believe in being a lifelong learner as well as a teacher. The area of my personal learning has varied according to what my scope of practice needed most from me. I had a four-year itch to add yet another accolade to my name. Patient Safety is the penultimate objective for any healthcare affiliate practitioner. The issue of safety in healthcare grabbed the media attention in recent decades after the publication of ‘To Err is Human: Building a Safer Health System’, the Institute of Medicine Quality of Health Care in America Committee’s first report in 1999. It was published with a background realization that at least 44,000 people, and perhaps as many as 98,000 people, die in U.S. hospitals each year because of medical errors that could have been prevented, according to estimates from two major studies. The report recognized errors were mostly caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. In 2000, the Chief Medical Officer (CMO) in the UK chaired an expert group to investigate patient safety in the NHS. The group’s conclusions and recommendations were published in the report, ‘An organization with a memory’. Despite these efforts, and other high-profile reviews (Frances Report, Keogh Report, Cavendish Report, etc) being conducted to keep patient safety at the forefront of our delivery points, here we are almost 20 years on and safety remains one of the biggest problems in healthcare Although individuals have good intentions, human fallibility inevitably leads to lapses in quality of care. In saying this, I am not denigrating the fantastic work of the NHS and other organizations in delivering safe, effective, timely, economical, ethical health-care services to the population they serve. The NHS sees 1,000,000 patients every 36 hours and has 1,205,949 employees, as published by NHS Digital. NHS employees work around the clock under challenging conditions and deliver a world-class service. But all the same, the rate of clinical error is too high and we owe it to our patients to improve it.
My experience of going to Harvard Medical School at age 53 as a Geeky Gynaecologist
As I immersed myself in the Certificate Program at Harvard, somewhat deluding myself into being a ‘young’ university student rather than a somewhat elderly postgraduate enthusiast, I saw some illuminating examples of how technology addresses this challenge. I became totally engrossed in the applied informatics side of the course and built a very large network around the use of disruptive technologies in healthcare. The examples I came across ranged from many different clinical situations involving wearables, monitoring devices, EHRs and EMRs, Patient Portals, Virtual and Augmented reality, mobile health (mHealth), Cyber Health (cHealth) and TeleHealth (tHealth). I was enchanted by Google Glass and Microsoft Hololens (Holoporting) after I saw what they can achieve when running seamlessly with support in acute clinical situations, i.e. enabling on-site paramedics to communicate details visually to the central hub where the expert team gives timely advice and gets a plan in place for relevant clinicians to receive patients. They reminded me of watching Star Treck in my younger days, where Captain Kirk would say, “Beam me up, Scotty!” But of course, one of the innovations which stood out for me was artificial intelligence (AI) and use of big data platforms such as IBM Watson. Contrary to popular misunderstanding, use of AI does not mean machines taking over decision making totally from human input. In contrast, it is pooling of several inputs from experts, observations and other data to give a triggered recommendation in any given situation. For example, a well-coded and connected EMR will immediately flag up the creatinine level in someone where a clinician is requesting a medication which has an impact on kidney function. This takes away the possibility of human oversight in considering the renal function before prescribing that medication. Some systems can even suggest a lower dose where the data inputs enable the machine to make an evidence-based recommendation. This example illustrates the safety net being expanded when we rely on the allied clinical workforce such as nurse specialists and physician assistants to take on wider remits including prescribing.
What is the difference between disruptive and sustainable technology?
– Disruptive tech totally unseats existing tech.* – Sustainable tech improves on existing tech. *NOTE: The theory of disruptive innovation underpins most of the market strategies used by stakeholders in healthcare.
Clinicians must join the Geeky Gynecologist in her clarion call
As a clinician, our prime focus is to get the best outcomes for our patients. We have an additional responsibility, as an NHS employee, to consider affordability, to facilitate the best and fair use of taxpayers’ money. Hence, we need to fully engage with the digital or disruptive revolution in healthcare technology to make informed judgments and recommendations to our CIOs (Chief Innovation Officers). Being disengaged with or resisting the technological takeover of healthcare could lead to one of two undesirable possibilities: either expensive systems will be commissioned which are not really best for our clinical use, or we lose a novel chance to bring real benefits to our patients. Anecdotally, surgeons are perceived as being more technically ‘savvy’ than clinicians from other disciplines. Perhaps, as surgical techniques have greatly evolved from scalpel and needle to robotic arm and laser beams, the users have found a niche in their area of expertise where they greatly improve clinical outcomes. Despite the surgeons having a rich history of innovation in their discipline, as a Gynecologist & Obstetrician, I would argue we are the pioneers of being tech-savvy as cutting the umbilical cord surely must have been the first essential surgical procedure required! Hence, I am well placed to call for my peers to engage with technology and meet the huge challenges of perinatal morbidity and mortality that loom upon us globally. The reason I narrated my personal continued professional development path was not to bore you dear readers with my somewhat eccentric direction of travels as a Geeky Gynecologist but to emphasize two important points:
  1. Age is not a barrier to engage with emerging fields of knowledge and skill.
  2. In order to meet the mutual goal, it takes a team effort. It is always good to be an asset to the team rather than a barrier by inaction or disinterest.
Ok, I’m off to put on my VR Oculus headgear to experience a new tool in medical education with haptic feedback! The image that comes to mind is that of crazy Doc Brown in the Michael J Fox classic Back to the Future. Great Scott! This article originally appeared in AIMed Magazine issue 04, which you can read here.
Author Bio
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Naila is a senior clinician affiliated with the NHS for almost 26 years. Her career has evolved not only in her specialty (Gynaecology) but also in medical education, patient safety and informatics in healthcare. She has held several senior leadership posts such as Associate Dean London Deanery, Associate Director for Medical Education and Lead for OBGYN undergraduate course at Imperial College. She is a champion for embracing technology in the delivery of high standards of healthcare and is a frequent speaker on disruptive technologies and their place in futuristic healthcare. Recently she was interviewed by HIMMS TV at the UK eHealth week, where she delivered two talks which were very well received.