Embedding feedback in electronic prescribing to improve patient safety

At the beginning of my fellowship...

In September 2019, my fellowship plan was to advance my knowledge of different approaches for digital transformation to enhance patient care through optimisation of health information technologies and digital solutions. I wanted to gain insights into strategic planning, implementation, and leadership of a range of technologies and apply what I’ve learned to my Topol project. I also planned to share new knowledge with my colleagues to further maximise potential benefits from the training.

For my Topol project, I planned to lead a feasibility study that harnesses the potential of a hospital electronic prescribing system to improve medication safety. I wanted to apply a proactive approach to medication safety, specifically looking at how we can:

  1. better use electronic prescribing data to identify and track previously underreported medications safety issues in context
  2. provide customisable feedback and support context-specific learning by individuals and the team, and
  3. use information to drive further improvements in medication safety at the team and organisational level.

Recognising the potential risks with developing and implementing technological solutions, I was prepared to be agile and used a quality improvement study design. Little did I know at the time that the COVID-19 pandemic would provide the greatest stress-test to the project and my planned development.

During my fellowship...

Throughout the fellowship, I have been privileged to have met and learned from inspiring digital leaders, innovators, disruptors, policymakers, educators, and the Topol Digital Health Fellows. The experience has deepened my understanding of strategic planning and implementation of digital transformation projects and provided me with new tools to shape such work. It has also enabled me to gain a more holistic and strategic perspective on digital-related health service improvement and patient safety. Furthermore, the small peer group discussions enabled us to sound out specific challenges, share ideas and they provided much-valued peer coaching and support.

As a Digital Health Fellow, I have developed greater confidence to push further and ask more of what existing technology can do for patients and health service providers, educators and policymakers, and to address different individual needs. While often this resulted in a ‘computer says no’ response, I also learned to channel such frustrations (eventually) to facilitate creativity in my team and I to explore alternative solutions. Consequently, despite the fellowship program being suspended for six months due to the COVID-19 pandemic, and the subsequent reprioritisation of clinical and operational demands, I was able to repeatedly adapt the project to meet the changing needs of my stakeholders. The project is now nearing completion and much credit goes to the individuals in the team who are continuing to work on the project when organisational priorities allow.

Outside of the project, I have also taken opportunities to be more actively involved in other aspects of collaboration and contribution to the digital health agenda. For example, I am now also a member of the Faculty of Clinical Informatics and a member of the Health Education England Digital Literacy Advisory Group. I also co-authored a BMJ blog post with colleagues titled ‘Patient centred care in a post-covid world’ that highlights some of the accelerated digital technology innovation and adoption in health care and key lessons going forward.

Lessons learned:

Being a Digital Health Fellow in a COVID-19 world has changed how I view digital health and innovation. Enabling the workforce to use digital technology effectively is as much about communicating and recognising each others’ digital expertise, as it is about supporting individuals to develop relevant digital skills. The variety of technologies and vast amounts of data have driven greater specialism in clinical informatics and software development. I have learned about the need for some data silos to manage risk, quality control, minimise duplication and ensure the appropriate use of information. However, when under-resourced, these same silos can lead to multiple bottlenecks and inadvertent waste of other resources.

Leading a multi-disciplinary team, where members were redeployed and work priorities were rapidly changing, was incredibly challenging. I have experienced the rapidity of digital adoption in primary and secondary care at scale and benefited from enhanced communication across hierarchies in the NHS and my affiliated academic research organisations. These experiences have emphasised the immeasurable value of leaders who continuously seek to understand and respond to patient and staff needs as part of their decision-making and make change happen.

I have now also seen it through the work of my Digital Health Fellows and the fellowship organisers. In providing a fellowship extension in the face of the COVID-19 pandemic, the organisers have allowed us all more opportunities to experience and apply what we have learned into practice. While the diversity of the fellows’ professions, expertise and projects meant that not all of what we wanted to learn was provided through the workshops, the organisers frequently sought to connect or support us to meet our development needs. Recognising our collective needs the Topol programme was adapted and the organisers have role-modelled digital leadership in another way, and I am truly grateful for all their efforts.