Mapping the digital landscape of cardiology
At the beginning of my fellowship...
To achieve my initial aim, outlined above, I had the following objectives:
- To map the digital landscape of cardiology within a region, taking a tertiary centre (The Bristol Heart Institute) and examining it and its feeder district general hospitals. This mapping was to include looking at how data generated from various tasks/procedures was curated, interpreted and monitored, how procedures were requested, how information was communicated between the hospitals and General Practitioners and what patient-facing digital health solutions are employed.
- To identify from this mapping areas for improvement, and then undertake an improvement project based upon one of these.
In this video Sarah Hudson discusses her experience from her time as a Topol Fellow during which she focussed on mapping the digital landscape of cardiology.
During my fellowship...
The plan was to spend the first half of the fellowship mapping the digital landscape of cardiology, so in September 2019 I began working on mapping via three threads:
- a freedom of information (FOI) request to all UK NHS hospitals which undertake percutaneous coronary intervention procedures to acquire information on basic digital systems and management of information/data
- interviews with those employed in cardiology departments around the region to identify positive use of technology, areas felt to require improvement and what apps/websites/other digital solutions they used/recommended to patients
- a survey of UK cardiologists’ use of medical apps
From this mapping the main areas I identified as possible projects for the second half of the fellowship were improving the availability of ECGs, streamlining the local TAVI (Transcatheter Aortic Valve Implantation) pathway or education around use of apps in cardiology. However, before any plans could be formulated the COVID-19 pandemic necessitated my return to full-time clinical work in March 2020.
During this full-time clinical period it became apparent that the pandemic had acted as a catalyst for digital maturity. I was asked to record a ‘talking heads’ video piece for the British Cardiovascular Society (BCS) on the effect of the pandemic on trainees, and I used this opportunity to also talk about the positive changes in the use of digital I had observed. As a result of this, and my background as a Topol Fellow, I was invited to join the BCS working group formed to produce a paper on ‘The Future of Cardiology’. The aim of this was to capture the positive digital changes and explore how they could be built upon going forward. I contributed to the writing of the paper, and produced a shorter ‘highlights’ version on behalf of the group which was published in BMJ Heart.
I also became involved in the drive to embed the positive evolution of digital education in cardiology, and am a member of the national Core Cardiology Digital Training Group working on ways to achieve this.
When in September 2020 I returned to the Topol Fellowship I decided to work primarily on the TAVI pathway. It was clear that the ongoing effects of COVID-19 on clinical services and resources would necessitate a pragmatic and flexible approach to delivering my project. I have been working with the TAVI team to improve the TAVI referral pathway and produce an online ‘shop front’ for patients to provide better information. Existing systems have been streamlined and already available material, for example British Heart Foundation videos, collated, to allow the service to be improved with minimal need for additional resources.
I have also used the information gathered regarding cardiology apps to promote better understanding of the regulation of apps and what apps could be useful in clinical practice. A written form of this was included in the Future of Cardiology Working Group’s paper appendix. Presentations have also been given locally (Cardiology Grand Round), regionally (South West Fellows Conference) and nationally (British Association of Cardiovascular Care Nursing webinar) and the concept of a curated library explored with the BCS.
The information gathered from the initial FOI request was presented at the Faculty of Clinical Informatics Scientific Conference, and has been shared with other interested parties on request.
Throughout the Topol period I have also kept a blog (www.DigiScrawl.co.uk) to explore digital issues, and I look forward to continuing this. The excellent Manchester University Machine Learning course has also encouraged me to learn more Python, and I plan to continue online courses in this post fellowship.
The Fellowship may have occurred during a particularly challenging year, but if anything this just highlighted how important getting digital right is to providing effective and safe patient care. My determination to advocate for digital transformation continues and my ability to do this has been increased by the skills learned during the Topol Fellowship.
- Digital transformation is as much about people as technology
- Dissemination of effective, proven digital solutions needs to be prioritised – so many fantastic solutions are not known outside their local ‘silo’
- Protected time is essential to enable the digital change the NHS requires to meet the needs of the population in the 21st century – it cannot be achieved solely with goodwill and enthusiasm.