Digital health systems: Improving care or contributing to burnout?

In the last month, I have been forced to confront how the usability of digital systems is determined by the way that the software is configured on our hardware. When NHS mail decided it would no longer support the use of the native iOS mail and calendar apps on my iPhone, I responded to the prospect of change in the way you might expect of the RCP’s digital health clinical lead – I stuck my head firmly in the sand. Eventually, I could no longer access the email and calendar on my phone, and it kept asking me for a password that no longer worked.

Left with no choice, I installed Outlook and some hours later worked out how to add an Outlook calendar widget to my home screen. Many of the third-party calendar apps, even those approved by NHS Digital (as was) don’t work with NHS mail. I have found the change difficult – it’s not how I’m used to working, it looks different, I don’t quite know how to use it – even while conceding that it might be better.

I suspect this is how many of us approach learning to use a new electronic patient record (EPR) or adopting new ways of working in existing EPRs. It begs the questions: Are our clinical digital systems simple enough to use? Do they make it easier to do the right thing? Is it possible to configure them so they work the way you need them to? Does training work? Is it delivered when you need it? Can you find the information you need? Does the hardware work?

I led a workshop with the RCP chief registrars this week focused on what was good and bad in NHS digital systems. The answers were unsurprising. Clinical systems are made harder to use because you need multiple logins, systems load slowly, and the hardware is often broken. At a time when we most need digital systems to make the working lives of clinicians easier, they are adding to the frustration.

Last summer’s national-level survey on the usability of EPRs across acute, community, mental health and ambulance settings demonstrated that it is probably not the system that is the key determinant of usability but its implementation.

According to a national survey carried out by Ethical Healthcare Consulting, NHS England and KLASS Research, 66% of variation in usability is down to the provider, not the system or the supplier. Only 33% depends on the system, its user interface and how configurable it is, the rest is dependent on implementation.

The factors that affect usability in hospitals are:

1. Training: can you learn to use that bit of functionality when you need to (not just at go-live or induction)
2. Infrastructure: broken hardware makes systems less usable – the broken computer on wheels, the laptop that hasn’t been charged, the network that runs slow, the time needed to log in
3. Clinical engagement: how easy it is for you to improve and change your systems.