Exclusive: Nurse aims to make trust ‘paperless’ in next few years

Joan Pons Laplana was one of four health and care professionals to take part in the clinical informatics fellowship scheme designed to strengthen links between NHS Digital and the frontline, and to raise awareness of roles in the field.

“It is critical that health tech is designed with frontline clinicians and care professionals”

Amir Mehrkar

He is now embarking on the all-new role of lead nurse for digital transformation at Mid Yorkshire Hospitals NHS Trust, where he will help introduce IT systems to eliminate time-consuming paperwork and boost patient safety.

Mr Pons Laplana told Nursing Times the fellowship had been an “opportunity of a lifetime” that had opened his eyes to the potential for technology to support great nursing care and improve the delivery of health and care services.

“Overall it has been very positive,” he said. “I had an opportunity to be curious, to explore, ask a lot of questions and to go up and down the country to see best practice – what NHS Digital was doing to try and bring the NHS into the 21st Century.”

He admitted he came to the national body feeling frustrated at slow progress in the NHS when it came to implementing effective IT systems, with staff “still using pen and paper on the frontline”.

However, the fellowship had revealed the sheer scale of the challenge when it came to ensuring different systems in the health service could communicate with each other, as well as external agencies like social services and the police.

“That is a mammoth task,” he said. “They may not go as fast as I want them to but what NHS Digital is trying to do is put everyone on the same page and create a base for the digital revolution that is coming in the next five to 10 years.”

“Technology is never a substitute for the care a nurse would deliver”

Joan Pons Laplana

He said: “This needs to happen, because if it doesn’t it will be very difficult to sustain the NHS as it is and carrying on providing the care we provide.”

As part of the fellowship, he had the opportunity to help shape technology that uses advanced modelling to predict length of stay.

“Don’t ask me how they do it but the fantastic mathematicians and data people created an algorithm and depending on age, condition and where you live, they can automatically generate a date of discharge,” he said.

“If I automatically know how many days a patient is going to be in hospital then I can plan a lot better,” he said. “At the moment we do it blind.”

This could be especially useful at peak times, such as winter when hospitals were under pressure and sometimes had to cancel elective surgery.

“Knowing how many days a patient is going to be in my hospitals means I will cancel less operations because I have a lot more data,” he said.

The technology, which looks set to be piloted at some point this year, could make a huge difference to discharge planning and be aligned to initiatives like the Red2Green campaign to reduce the number of wasted bed days in the NHS.

“As a nurse, I have realised that maths can help me find the evidence I need”

Joan Pons Laplana

App-based solutions also had huge potential to free up nurses’ time, ensure timely information was shared between agencies and empower patients to aid in their own recovery, noted Mr Pons Laplana.

For example, he suggested it would be possible to send automatic patient welfare updates to worried relatives after daily ward rounds.

Meanwhile, updates sent to care agencies could help prevent delayed discharge – one of his main frustrations as a nurse.

“Discharge is often delayed because care agencies have not been informed a patient is ready to leave hospital,” he explained.

“However, the app can send an automatically generated email or text message to the care agency to say ‘Mrs Smith is going to be discharged in 72 hours – make sure you have everything in place’,” he said.

“They can be kept to up to date every day, so it will be no surprise when I call to say ‘Mrs Smith is coming out this afternoon’, which would make my life a lot easier,” said Mr Pons Laplana.

The wealth of data generated could also help identify wider patterns and blockages in the system and ensure managers took action to address these.

“For example, if I can see that in the last month I lost five days because I could not send patients to X-ray then I can go to managers and say ‘here is the evidence – you need to hire another radiographer or by another X-ray machine because this is costing the hospital a lot of money’,” he said.

Joan Pons Laplana

Joan Pons Laplana

Joan Pons Laplana

As well as helping professionals keep on top of things, technology could ensure patients were much better informed about their care pathway and things that should be happening day by day such as key tests, scans and X-rays and send reminders of things they could do to speed their recovery such as physiotherapy exercises.

“Sometimes when you got to hospitals you see patients sitting next to the bed not doing a lot all day and this needs to change,” he said. “We need to empower patients and ask them to help nurses with their work and technology is fantastic for that.”

However, he stressed that technology could never be a substitute for direct nursing care.

“Technology is never a substitute for the care a nurse would deliver,” he said. “What technology can do is to free us up from a lot of tasks and give us more time to do what we do best and that is caring for patients.”

This in turn could help boost job satisfaction and nurse recruitment and retention rates, he added.

“Nurses’ number one priority is to make a difference to patients but one of the main complaints I get from nurses is they are struggling to find the time to do that,” he said.

“I do believe technology will help nurses make a difference and that will mean job satisfaction will increase and people are happier at work,” he noted.

He highlighted that one of the most unexpected things to come out of the fellowship experience was that he had “fallen back in love with maths”.

“I used to hate maths with a passion,” he said. “However, coming to NHS Digital and working on intelligent use of data, I realised that if you apply maths to health you can make predictions, find patterns in people’s behaviour and then plan services a lot better.

“For me, that has been a real eye-opener,” he said. “As a nurse, I have realised that maths can help me find the evidence I need for projects and make my business cases for change a lot stronger.”

He said he was excited about his new role at Mid Yorkshire Hospitals, which started this month, and was looking forward to working with staff to develop IT products that would help them do their jobs.

“It is a completely new job title. The trust has as chief information officer who is a doctor but decided they needed someone to represent nurses as they are the biggest employee group and also the ones who are nearest the bedside and who have to use products more often,” he said.

“They wanted a nurse lead who could engage with staff and ensure they products they put in place are the right ones,” noted Mr Pons Laplana.

He said his goal was to make the trust paperless within the next few years, which would include introducing new electronic patient record and prescribing systems.

“I think we need to get a bit more angry and a bit more forward”

Joan Pons Laplana

Mr Pons Laplana, who is part-way through a Masters in health informatics at the University of Leeds sponsored by NHS Digital, said he would continue to work with the body as one of a pool of clinicians that provide insight and advice.

He said his ultimate goal was to become a “chief nurse information officer”. Meanwhile, he said it was vital nurses got involved in the development of IT solutions from the outset and he felt the profession needed to be more pushy when it came to ensuring this happened.

“If we don’t put our ideas forward then they are going to design products and care systems without us. Then when these products and projects come back to the hospital all the nurses are going to moan saying ‘We don’t like this product, it is not doing what we want it to do’,” he said.

“We are the biggest health profession and sometimes we have the smallest voice,” he said. “I think we need to get a bit more angry and a bit more forward. If you are not invited to the table just take your deckchair, knock at the door and say ‘I’m coming today because my voice needs to be heard’.”

NHS Digital said the clinical informatics fellowship scheme had been a “great success” but confirmed it would not be running the scheme in 2019-20 – although this will be reviewed for 2020-21.

Dr Amir Mehrkar, interim chief medical officer at NHS Digital, said: “The programme has been important to create opportunities to bring together clinicians at different stages of their clinical informatics careers to learn, question and challenge each other in a safe environment.

“It is critical that health tech is designed with frontline clinicians and care professionals so they are useful, usable and used and we look forward to the clinical fellows being part of this positive change in their careers,” he said.