Microsoft’s Common User Interface programme supports Imperial e-handover project

Having to constantly enter the same information into clinical systems is a huge frustration for clinical staff – and it can lead to errors. London’s Imperial College Healthcare NHS Trust decided to develop an e-handover solution to tackle the problem.

In doing so, it worked with Microsoft’s Common User Interface team to get advice on how to structure and display information, and to make sure its solution could be rolled out more widely. Sally Whittle reports.

When patients at Imperial College Healthcare NHS Trust move between departments or wards, there’s more to the move than just physically moving the patient. Each move triggers a series of changes in the trust’s bed management, case management, prescribing and observation systems.

“There are a number of systems that need to be updated whenever a patient is moved, sometimes on the computer, but often using paper forms,” explains Sarah Rodenhurst, emergency planning manager.

“With each system or form, the clinician needs to fill in information like demographic details, admission date and medication details. But really, that’s unnecessary. Most of the information is already there in one system – it’s just that we can’t transfer it between the different systems.”

To reduce this data duplication and improve staff efficiency, the trust developed an e-handover application that automatically updates multiple systems when patient details are updated in one system. “It means that if someone makes a change in the bed management application, it’s reflected in the bedside observations system,” says Rodenhurst.

Imperial and CUI

One of the reasons this kind of project is feasible for the trust is that it has been involved with the work of Microsoft’s Common User Interface (CUI) team. This has helped to provide a framework for common layouts and structures for NHS data.

Rodenhurst first became involved in the CUI programme in 2004, when she was working on a project to develop a new e-prescribing and drug administration application. “CUI approached us and we felt it was a good idea because, if the application was going to be rolled out widely, consistency was obviously important,” says Rodenhurst.

Since then, Rodenhurst has attended a number of CUI workshops, where nurses, hospital doctors, GPs and other healthcare and IT professionals have meet to discuss clinical needs and priorities on issues such as electronic notes.

“I’m not sure how useful they are sometimes, because we never seem to come to any final agreement on what we need,” says Rodenhurst. “But the process of discussing formats and issues of usability is useful, and there’s never going to be absolute agreement in such a large, diverse group.”

Intuition and guidelines

When Imperial College Healthcare NHS Trust began developing the e-handover application, the starting point was clinical need – closely followed by CUI guidelines.

“A big problem we have within the trust is that many applications aren’t really fit for purpose,” says Rodenhurst. “Our experience shows that if clinicians don’t find something usable then they will simply wander off and do their own thing.”

For this reason, the e-handover project’s first priority was to have something doctors, nurses and bed managers would find useful and intuitive.

“We developed an application based on what they needed, and then we started to work with a partners’ group - which included CUI, the National Programme for IT in the NHS and the National Workforce Programme - to make sure the programme could be rolled out to other organisations if we were able to develop it into a product,” says Rodenhurst.

“We made a number of adjustments to the system to bring it in line with national CUI guidelines. We also shared knowledge from our pilot with CUI, and provided feedback on what clinicians told us about their preferences and needs in this kind of application.”

The e-handover pilot was extremely successful and is now being used by a range of staff. “We’ve got a system that works on Tablet PCs, smart boards, handheld computers and PCs, depending on the clinician’s preferences and situation,” explains Rodenhurst.

“It’s extremely intuitive and is designed to absolutely reduce the number of times someone has to go over and over, entering the same information. People really like that aspect of the new system.” The project is due to be presented to the trust’s executive board to approve further roll-out in the coming weeks.

Get involved

Rodenhurst hopes that other trusts will follow Imperial’s example and involve CUI in new IT projects. “At the end of the day, new NHS systems will be used by clinicians and if those systems aren’t agreed by the people using them – and if those users aren’t consulted at the earliest stages of the project – then you’re going to have a lot of problems,” Rodenhurst says.

“If we sign up to common data sets that work for clinicians, then we’re more likely to achieve systems that are fit for purpose.” CUI has the potential to help to do this, Rodenhurst believes. More importantly, it improves patient care by providing consistent systems that can share information – reducing the risk of human error.

“One of the things we found when we looked at systems was that diagnosis and other patient information could vary depending on whether it was entered by nurses or doctors – because of the different interpretation they put on information. With information able to flow from one system to another, that problem is eliminated.”