EHI Awards 2010: Blue light for success

The overall winner of last year’s EHI Awards ticks every box when it comes to what a healthcare IT project should look like.

Universal take-up, direct improvements in patient care, cross-organisational information sharing and effective use of the data for secondary purposes are all part of the package in the mobile technology solution that is now used every day by the Scottish Ambulance Service.

The project to provide navigation and key patient information to ambulance crews not only won the category for best use of mobile technology, but was also chosen as the overall winner from the ten awards categories.

Navigation and information

The clinical objectives of the project have been led by Robin Lawrenson, a former ambulance man and now clinical performance manager for the Scottish Ambulance Service, who has been involved with the project since it started more than ten years ago.

He says: “We had been audited by the National Audit Office in 1999 and it had criticised our clinical reporting. It was quite poor - as it was with every ambulance service at that time. We decided to do something about it and in 2001 came up with the idea that we could create an electronic system for our vehicles.”

Originally intended to be a communication tool for vehicles, the eventual solution equipped each of the service’s 600 vehicles with two units which use GPRS technology.

The unit in the front of the ambulance has satellite navigation and provides incident management information to the crew. At the same time, automatic vehicle location functionality means the control room knows where the ambulance is at all times.

The unit in the back of the ambulance provides a purpose designed clinical and emergency health record. Incident information is pulled from the front unit on to the rear and the crew are able to input additional data. A wide range of clinical support information is also available.

Lawrenson adds: “By and large ambulance crews don’t need anything to help them get on with the job but it will help them if they need it. In Scotland it can also be a long way to hospital and it can then provide support if necessary while the patient is transported.”

Lawrenson says the design has deliberately been made as simple as possible, with data pre-populated where possible and a simple ‘next’ button for ambulance crews to select at each stage, rather than options to choose from a whole range of icons.

The rear unit also now links to other clinical devices such as defibrillators, which also automatically input information into the record.

Both units are fully portable and also work from docking stations in the ambulances. If there is a problem with either unit it can be swapped from front to back and immediately switch functions to be a ‘front’ or ‘rear’ system.

Getting into hospitals

Links with hospital systems were high on the project’s original wish list. The system has achieved this with some Scottish hospitals.

Where this has been done, ambulance crews can transmit data to the receiving hospital – in one case direct to an electronic whiteboard in an A&E department - as they leave the incident, half way to the hospital and on arrival. Lawrenson says this allows hospitals to be better prepared for a patient, saving vital minutes in some emergencies.

Where links have not yet been established, an on-board printer means the crew can print out the clinical record and hand it to the A&E department on arrival. Ambulances across Scotland are also accessing the GP’s Emergency Care Summary record and palliative care record.

“Crews can see demographics and information such as allergies, medication, and ‘do not resuscitate’ instructions and that works very well. We don’t need to access the ECS for most of our patients, but it’s useful when it is needed,” he adds.

The system took several years to create. In 2001, Lawrenson was tasked with finding a suitable system, but found there was very little available in the market in the UK; and US solutions did not impress him.

Lawrenson explains: “I thought they were very poor – created mainly by clinicians who had never been in a mobile care scenario in their life.”

Eventually he approached Terrafix, a Stoke-on-Trent based company already creating mobile solutions for ambulance services, which had developed its own ambulance record solution. A joint project between Terrafix and the Scottish Ambulance Service developed a whole new record solution.

Working from a piece of paper with just the word ‘patient’ in the middle, the team set about writing a system to meet their needs and the hardware to go with it.

The “ruggedised” hardware is robust enough to withstand an ambulance driving over it - and to cope with all the different situations ambulance crews sometimes find themselves in.

Lawrenson adds: “At one early point, to demonstrate why we needed clear, large options on the screen, they crouched underneath a table and we threw coffee at them to replicate the kind of conditions ambulance crews work in.”

Wider use

The time spent in meticulously creating a system appropriate for working ambulance crews has paid off in Scotland. Lawrenson says use of the system is close to 100% compliance, when less successful introductions of ambulance systems in some part parts of England have seen just 2% of those meant to be using the system doing so.

Lawrenson also runs a well-used forum, which enables ambulance crews to ask questions about the system and to input their own ideas. Many of these have led to changes to the system, which is currently in its 74th iteration.

Another significant benefit has been the addition of a data warehouse, which manages all the information that has been held in the system since 2007, providing a highly valuable database of information on pre-hospital care.

Lawrenson says: “It’s a very, very powerful tool that we use to generate reports and then change care, for example by looking at what happens to how well asthma patients do when given hydrocortisone before they get to hospital compared with those who we didn’t give it to.”

As performance manager, Lawrenson says he spent many years writing guidelines based on consensus rather than empirical evidence. But the advent of the IT system has meant that all that has changed. The warehouse also means audit work is much quicker and easier.

“Before it might take me a long time to identify something we were not happy with but now I can press a button and have the answer in 20 minutes.”

Future plans include possible use by other ambulance services which Lawrenson is very excited about for its potential to create an even more powerful database for research into pre-hospital care.

The Scottish Ambulance Service is also working on linking the system to Scotland’s forthcoming Clinical Portal. This would mean patients could be followed right through the system from ambulance care to discharge.

And it is looking at adding telemedicine and video-streaming functionality and continuing to improve the connectivity.

Championing success

Even without these developments though, the system is already more than proving its worth in Scotland. Lawrenson adds: “We can show month on month and year on year improvements in just about every single treatment that we have.”

Lawrenson’s advice on setting up and running a successful IT system is simple. He says: “Systems shouldn’t manage people they should support people - and every project needs a champion who sees it as their own and drives it.” The Scottish Ambulance Service clearly ticks both those boxes as well.

The EHI Awards 2011 in association with BT seek out and reward outstanding work within the UK healthcare IT sector. Entries are open now on the dedicated awards website, and will close on 3 June at 4pm.

This year’s awards will be presented on Thursday, 6 October at the Grand Connaught Rooms in Covent Garden, London. For more information or to reserve a table, please visit the awards website.

To find out more about previous winners of the awards, visit our case studies showcase.

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