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Content ArticleHealth care algorithms are used for diagnosis, treatment, prognosis, risk stratification and allocation of resources. However, bias in the development and use of algorithms can lead to worse outcomes for racial and ethnic minoritised groups and other historically marginalised populations such as individuals with lower incomes. This study aimed to provide a conceptual framework and guiding principles for mitigating and preventing bias in health care algorithms, in order to promote health and health care equity. The authors suggested five guiding principles: Promote health and health care equity during all phases of the health care algorithm life cycle Ensure health care algorithms and their use are transparent and explainable Authentically engage patients and communities during all phases of the health care algorithm life cycle and earn trustworthiness Explicitly identify health care algorithmic fairness issues and trade-offs Establish accountability for equity and fairness in outcomes from health care algorithms.
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Content ArticleThis systematic review conducted for the Agency for Healthcare Research and Quality (AHRQ) aimed to examine the evidence on whether and how healthcare algorithms exacerbate, perpetuate or reduce racial and ethnic disparities in access to healthcare, quality of care and health outcomes. It also examined strategies that mitigate racial and ethnic bias in the development and use of algorithms. The results showed that algorithms potentially perpetuate, exacerbate and sometimes reduce racial and ethnic disparities. Disparities were reduced when race and ethnicity were incorporated into an algorithm to intentionally tackle known racial and ethnic disparities in resource allocation (for example, kidney transplant allocation) or disparities in care (for example, prostate cancer screening that historically led to Black men receiving more low-yield biopsies).
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Content ArticleThis leaflet aims to help people with type 1 diabetes decide between the different technologies available to manage diabetes. It contains summaries of devices available and infographics outlining eligibility criteria for continuous glucose monitors (CGM), insulin pumps and hybrid-closed loop systems. Diabetes care is one of the five clinical areas of focus for integrated care boards and partnerships to achieve system change and improve care as part of Core20Plus5 for children and young people with the aim to increase access to real-time continuous glucose monitors and insulin pumps across the most deprived quintiles and from ethnic minority backgrounds.
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News Article
Widespread failings discovered in EPR launch linked to patient death
Patient Safety Learning posted a news article in News
“Better upfront planning, training and testing” were needed in a tech launch which was tied to patient harm and service disruption, an NHS England review has found. Royal Surrey and Ashford and St Peter’s Hospitals foundation trusts went live with Oracle Cerner’s electronic patient record in May 2022 – under a programme called Surrey Safe Care – but the implementation has since been linked to incidents of patient harm, including one death, and significant disruption to trust services. Now, a lessons learned review, carried out by NHSE’s frontline digitisation team and obtained by HSJ via a Freedom of Information request, has identified 24 areas of improvement. The key lessons cited by the review are “better upfront planning, roles and responsibilities, training and testing”. It recommended that, in future implementations, trust boards should be supported by others experienced with implementing EPRs within the NHS to “aid board level decisions and ‘what questions to ask when’”, while clearer responsibilities should also be agreed upon for programme leads and EPR suppliers. The review also found the content of training must be evaluated thoroughly, while the EPR supplier should provide “upfront and continuous training”. It added the “full end-to-end testing [by] representatives from all end user groups” should be completed before go-live. It also said EPR readiness needs to incorporate “data readiness, such as data quality, and mapping how data has originally been captured [which] may impact reporting and organisational readiness”. Read full story (paywalled) Source: HSJ, 15 January 2024 Related reading on the hub: NHS England warns electronic patient record could pose ‘serious risks to patient safety’: what can we learn? -
Event
ISQua 2024
Patient Safety Learning posted an event in Community Calendar
untilTogether with the Türkiye Health Care Quality and Accreditation Institute (TUSKA) and the Ministry of Health, Türkiye, ISQua is delighted to host their 40th International Conference in Istanbul. The theme for the 2024 conference is 'Health for People and Planet: Building Bridges to a Sustainable Future'. It will address the continued challenges of making person-centred care part of the healthcare system, as well as addressing some of the hot topics that matter most in a rapidly changing world. Issues such as environmental challenges, reducing the healthcare sector's carbon footprint, and ensuring the long-term resilience of healthcare will be addressed at the conference. It will also examine the potentials and pitfalls of AI and Digital Transformation in healthcare, and how it can revolutionise healthcare and enable better patient engagement. Further information -
Content ArticleThe Medicines and Healthcare products Regulatory Agency (MHRA) has published a roadmap which outlines the intended timelines for delivering the future regulatory framework for medical devices.
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Content ArticleLarge language models such as OpenAI's GPT-4 have the potential to transform medicine by enabling automation of a range of tasks, including writing discharge summaries, answering patient questions, and supporting clinical treatment planning. These models are so useful that their adoption has been immediate, and efforts are already well underway to integrate them with ubiquitous clinical information systems. However, the unchecked use of the technology has the potential to cause harm. In this article for The Lancet, Janna Hastings looks at the need to mitigate racial and gender bias in language models that may be used in healthcare settings.
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Content ArticleThis cross-sectional study in JAMIA Open aimed to identify concerns, barriers and facilitators impacting the use of patient portals by older patients, as well as desired features in future updates. The authors held two focus group discussions culminating in an anonymous survey completed by women who were 65 years and older receiving urogynaecology care in Northwest Ohio. The authors concluded that the lack of age-aligned medical access software and products may lead to worsening digital exclusion and disparities in healthcare. Portal application developers and healthcare systems must advance efforts that consider the needs of those who are older when designing patient portals.
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News Article
IT failures causing patient deaths, says NHS safety body
Patient Safety Learning posted a news article in News
Urgent action is needed to address NHS computer failings which are causing harm to patients, the patient safety watchdog has told BBC News. The watchdog has evidence of patient deaths due to IT system errors. The government called the reports "concerning" and said it would work with NHS England to take necessary action to protect patients. A recent investigation found thousands of hospital letters were unsent due to computer issues. The Health Services Safety Investigations Body (HSSIB) says IT failures are among the most serious issues facing hospitals in England. "We have seen evidence of patient deaths as a result of IT systems not working," said interim head, Dr Rosie Benneyworth. Dr Benneyworth cited the example of a patient who was found unresponsive and then wrongly identified by healthcare staff as not wishing to be resuscitated. Staff were unable to access information on the patient quickly through their IT system, which would have shown a mistake had been made, said the watchdog. Read full story Source: BBC News, 16 December 2023 -
News Article
Only half of trusts’ staff were trained ahead of troubled IT go-live
Patient Safety Learning posted a news article in News
Only half of staff across two acute trusts were fully trained in the use of a new electronic patient record before its introduction, which led to disruption and patient harm, HSJ has revealed. The implementation of Oracle Cerner’s EPR at Royal Surrey Foundation Trust and Ashford and St Peter’s Hospitals FT was carried out, despite the trusts not having achieved their target of 80% of staff having completed the necessary training, newly disclosed documents show. HSJ has also seen an internal report by the Royal Surrey’s informatics team which warned of risks to patient safety and data problems, unless preparations improved in the three months leading up to go-live. The two acute trusts implemented the EPR in May last year under a programme called Surrey Safe Care, but there have been multiple problems ever since – including some of the issues that the internal report warned of. The trusts acknowledged the process had been “challenging” but said they had trained a higher proportion of the staff who were working in the two weeks after go-live, with Royal Surrey describing the findings of the internal informatics report as an “inaccurate representation” of readiness. Read full story (paywalled) Source: HSJ, 13 December 2023 -
Content ArticleThe health service is facing workforce shortages and growing backlogs of care, as well as future increases in demand. In response, policymakers and providers are looking to advances in health technologies and data to improve quality and efficiency and reshape services to better meet future needs – most recently with the announcement of £100m to advance the use of artificial intelligence in health care. Ensuring new uses of health technologies or data have the backing of the public is critical if these are to become business as usual. As seen with the care.data scheme and the General Practice Data for Planning and Research programme, lack of public support can significantly constrain innovation and service transformation. So how does the UK public feel about the use of health technologies and health data? To explore this further, in March 2023 the Health Foundation commissioned a nationally representative public survey to investigate attitudes towards health technology and data uses and the key factors affecting these views.
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Content ArticleIn this blog, journalist Rory Cellan-Jones reflects on some major challenges the NHS currently faces. Sharing insights from a recent meeting with medtech companies and a lecture by economist Professor Diane Coyle, he shares concerns that productivity in the health service has decreased as a result of the pandemic, and that medtech companies face barriers in selling their solutions to the NHS. He highlights a growing consensus that policymakers need to think beyond immediate firefighting and look at how to transform the NHS over the long term.
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Content ArticleThe NHS’s deal with the US tech company Palantir raises privacy concerns, but a unified database could be a medical gamechanger writes Martha Gill in an article for the Observer. Governments have been trying to stitch together our patchwork system for decades. Billions have been lost in these attempts. However, they always run up against the same problem: people just don’t want to share their medical data, even when assured it will be anonymised. When the government aimed to build a collection of anonymous GP health records, around a million patients opted out. The latest of these attempts has closed a loophole: patients cannot now opt out. But this has enraged civil liberties groups, which are concerned about the company chosen to merge, clean and provide tools for sorting through the data.
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News Article
Patient privacy fears as US spy tech firm Palantir wins £330m NHS contract
Patient Safety Learning posted a news article in News
The NHS has sparked controversy by handing the US spy tech company Palantir a £330m contract to create a huge new data platform, leading to privacy concerns around patients’ medical details. The move immediately prompted concerns about the security and privacy of patient medical records and the suitability of Palantir to be given access to and oversight of such sensitive material. NHS England has given Palantir and four partners including Accenture a five-year contract to set up and operate the “federated data platform” (FDP). The British Medical Association, which had previously voiced concern about the NHS’s alleged lack of scrutiny of bidders on “ethical” grounds, said Palantir’s winning bid was “deeply worrying”. NHS England sought to allay such concerns. It stressed that none of the companies in the winning consortium would be able to access health and care data without its explicit consent; that it would retain control of all data within the platform; and that it would not include GP data. It said the new software would be protected by the highest possible standards of security through the deployment of “privacy enhancing technology”. Read full story Source: The Guardian, 21 November 2023 -
News Article
Private health firm Sciensus fails to fix defects that led to UK patient’s death
Patient Safety Learning posted a news article in News
A private health company paid millions by the NHS has failed to fix safety defects that led to the death of a cancer patient, the Guardian can reveal. Three patients were hospitalised and a fourth died when they were given the wrong doses of a powerful chemotherapy drug after a catastrophic IT failure at the medicine manufacturing unit of Sciensus in April this year. The incident, first revealed by the Guardian in July, prompted an investigation by the Medicines and Healthcare products Regulatory Agency (MHRA). Its inspectors found “significant deficiencies” at the Sciensus manufacturing facilities and ordered the partial suspension of its manufacturing licence. However, six months after the IT blunder, Sciensus has not fixed the problems identified by the regulator, according to people familiar with the matter. As a result, the suspension of its licence – originally due to be lifted last month – has been extended until July next year. Sciensus is the UK’s biggest provider of medicines services to NHS and private patients at home. It is contracted by the NHS and other organisations to deliver and administer medicines to more than 200,000 people with conditions such as heart disease, diabetes, dementia, HIV and cancer. Read full story Source: The Guardian, 5 November 2023 -
News Article
Hunt tech adviser calls for ‘new central investment’
Patient Safety Learning posted a news article in News
The NHS requires a ‘new central investment’ to achieve digital maturity and realise the potential of emerging technologies, according to the person who was commissioned by Jeremy Hunt to examine the issue in 2015. Bob Wachter was commissioned by the then health and social care secretary in 2015, and authored the 2016 report Making IT Work, which called on all NHS trusts to achieve the “realistic target” of a good level of digital maturity by 2023. While Professor Wachter told HSJ that there had been “reasonably good” progress, he said it was “not quite what I would have hoped for” seven years on from his report. He acknowledged that factors such as the pandemic and the subsequent economic situation slowed progress, but added that he was “a little bit worried” at the state of digital maturity in some areas, including interoperability and reliability of key systems such as electronic patient records. Read full story (paywalled) Source: HSJ, 1 November 2023 -
Content ArticleIn late 2015, the National Advisory Group on Health Information Technology in England was formed to advise the Department of Health and NHS England on its efforts to digitise the secondary care system. Our recommendations fall into two broad categories: 10 overall findings and principles, followed by 10 implementation recommendations.
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News ArticleA trust saw nearly 1,000 safety reports filed after introducing a new electronic patient record (EPR) – including one where a patient died and 30 others where they suffered harm. The Royal Surrey Foundation Trust and Ashford and St Peter’s Hospital Foundation Trust installed a new joint EPR system in the middle of last year. But Royal Surrey’s board was told there had been 927 Datix reports — which are used to raise safety concerns — related to the introduction of the “Surrey Safe Care” system, running up until mid September this year. The catastrophic harm involved a patient death which the trust says was not “directly linked to technical problems” with the EPR, as “human factors” were involved, including inexperience or unfamiliarity with the electronic prescribing system. Louise Stead, chief executive of Royal Surrey, said: “Implementing an electronic patient record is a huge shift for any workforce and we experienced some issues with the functionality of the system and getting users sufficiently trained and confident in using it correctly. We have worked hard to address these issues as quickly and responsibly as possible. “Our fundamental aim is for ‘zero harm’ and any harm caused to a patient is taken extremely seriously and investigated. In the case of these Datix incidents the vast majority (over 99%) resulted in low or no harm to patients. “However, one case resulted in the tragic death of a patient and we have been working closely with their family to be transparent and learn every possible lesson. This case was not directly linked to technical problems with the electronic patient record system and human factors did contribute. We are sincerely sorry for the failure in their care and devastating impact upon this person’s family.” Read full story (paywalled) Source: HSJ, 11 October 2023
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Content ArticleModern health systems must embrace digital technologies to address challenges like ongoing shortages in the global health and care workforce, significant diagnostic backlogs and the requirements of diverse and ageing populations. The COVID-19 pandemic and the exceptional advances in artificial intelligence (AI) and machine learning (ML) have accelerated the drive towards digitalisation of health systems. However, making digital health technologies work in practice remains challenging in terms of how these technologies are designed, how their performance and safety in operation are assured and how their impact on staff and on patients is assessed, writes Mark Sujan in this BMJ Editorial.
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Content ArticleNHS England provides regular updates on progress with the implementation of the Digital Clinical Safety Strategy to show how they've captures insights about digital clinical safety, how they are training their workforce to support safety in this area and how they use technology to drive safer care.
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Content ArticleFor many years the NHS has talked about the need to shift to a more personalised approach to health and care—where people have choice and control over the way their care is planned and delivered, based on “what matters” to them and their individual strengths, needs and preferences. In this HSJ article, Ben Wilson, product solution director at Orion Health, discusses the progress, benefits and future possibilities for an integrated, patient-centric healthcare system.
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Content ArticleThis report summarises the findings of an evaluation conducted by Health Innovation East and Health Innovation Manchester on behalf of the national Innovation Collaborative for digital health. It presents findings from an evaluation of a chronic obstructive pulmonary disease (COPD) virtual ward that falls within a virtual hospital managed by South and West Hertfordshire Health and Care Partnership. It aims to inform the potential wider adoption of the virtual ward model across the UK and understand the model’s potential to support people with other health conditions. It also considers the success of South and West Hertfordshire Health and Care Partnership Virtual Ward objectives to improve patient care, clinical outcomes, healthcare utilisation, and patient and staff satisfaction.
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News Article
Nottingham University Hospitals Trust failed to send 400,000 letters
Patient Safety Learning posted a news article in News
An NHS hospital trust in Nottingham failed to send more than 400,000 digital letters and documents to GPs and patients, BBC News can reveal. A former employee has told of "a lack of responsibility" over a new computer system. Patient body Healthwatch said it was "deeply concerned" by the scale of the incident and the impact on care. The trust says a full investigation took place in 2017 and found no significant harm to patients. But it has now said it will carry out a review of that investigation and take any further action needed. The healthcare regulator the Care Quality Commission (CQC) said it was not aware of the incident and would be following up with the trust. This is the second major incident in England involving unsent NHS letters uncovered by the BBC recently. Read full story Source: BBC News, 30 September 2023 -
News Article
24,000 hospital letters lost in computer error
Patient Safety Learning posted a news article in News
A hospital trust failed to send out 24,000 letters from senior doctors to patients and their GPs after they became lost in a new computer system, the BBC has learned. Newcastle Hospitals warned the problem, dating back to 2018, is significant. The BBC has been told the problems occurred when letters requiring sign-off from a senior doctor were placed into a folder few staff knew existed. The healthcare regulator has sought urgent assurances over patient safety. Most of the letters explain what should happen when patients are discharged from hospital. But a significant number of the unsent letters are written by specialist clinics spelling out care that is needed for patients. It means that some crucial tests and results may have been missed by patients. Staff have been told to record any resulting incidents of patient harm and ensure these are addressed. Following a routine inspection by the regulator - the Care Quality Commission (CQC) - in the summer, staff at the trust raised concerns about delays in sending out correspondence. A subsequent review of the trust's consultants revealed that most had unsent letters in their electronic records. Read full story Source: BBC News, 26 September 2023 -
Content Article
In October, the Healthcare Safety Investigation Branch will tweak its name, become independent from NHS England and the UK government, and gain new powers to strengthen investigations. With the announcement of the change in status, Health Secretary, Steven Barclay, reported it would be leading an investigation into inpatient mental health. This follows swiftly on the heels of the Strathdee rapid review into data on mental health inpatient settings, which itself was launched in response to well-documented failures in these settings. The aim of this new investigation into mental health is simple: to improve safety. In this blog, Karen West, Head of Transformation (Mental health) at Oxehealth, and Professor Dan Joyce from the University of Liverpool, discuss the importance of data in patient safety improvement and explain why inpatient mental health data is so difficult to collect and what can be done to improve this.
