Heart monitoring … a patient’s experience
I popped back to Suffolk, in the UK, this weekend to visit my parents. I was very interested to hear that my mother would be wearing a device to monitor her heart for 24 hours. This is part of a barrage of tests to check her health and try to help diagnose various ailments she has. Many years ago she was diagnosed with Churg-Strauss syndrome so she is no stranger to being bombarded by tests to diagnose a hard to diagnose disease.
What interested me in this device, besides how it would help my mother, was to see how the NHS was making use of monitoring devices and technology. Now I am a huge fan of the NHS, but I am aware that this massive organisation has struggled to join the digital world. How would they go about monitoring a patient remotely I wondered.
I should probably not have been surprised at what I discovered as I found out about my mother’s heart monitor. Now while some devices have taken the crazy concept of user experience and usability on board – others clearly have not. This was the case with my mother’s monitor. What she had was a device about 2/3 the size of an iPhone attached to her chest with a very long cable and monitors stuck to her chest. That was it. She was left to her own devices as to where she would carry that device. The obvious place of course is a shirt pocket. What % of ladies wear (including night wear) do you suppose has a pocket in the chest area? My mother was fortunate as she had appropriate clothing – I would be less fortunate as I believe the only thing I could wear would be a borrowed shirt (and being single I could not turn to my boyfriend’s wardrobe for support) or inside my bra (no comment on that). Minor issue.
Apparently at night the cable is long enough so that you can place the device under your pillow without the need for a pocket – easy! Oh except there is also a reasonable chance that if you have health issues you are not sleeping well and will toss and turn and consequently get totally entangled in the cable, increasing your night time stress levels. Minor issue.
After her twenty four hours were up the doctor had informed her to take the battery out. Again – easy! Right? Sadly not. My mother tried to do as her doctor had showed her, removing the battery with a card. She had no luck, neither did my aged father, so as always in matters technology she turned to the younger generation – me. I am no technophobe nor am I a total idiot but for the life of me I could not work out how to remove the said battery. By this time my mother was in some distress as she had been specifically told to remove the battery after her 24 hours and was concerned that by not doing so she would invalidate the whole experience and have to re-do it (I will not repeat her thoughts on that!). But hey ho – minor issue!
At the table I had also noticed her jotting things done on a piece of paper. Was this a shopping list? Perhaps a to do list? No – it was of course her hourly diary taking to document her actions during the 24 hours. A piece of paper. Fabulous. What a wonderfully efficient tool this was – she would have to write it all up, remember to take it with her to the doctors, where they doctors would then need to type it all up and also store the said piece of paper. What a total waste of NHS resources … but minor issue right?
What struck me about all these “minor issues” is the waste of time, resources and total lack of patient centricity in the whole process. Why could the device maker not simply provide a device that came with a practical way of carrying it around for 24 hours? Why was it not linked to an app which the patient would also use as a diary with all the results being sent to the doctor, at the end (or indeed during) the 24 hours? With today’s technology this is not a crazy suggestion.
Of course the big issue here is budget. The NHS does not have the budget to upgrade the devices they purchased (I hope) some time ago or to develop the accompanying app diary for this device. I would see this as being a great value add from the part of the device manufacturer but they probably have no motivation for this, or indeed totally lack the creative, user-centric thinking this would require.
The other issue that this raises is of course security and IT systems. Ensuring the app is secure enough to comply with regulatory requirements and that it interacts with the NHS systems is of course another whole boardgame. Paper is still considered far more secure (I would sometimes question this – but that is something for another discussion).
Surely though as the NHS looks for cost cutting and efficiency measures examples like this should raise a flag. How many other patients, for other conditions or with other monitors, are having to document a daily diary? Why not develop a single NHS app for this which could be used across multiple situations? Surely the sheer reduction in excess paper work and saving in time would make it a more than viable investment? Indeed perhaps this app already exists – in which case the question is why is it not being used? I could go on and on along this line of thinking (and please feel free to continue this and answer these questions in the comments) but for now I have said my piece.
I have flagged a single example of a procedure not making use of technology, not being patient-centric and generating unnecessary costs for the NHS. As far as my mother is concerned though she has done her bit, has vented and muttered about this, and has now returned to her normal life, without having to fret about long cables, pockets or how to remove ****** batteries.