UPA London hears NHS Handheld Pilot Evaluation

In a departure from its usual fare, the UPA meeting in London last week heard Louise Ferguson's ethnographic study of an NHS trial of handheld electronic drug charts.

Having initiated the study as part of an MSc in Human-Centred Computer Systems at the University of Sussex, Ferguson pointed out that many NHS trials are talking place without formal evaluation and hospital trusts are not sharing findings, but keeping quiet over problems revealed in pilot usage: 'Instead of learning from the bad news of others, the same mistakes are being made again and again.' Indeed, neither the French manufacturers of the tested system, nor the British licensees had undertaken any usability work at all when Ferguson began her contextual study.

However, a good audience, including representatives from the medical informatics world, turned out to hear the talk and discuss the state of technology and testing in the health service.

Ferguson explained her methodologies: heuristic evaluation, ethnography and a staff questionnaire, before reporting on key findings.

She identified several problems with paper patient records that made a move to a portable electronic format desirable: illegibility, incompleteness, multiple records/locations, duplication, fragmentation, difficulties in sharing and analysis, tendency of records to deteriorate, disappear or become misfiled, difficult and expensive to store. She drew attention to the 2001 Audit Commision report revealing that Britain has seen a 500% increase in medication-related deaths over past ten years.

The electronic device that was being tested, while solving some of these problems, introduced several more. There were product specific issues such as the inflexibility of the design, and the poor choice of some features. More generically, Ferguson’s study revealed some endemic problems with introducing tablets to the hospital ward:

* downtimes in connectivity rendered records unavailable,
* shared ownership of devices led to lack of responsibility for matters such as recharging, cleaning, etc,
* a tendency for non-assigned users to emerge as functions got adapted to meet other needs,
* the need for training of locums and other high-turnover additional staff at times when no support was available, such as night shifts,
* protecting the valuable and highly portable devices from casual theft, etc,
* the vulnerability of the tablets when dropped, or otherwise mistreated.

Ferguson said that the staff using the pilot devices were sophisticated ICT users, with PCs and PDAs at home. Their comments on the questionnaire endorsed much of the initial heuristic analysis she'd undertaken. She was also able to add comments on the culture of the workplace – for instance, the need for extra units (at least to begin with) since traditionally doctors and nurses do not share space or kit in this hospital.

Ferguson's findings have been submitted to the project team assessing the pilot to help them assess the product's effectiveness.

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