An Oncologist's open letter to Health Tech

Dear health tech,

I'm looking around at so many tech companies developing software using AI, because AI is exciting and awesome, and sometimes - we build cool things because we can.

However, sometimes, It's not a solution. I implore you to stop wasting your time on non-solutions.

I walked around my hospital yesterday, and I saw ZERO implementations of AI or health tech. If it's possible, I saw the opposite in fact.

The focus needs to be back on the solutions, and the reason is chaps, we've got a lot of problems that need to be fixed. AI can provide some brilliant ways of doing this.

I was on call yesterday, and I want to paint a snapshot of the picture for all of you out there developing, I want you to have some insight into the current practice within the NHS and the challenges I need solutions for to be an effective oncologist.

Why? I want to see patients, not paperwork.

I want you to see where we need solutions.

I'll be honest, there is no money or room for your tech, no matter how fun cool, and shiny it is, if it doesn't fix a problem, and it isn't cost-effective.

So many people are developing without ever stepping inside the shoes of a doctor.

Thanks to enterprises like Adopt A Doc, we're giving you a bit of that insight - but time and time again, the solution doesn't fit. So buckle up :) Have a quick seat in my shoes.

On call begins

I'm on call today, so I don't have clinics but I'm looking after patients.

I head to the ward to try and see my first patient.

I walk around looking for their notes, and find them from a barely surviving notes trolley from what appears to be the 1900s, with metal clips holding the drawers up that are about to give way. I try to decipher from the paper notes what has been written by the clerking doctor. Doctors' handwriting has a reputation for a reason you know! ;).

I log onto one of the PCs to look up some medical notes on the patient - this takes about 5 minutes and as I log on it starts erroring telling me how little space I have left on the disk and multiple access errors trigger. I close the errors and carry on. I've never used this machine before.

I log in and find the patient details from 1 of the 5 different systems we use.

I find that when the phone call was taken from the cancer treatment helpline, the details were written on a paper pro forma, and then scanned on.

My bleep goes off (yes we still carry bleeps), I need to do an urgent prescription for a patient down in radiotherapy. I find a prescription pad, and write this on a paper prescription chart, which you have to carefully peel 5 sheets off to write the prescription because somehow, we need 5 copies of this paper prescription.

At the end of writing it, I can guarantee that in the last 2 copies, the writing is so faint it's illegible. I have to run this 3 floors down and physically hand it to the pharmacy. I hand it over and run back up.

Preparing to see the patient

I come back up, I start again, log in again, and remind myself of what I was looking for.

I get very minimal details on this patient and realize they are from outside of Glasgow, so I have to log onto their system using a portal that gives access to trusts from other parts of Scotland. This is a different version to the same named system in Glasgow, everything is organized in a different way and different structure.

I navigate through the subtitles trying to find what I'm looking for. 'outpatient letter', 'outpatient letters', and 'clinical outpatient letters' I find it. Whilst mumbling under my breath at how stupid the sub-classification of letters is...

Unfortunately, the first 5 letters I go through don't have a summary of treatment or diagnosis. Everyone does their letters a bit differently, some are better than others at telling you what the patient actually has and what treatment they are on. I start Chemocare on the side to try and speed up the process of seeing what systemic anti-cancer therapy they've had.

I go back to the first system to get the blood results taken today in the Beatson.

I open PACS to look at the images for the patient. I open up Hepma, another piece of software to see what's been prescribed.

This isn't the whole story though, there are no fluids prescribed on Hepma. That uses a paper prescription chart. So does our syringe driver prescription, and so does our gentamicin and vancomycin antibiotics. But you still have to indicate these antibiotics are in use, by prescribing them on Hepma in a fashion - to say "see paper chart".

Trying to see the patient

I write all the relevant details in the paper notes.

But the obs and fluid charts stool charts and I/V Prescriptions as mentioned are all outside the patient room. So I walk over and try to find them. The nursing staff have the fluids chart to make up what they've been prescribed, so I can see what they've had so far.

I flick through reams of paper trying to find a blood glucose level, see what the obs chart shows, and see what their fluid balance is. All of this is just clipped randomly to the clipboard. No discernable order. Often difficult to find through reams of wasted paper, not filled out.

My bleep goes off twice, I look around for a free phone with some privacy.

The first is to see a patient having chemotherapy, the other is again for another prescription. Sigh. I mentally triage and decide I have time to see this patient and the other one can wait.

Seeing the patient

I see the patient, we have a good discussion, I examine them and make sure they understand everything that is going on with their treatment. We have a bit of a joke together, and we are both smiling as I walk out of the room. Success. Best 10 minutes of my day so far.

I go back and quickly write in everything the patient told me, the examination findings, diagnosis, and the plan. I try to write more legible than my counterparts given how frustrated I was at not being able to read theirs. I ask one of the junior doctors to prescribe on Hepma and the paper charts for I.V. fluids. I ask them to request an additional scan using a different system. And that will do as a snapshot.

Conclusion

The astute among you will identify several areas of potential improvement.

I became a doctor to see and care for patients, but I spent probably less than 1/5 of my time doing that. The rest is as you can see, fluff that in many cases should not exist. Not in our AI generation. Hell, not even before the AI generation.

Now we have the opportunity to use the excitement and funding being thrown at AI to bring the NHS up to speed.

Please do this for our healthcare system, our patients, and each other. We need the NHS, it is broken. AI can fix it, and so can you.

Thank you.

Kind Regards,

Sam

Dr. Samuel McInerney BSc(Hons) MBBS MRCP(UK)