Use of technology

Technology’s role in preventing healthcare catastrophe

"Swine flu vaccines will have to wait", "Swine flu vaccine expected in October", "Swine flu may hit one in three", "UK to face swine flu preparedness test". We’ve all read headlines such as these over the last few months with apprehension and concern. Each individual is concerned about swine flu in their own way; whether they are worried about getting swine flu themselves or the impact it will have on lives, jobs, the economy or friends and family.

As predicted by health experts the current flu epidemic has weakened over the summer, however it could re-appear, in a stronger form, in the autumn.

In the report, Impact of Swine Flu, think tank Oxford Economics outlines the multiple effects that a swine flu pandemic would have on the economy: from sick employees or family members not going to work to consumers avoiding crowded activities/services, such as restaurants or travel, to avoid infection. The economic uncertainty will likely have negative impacts on financial markets, bringing lower share prices and higher market interest rates than warranted by the economic situation.

With these individual and wider economic concerns, we are all pushing our apprehension towards the NHS. How will it cope with the pandemic? Is the Department of Health (DH) and NHS ready to get Tamiflu to infected patients? What would a pandemic catastrophe look like? Are the principles behind good emergency planning enshrined in the NHS culture?

With all these questions and concerns at the forefront of the general public, the NHS is under more pressure, than ever before, to combat the spread of swine flu. But what is the role of technology in helping to prevent a healthcare catastrophe such as the spread of swine flu?

The spread of swine flu

It’s impossible to fully prevent swine flu spreading as humans transmit it in the same way as the seasonal flu, by touching something contaminated with flu viruses, then touching one's mouth or nose and through coughing or sneezing. The Government has stockpiled over 14 million courses of Tamiflu as part of its pandemic plan, detailing action by everyone from pharmacists, who will hand out anti-viral drugs, to hospitals handling the seriously ill.

Tamiflu and Relenza will play an important role as the NHS seeks to limit the swine flu severity, but coordinating the dissemination of Tamiflu is another concern to add to the list.

According to a survey by 21C, more than half of the UK population feels that a breakdown in communications between healthcare agencies would allow a pandemic outbreak such as swine flu to spread unnecessarily and slow the effective distribution of vaccines.

According to respondents, 44% were concerned that the NHS and DH are not prepared to control a worldwide pandemic in the UK. The reality, however, is that the technology, systems and processes required to proactively mitigate risk do not feature in the infrastructure of most NHS Primary Care Trusts (PCTs).

More specifically, the National Flu Line technology helps by organising some of those issues that can best be managed centrally by a non-clinical team using a call-centre approach. However, that technology cannot address local issues such as: handling unusual features of the local population, which require a different clinical approach and different processes; the local management of operational processes such as stock control which may not be flexible enough to respond to changes in the way pandemics are managed.

There are a number of examples that could mean the technology isn’t available such as if the local strategy moves on to include mass vaccination as part of its approach, if the virus mutates and develops resistance to antivirals or if new viruses, such as the avian flu, emerge and require a different approach.

The DH only recently announced the decision to stand up the National Pandemic Flu Service (NPFS) with the introduction of the self-care service to give people with pandemic swine flu symptoms fast access to information and antivirals over the phone and online. If it’s decided they have swine flu they will be given a reference number and this is passed to a Tamiflu distribution point or pharmacy for a ‘flu friend’ to get the medication. But what happens if the NPFS technology fails?

Abdul Razzaq, Director of Public Health, Trafford PCT explains, “In the event of the national flu response service suffering technical problems or being overwhelmed by the volume of inquires, we are now equipped as a local telephone flu triage unit. We needed to replace paper flows of data between the various anti-viral locations. These sites are scattered across the borough and require a constant IT connection so that we can understand in real-time, who is coming to collect appropriate medication.”

Further to Razzaq’s point, in July, the Government needed to reassure the public that its strategy for coping with the flu pandemic was robust after the website designed to ease pressure on overwhelmed GPs was blocked to visitors within minutes of its launch. A DH spokesperson said that “The National Pandemic Flu Service website had not crashed. It was experiencing unprecedented demand with 2,600 hits per second, equivalent to 9.3m hits per hour. The technology for the call centres and the antiviral collection points has not been affected by this issue and is working normally.”

Whether or not the technology for the antiviral collection point had not been affected, Primary care trusts (PCTs) have no choice but to individually act on mitigating the serious risk to public safety posed by the pandemic outbreak.

Each PCT is trying to mitigate the risk of the flu by appropriately diagnosing swine flu and providing antiviral treatment. Contingency planning in the event the NPFS fails should be part of each PCT's individual emergency solution. With a business intelligence solution that automates the process for assessing patients and the public, managing, distributing and dispensing vaccines, PCTs will save even more lives.

The bigger picture

Swine flu is one of many major events that the NHS needs proper emergency planning in place to handle, but there are other events that require emergency and crisis planning. We’ve seen examples of this only too recently; 7/7 bombs, avian flu, 2007 floods or the Kegworth Air disaster. Whilst rare, they do happen and preparation is essential.

A proper emergency plan would include specific policies outlining the procedures to be implemented including a detailed instruction for the role of the Government. It would include steps for civil protection, details on the response and communication management, a plan outline and tests of this plan. A cycle of responses, assessment and management until there is a return to normality should be planned and delivered. Included within all of the above, should be an outline of how agencies will work together and how information sharing and the use of technology will be deployed.

How technology can help

Technology’s role for emergency planning is to help keep records, provide a platform for collaborative working and automate the process of allocating, following-up and discharging actions. In addition, technology must provide an overview of key metrics, sharing policies and procedures to keep everyone informed.

Using swine flu as an example, the NHS can benefit from business intelligence solutions that automate the allocation of vaccines to PCTs who manage vaccine distribution centres. Simple and effective, these solutions can provides PCTs with a ‘command-and-control’ facility to collaborate and report between other PCTs and distribution centres. By managing the stocks, distribution and dispensation of vaccines, as well as patient contact and GP liaison using a simple set of electronic forms and workflow, this technology can help provide a clinical dashboard that gives healthcare professionals access to critical data for accurate analysis and reporting.

The business intelligence technology should be more than just a supply-chain solution; it must be tailored and designed to meet the individual circumstances of the NHS. Full understanding of the NHS standards and health challenges must be understood and taken into account to avoid healthcare catastrophe.

Technology’s role in preventing future healthcare catastrophes

Using a technology response tool that not only automates the allocation of health services, but captures lessons for business intelligence is essential. Business intelligence is about the cycle of what you want to happen, what will happen and what happened. Having a solution that fills the missing link of ‘what is happening’ is crucial. The data collected, across this knowledge lifecycle, will be helpful in planning future emergency measures based upon better evidence.

Enshrining good practice into an emergency planning enables people to work more quickly based on better evidence. Acting now, when dealing with the swine flu, will mitigate risks as we continue to deal with it, but also as the avian flu or other future pandemics and emergencies arise. The NHS and DH are acting now, but it’s important that PCTs and the local NHS feel adequately supported and confident that the healthcare infrastructure will get it right the next time. Technology will play a key role in providing this assurance.

Paul Henderson, 21C, specialist healthcare technology consultants.

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