Interview: Dr Mike Christian of London’s Air Ambulance Charity on their digital transformation
Mandy Langfield spoke with Dr Mike Christian, Research & Clinical Effectiveness Lead and HEMS doctor at London’s Air Ambulance Charity, on the transition from paper to digital systems and their impact on efficiency and information distribution
What’s your background and training in pre-hospital medicine?
My background in pre-hospital medicine actually began at its earliest stages; in my youth as a volunteer with St John’s ambulance. I went to college to become a paramedic and, after practising as a paramedic for a few years, I went to university to study medicine and pursued a career in intensive care medicine. As in intensive care physician, I worked in both the civilian and military settings in pre-hospital care throughout my career prior to moving to the UK in 2016 to work with London’s Air Ambulance Charity (LAAC).
Whose decision was it to move to digital rather than paper-based systems, and what prompted the decision?
The decision to move to digital rather than paper-based systems was part of a larger strategy of digital transformation. Although our service has been at the leading edge of clinical innovation, we were far behind the curve in terms of our processes and systems to support our clinicians. In particular, our operations were very inefficient in requiring our doctors and paramedics to record the same data in multiple different places, very little of which was then ever used to inform our practice or operations. We worked with a consulting firm which had significant experience in digital transformation to develop a strategy and road map for our services. We chose to harness low-code technology in the form of Microsoft Power Apps to log kit digitally and remove manual processes and duplications, so teams have one clear picture of equipment regardless of where they are.
Why did it take so long to move away from paper-based systems for the medical kit bag checklists?
There are a number of reasons why it took so long for this change to occur. Firstly, paper is easy, fast, and simple. Thus, it works relatively well for doing the basic job. However, what it lacks is any added value or the ability to use it to drive improvement. The second factor delaying any change was the lack of someone to dedicate the time to developing a plan and to lead the change. We were fortunate that Bart’s NHS Health Trust, UK, funded my role which, in addition to my clinical work, is primarily focused on research and quality improvement. It requires a lot of time and effort to lead change of any type, and that often causes inertia.
Once the decision was made to replace paper-based systems with Microsoft Power Apps, the development speed was very quick. One great thing about Power Apps is that because they are ‘low-code’ solutions, they are easy to build and there is no need for bespoke development.
Are all the bags standardized? Do you have different bags for different mission types, or are they too short notice and unpredictable? How does the digital system adapt as needed?
We have a number of different packs that are brought with us on all missions and are identical on our cars and aircraft. However, we select which packs we bring with us to the scene depending upon the job type, although our two core packs (medical pack and monitor pack) and suction are brought to every job. Our pilots can always bring to scene any additional kit we need.
How straightforward is it for medics to log and share what they’ve used on a mission so that everyone is aware of what needs replacing?
At the present time, our doctors and paramedics restock the packs they use themselves, so we don’t log what we’ve used in that way. However, because we have many sets of kit, we use the tracking system to inform the entire team of the status of any pack and if it has deficiencies. Therefore, if for some reason we haven’t been able to re-stock a pack due to time between jobs or are missing a piece of equipment in short supply, we can flag this so that other teams coming on shift know that particular pack is missing something or is out-of-service.
What difference has the move to Microsoft systems made to operations so far in terms of speed of take-off and ease of finding the right piece of kit for the treatment needed?
Bringing the hospital to the patient isn’t easy. Medics require access to the same equipment you would find in an ICU unit, from bandages and syringes to ventilators and defibrillators, plus safety kit to keep us safe. A setup like this enables us to perform lifesaving treatment. In a job where every second counts, it is so important to know what’s happening around you and your team.
The biggest way in which the move to Microsoft Power Apps has helped our team is situational awareness of where kit is and the status of our various vehicles. Previously, this information was documented on a white board in an office on the helipad, so the only way to see it was to go to that office and look at the board. Now, regardless of where the team is, as long as they have Wi-Fi or 3G, they can look on their device and not only instantly be able to see the location and status of kit but also make changes to update the information.
How was the Physician Response Unit (PRU) changed to adapt to the pressures of Covid-19 on the National Health Service and the air ambulance unit?
The PRU introduced several new processes during Covid to help prevent vulnerable patients being exposed by coming into A&E. In particular, they have been providing support to oncology and palliative care patients in the region. They are able to see and treat the patient at home, if appropriate, or if necessary, arrange direct admission of the patient to a ward or clinic where they can more safely be seen with a lower risk of being exposed to patients with Covid. The PRU is significantly advancing how urgent care can be delivered within the community, to reduce demand on Emergency Departments and inpatient wards, and delivering holistic and patient-centred care in the most appropriate setting.
How badly has fundraising been affected by Covid-19 lockdowns?
The charity relies heavily on public donations and, since the pandemic began, has had to stop many fundraising activities and cancel or postpone a number of crucial events, the impact of which will be felt for some time to come. For example, our annual Abseil at The Royal London Hospital, which in 2019 raised £132,000 for the charity, sadly had to be cancelled last year. We forecast that we will suffer a £6 million loss of income over the next five years. Although Covid-19 has brought with it a degree of uncertainty, we have strength in our resources and are as ambitious as ever. We are extremely grateful to our supporters, partners, and stakeholders for their continued support.
Looking forward, how do you see LAAC changing in the future, whether this is adoption of more digital solutions, investment in simulation training facilities for medical staff, or upgrading the helicopter?
The digital transformation strategy mentioned earlier is well underway, looking to leverage the power of digital capabilities across our clinical and operational processes and embed digital infrastructure into our everyday working. This includes partnering with the London Ambulance Service on a common platform for electronic capture of patient data. This will enable not only patient data to follow them through their healthcare journey via the One London project but also enable more sophisticated data analysis, and greater integration with the London Major Trauma Network and NHS Digital. This project will serve as a model for other air ambulances across the UK.
More broadly, this is truly an exciting time for LAAC and we are conducting research on the feasibility exciting new pre-hospital medical procedures that have the potential to be transformative for our patients. Our teams continually strive to innovate not only in on-scene medical procedures.