The combined clinician, consumer, developer and mentor voices are valuable in healthcare software development

I am privileged to span the divide between clinical healthcare, academia and the growing digital world and I often find myself translating meaning in any one of these environments for those who work in another.  To give you context, these are the groups I identify with:

  • Healthcare – ED Nurse / former EMT, Practice Nurse, public sector Clinical Nurse Specialist, a paediatric nurse and consumer of healthcare.
  • Education – Lecturer, Clinical Standards Tutor, online education developer and consumer/student (PhD).
  • Digital – User, software developer, database admin, online education designer, PhD Candidate,  *nix user (with the numberplate LNXCHK) and geek.

Today I was able to combine all of these skills to begin solving a health problem at the 2018 “Developers on FHIR” Challenge.  Where the skills of developers and clinicians combined to work together on a health solution.  In this case, interoperability using HL7FHIR framework to provide a solution in managing adverse events in healthcare.

This opportunity was exciting as it allowed me to make links between my previous clinical roles, past research (reducing error and cognitive load associated with weight estimation during paediatric resuscitation), current PhD (mobile application development for paediatric resuscitation) and position as an educator of future nurses.  While these roles share common goals which relate to adverse events each has their own management solutions which highlighted the amount of siloed information and processes we navigate in our health journey.   If this data were shared, with more streamlined interoperability it is highly likely patient outcomes and experience would improve.

Our team met in person for the first time at 0900 this morning after a brief email conversation.  A small amount of preparation, an APP framework, a little background research and beginning of the final presentation/pitch were completed, but there was still a lot of work to do.

What struck me, to begin with, was the diversity of our team, for example, a strong “coder” / masters IT student, an IT lecturer / PhD Student, an IT Tutorial Assistant and myself who all had different strengths, backgrounds and personalities and had never met in person before.

The second thing that struck me about this experience was the passion and words of wisdom from the mentor team from HL7 at this event (Peter Jordan, Martin Entwistle and David Hay).

Interestingly, until now, I had always felt like a bit of an outcast in the clinical world and software development world as I did not entirely belong in either.  Today, I entered this event thinking I had limited experience in software development and would not contribute much.  However, I found that, as a clinician, I could offer knowledge of the environment, processes, as a patient and a consumer point of view and as a developer an understanding of data storage, transmission and app development.  What turned out to be the most important contribution was a combination of all of these skills and the ability articulate both clinical and software development perspectives within our team.

Overall, I have learned a lot today, predominantly that we need to work together up front to succeed.  This means, clinical and digital teams who manage health data need a standard language/interface which is where I believe FHIR is essential.

You are probably wondering what we developed/prototyped?  A mobile APP called “Ad Rec” for adverse event reporting where, patients, treating clinicians, general practice staff and external agencies all contribute to adverse event reporting using common data structures and sources while with built-in reporting to external auditors such as governmental organisation.  Where future research could evolve:

  • Standardising adverse event classification.
  • Simplify user APP user interface.
  • Implementation of reporting such as direct reporting to MEDSAFE or CARM.
  • Integrating different terminology such as patient versus clinician versus analyst needs.
  • Push notifications for clinicians.

Here is a photo of our team at the end of the day after winners were announced.

IMG_2382Photo previously published on Facebook with permission of those photographed.

From left Sally Britnell (RN, Lecturer and PhD Candidate at AUT / Auckland University of Technology), Jun Han (IT tutorial assistant at Whitireia New Zealand), Sarita Pais (PhD Candidate at AUT / Auckland University of Technology and IT Lecturer at Whitireia New Zealand) and Feng (Thom) Zhao (IT student at Whitireia New Zealand).

BTW – our project won.

Adapting to what is required is key in providing quality education.

Tonight I had a phone call at about 1630 hrs asking for assistance with teaching first aid for a group of young people at 1830.  If there was no one to help the night would be cancelled for around 80 young people.

I agreed and took on a group of around 20 young people aged 13 – 18-years.  We looked at the basics of assessing an unconscious patient, which went well.  However, when it came to assessing a conscious patient, it became apparent much of the learning was rote learning of the process and knowledge of the what and why needed some work.

While practical activities were going on I thought to myself, does rote learning actually still have a place in first aid teaching?  I then asked myself what would first aid education be like without rote learning?

In first aid, learning by rote provides a person with a process to follow in an emergency, which is useful for remembering what to do stressful situations.  For example, for an unconscious patient, we use DRSABC or Danger, Response, Send for Help, Airway, Breathing, Circulation.

I posed a question to the group, is rote learning a process good enough to apply to all situations?

With this in mind, I asked students to work in pairs.  Number 1 is a first aider and number 2 the patient.  The patient was to think of something that is wrong with them, and the first aider asks questions to learn what is wrong.  As expected, the students predominantly used closed-ended questions and a rote-learned process which did not go beyond these.  We then discussed trust and using communication skills to collect information.

I introduced the SAMPLE (Signs and Symptoms, Allergies, Medications, Past History, Last Meal, Events Prior) pneumonic with the rider that they need to find out as much as they can with as few questions as possible.  While doing this using all of their senses to gather information about a situation.  This also went very well with all of the cadets engaging, participating, using teamwork and respecting the needs of each other.  The information gathered was more rich and complete than in the initial exercise.   

Therefore, in doing this exercise, we learned that there is a need rote learning (e.g. SAMPLE), but it is the way we use this and formulate questions and gather information is key.

Another key piece of learning for me today was by way of a reminder that learning can be fun and educational.

One of the younger children (11 years) who had been in the group being taught alongside my group came up as I was leaving.   He asked, are you coming to teach us again?  I replied that I would be happy to fill in if need be but I couldn’t be there every week.  I asked why he wanted to know and he replied that he would be old enough to be in the group I was teaching in two years and he thought that the teaching and learning the group I was with was both “work and fun”.

This reminded me, not only, why I became a teacher for adults and children.  But what I value the most about my day job and volunteer job.  Adapting what I do to meet the needs of learners by providing education in a way that is meaningful for them.




While I taught the 8-10 year old’s the importance of recognizing good and bad thoughts or feelings and controlling the outcome they taught me of an important a lesson too …

Tonight I stepped in at the last minute to teach around 15 children aged eight to ten years.

The subject was health and they had covered the basics like healthy eating and hygiene needs so we tackled our thoughts and feelings.

I asked them if they wanted to work as a large group or two smaller ones and they wanted two smaller ones. We identified good and bad feelings and then I set them a task to script, design and act a play to teach their peers about good and bad feelings. How to put themselves in someone else’s shoes.

We have some very strong minded children in the group along with a shy new person with limited english. Initially they split themselves into two groups with different ideas. One group got on with what they had to do, scripted, found roles for everyone in the group, made costumes out of butcher paper and worked as a team.

The second group found it hard to agree on ideas and consider each other in this. I watched the group having trouble and offered suggestions however it was not working out.

The three in the second group wanted to join the others who were working well together well. This group opted to disband. I agreed and they wanted me to get them something to do in the other group. Instead, I suggested they go and ask if there was a role they could have in the others play. Which two of the three did and were readily accepted by the others.

The play and props they designed were impressive for the 90 minutes they had to achieve this. The play centered around bullying at school and every person had a role, even the shy person who only joined that evening.

They learned not only about teamwork, inclusiveness, but also thoughts, feelings and how to manage these.

What I learned was about challenging my own assumptions and stereotyping. The young people had unconsciously put the people who were biggest, loudest and that I felt had the most stereotypically bullying characteristics in the most vulnerable role of the person being bullied. This made me reconsider my own assumptions around this.

I would like to thank this group of young people for being so inclusive of all others no matter their personality, age, gender and culture in this activity. They adapted and included others at the last minute readily and I believe that working together and displaying these qualities at age eight to ten is an amazing achievement.