469 
Dean Grinham
IT Programme Delivery Manager, University Hospitals Birmingham NHS Foundation Trust, UK
University Hospitals Birmingham NHS Foundation Trust (UHB) is the leading university teaching hospital in the West Midlands region of the United Kingdom. As one of the largest acute care hospitals in the UK, it treats over half a million patients every year. It has the largest solid-organ transplantation programme in Europe, and is the largest centre in the UK for liver transplantation.
The trust currently employs six liver surgeons, 10 physicians and six transplant recipient co-ordinators, who provide surgical and medical care for patients around the globe who have a wide range of biliary, pancreatic and liver diseases. The transplant team has now performed well over 3,000 transplant operations to date, and this figure is expected to climb at an increased rate due to the prevalence in liver-related conditions in the UK.
The problem
The hospital’s on-call liver transplant teams carry a copy of the liver transplant waiting list with them at all times to quickly establish the information about patients on the waiting list. This enables them to respond immediately when an offer of a donor liver is made and enables the selection of a suitable candidate from the waiting list to be selected. Historically, the list had been an anonymised paper printout.
There were a number of operational issues with the paper process to overcome:
- On average, a transplant list would consist of a 14-page Word document containing the details of over 100 patients
- The document would typically contain 28 ‘sub’-waiting list categories, e.g. Adult priority blood group ‘O’
- The patient list had to be updated regularly by the transplant co-ordinators
- Only one person could access the waiting list at a time to update
- The list had to be printed out and handed to each member of the liver surgical team, consultants, specialist registrars, liver transplant recipient co-ordinators, and secretaries on every update
- Version control was difficult to manage
- Although the data was anonymised, there was still a reputational risk to the trust should the data be mislaid
- Identifying the most suitable donor from the list was time-consuming.
The issues above are typical of most paper processes; however, due to the nature and importance of the data, any replacement electronic process had to be accurate, timely and reliable. Faced with these challenges, the medical director asked the trust’s IT department to find a solution that met the operational demands and security required.
The solution
A formal project was raised with an objective of recognising the benefits of enabling the liver surgeons and transplant recipient co-ordinators to obtain secure, specific and relevant patient information quickly and easily. The IT team’s goal was to find a computerised data system specific to their needs, that was secure and able to gather and view real-time information.
UHB had already deployed BlackBerry smartphones to the trust’s managers to provide them with mobile email, calendar and contacts. This was initially implemented within the trust executives and then extended to senior managers and clinical service leads, with further roll-out to all trust consultants.
The BlackBerry solution was an ideal platform; in particular, the IT department knew that it provided the end-to-end encryption and device security needed, as well as the push technology for email and data.
One of the concerns was always going to be the current screen size of the current deployed devices, and this was a major factor in developing the application.
The UHB group consisting of IT project manager Rachel Brazier, transplant recipient co-ordinator Peter Ashcroft and his team, together with the liver transplant consultants, brought in Airpoint, a member of the BlackBerry Alliance Program that specialises in providing bespoke mobile applications. Together, they developed a specific piece of software for the BlackBerry using the BlackBerry Mobile Data System that enables users to query the waiting list using an agreed search criteria.
The list is stored securely on the smartphone and is updated any time the database is modified. The list is encrypted and the smartphones are password protected. End-to-end encryption ensures the confidentiality of the information being sent. In the event a device goes missing, UHB can wipe data from it remotely, which is not the case for many other Smartphone devices.
The process
Using the Airpoint application on their BlackBerry, the liver surgeon searches for a suitable organ recipient based on the information provided by the co-ordinator. A suitable donor recipient is searched for by using combination of defined criteria filters on the Airpoint BlackBerry application. For example:
- Type of patient – (e.g. adult or paediatric)
- Blood type – (e.g. O, B, A or AB)
- Transplant type – (e.g. liver only or liver & kidney)
- Queue type – (e.g. priority patient).
All patients that match the selection criteria are viewed on the Airpoint BlackBerry Application by the on-call liver surgeon. Further diagnostic and other clinical information can be viewed on the BlackBerry by clicking the roller ball on a highlighted patient name. A decision on a suitable organ recipient is then made by the on-call liver surgeon.
The basic outputs of the application were:
- Enable a decision on organ donor/recipient compatibility to be reached
- Provide users with a wireless connection to their trust email, calendar and address books while also acting as a phone.
An additional requirement of the project was for the development of a database to store the recipient detailed information. Once the data was entered into the database, the information was pushed to the Blackberry over the air, so the data being viewed was the most recent copy.
During a three-month development and testing phase, surgeons and co-ordinators were issued with BlackBerry smartphones to give them the time to become accustomed with the handsets. Then the application was installed over the air straight onto the devices.
During a short transition phase, the surgeons were allowed to carry both the BlackBerry smartphones and the paper list. Then, after a month, the specialty announced that they would stop publishing the paper version. The specialty came back to Rachel and said: “Actually, we no longer need to rely on the paper version any more”. At that point, the trust knew that the deployment had been a success and the solution had been fully adopted and signed off.
The benefits
Surgeons can now reply to offers of donor organs with much greater speed using their BlackBerrys. The application’s interface and search functions makes looking up and viewing the records very convenient, and faster than in the past. And surgeons are more likely to have the donor transplant list with them at all times because it is accessed via a smartphone, which provides all their other communication needs such as email, texts and phone calls.
And the reliability of the BlackBerry and the wide coverage of its operator’s mobile network make it easier for the transplant co-ordinators to reach the surgeons, whether at work, at home or out shopping. As a result, the speed of matching the most appropriate recipient for each donor has been improved.
The quality of the information has also been improved, as the latest version of the transplant waiting list is continually updated and automatically sent to their smartphone. Even if the surgeon is in an area with no mobile phone signal, he or she can still view the last transmitted version, which is stored on the device.
The success of the BlackBerry solution for liver transplant patients has opened a door to the future for UHB in the mobile arena. Since the implementation, the trust has purchased its own development tool (Webalo) that has enabled the rapid development of additional mobile applications to other clinical areas of the trust.
