Forceps, drill…and now technology

Sam Shah is a Founding Fellow of the Faculty of Clinical Informatics and Director of Digital Development of NHS England, as well as being an NHS Consultant in Kent and General Dental Practitioner in London. As one of the  dentists within the Faculty, Sam has very kindly agreed to share his experiences of employing informatics within dentistry and beyond, and looks the future of informatics for all health and care professionals.

Clinical informatics is a broad topic area and covers everything from systems and standards through to technology that is used in healthcare.

In 1995, I started summarising patient records and implementing a computer system for a GP. I remember working weekends, answering the phone and dealing with out of hours patients. It was certainly very different, without any triage system, call recording or Directory of Service. Fast forward, I remember showing my clinical director how to use a pivot table, which seemed to change how she reported on clinical activity. I got immersed in informatics within public health, which involved aggregating data, carrying out endless analysis and producing pretty maps.

I’m really lucky that I still practice clinical dentistry and also get to work in clinical informatics. Within dentistry, we’ve been using various forms of technology and, for most dentists, digital dentistry probably means impression scanning, digital imaging and robots. However, the area is growing with the advent of voice-based user interfaces, initiatives on record sharing and, more recently, an explosion in electronic referral. There has been a growth in the number of dental related apps, and other innovations that go as far as recording brushing habits through the Internet of Things.

Clinical informatics has an essential place in professional practice for so many reasons. We need to equip professionals with an understanding of clinical safety, governance and assurance of digital products, but also how to get involved in user-centric design and design thinking.

Only recently did the debate reopen on electronic referral; simply rolling out a product doesn’t necessarily mean it’ll be used, and worse still, doesn’t mean it’s been designed to be used in a particular environment. In 2014, when exploring what to do about eReferral for dental services, the first response was that we should just use the national product, even though dental services weren’t on the N3 network and didn’t have any smart cards. I often describe this as asking someone to drive a car without giving them a road and taking the tyres off.

The next solution that was proposed was not any better than paper referrals, it was to use eMail and scan and print at either end. Undeterred and frustrated, I convinced a savvy commissioner about designing something that met the needs of general dental practitioners. Glad to see it’s now live, iterating and in use across the whole of the South East of England. As a profession, we have the opportunity to make a contribution and to influence the adoption of technology in healthcare.

The Faculty of Clinical Informatics is an important professional home for all professionals that are trying to improve the quality and safety of care through the lens of informatics. As patients start using an increasing number of devices and apps, we need to develop clinicians that can get much more involved in the design and also lead development and deployment in clinical settings. The Faculty of Clinical Informatics offers an opportunity to develop standards and training for a growing set of requirements for all clinicians.