Interview Series: Andrea Jones, Lancashire Teaching Hospitals NHS FT

In our latest interview, HTN had the opportunity to talk to Andrea Jones, Medical Photography Team Leader at Lancashire Teaching Hospitals NHS Foundation Trust, about an app she has recently implemented within the hospital.
The app integrates with the Royal Preston Hospital’s FotoWare Digital Asset Management system, and is used to collect patient data, consent and clinical photography, providing a concise and time-effective solution for accumulating and managing patient images.
Could you tell me about yourself and your role in the organisation?
I’ve worked at the Lancashire Teaching Hospitals for 30 years, since I came out of college. I did my degree whilst I was working as a trainee here. Royal Preston Hospital and Chorley and South Ribble care for around 390,000 people so we cover quite a large area of the North West.
Myself, personally, it’s been quite a journey, really, from where I was to where I am now. I love it; I love what I do—I’m loving now being able to lead the team, to bring innovation to the team. We’d been a bit stuck for a while with no direction before I came onboard as the lead. We didn’t have a manager for a couple of years, so it’s been quite the challenge over the last 12 months.
Got everything whipped into shape, then!
Well! Mostly [laughs]. It’s getting better. We had to relocate our department and our service, which didn’t help. We had to relocate the first week I started as clinical lead, and then COVID started a few months later. It’s been a very challenging year.
What are some of the challenges around providing care with minimal contact?
We always have infectious patients that we have to deal with—that’s not a new occurrence. We’re also very much familiar with PPE. COVID, obviously, made it considerably worse and the need for PPE and minimal contact even more of an issue. My team has to go into Critical Care—we go everywhere, really—so we really need to be following all the PPE guidance and correct infection controls because, potentially, we could be spreading it across the Trust if we didn’t. My team are very professional and experienced so know the importance of this.
How has the Clinical Uploader App allowed you to overcome these challenges?
The Tissue Viability team, who go around and see patients as well, have the app, so they can give advice first-hand and capture the image. If the Tissue team can’t see a red patient, the Critical Care staff caring for them can use the app, which is integrated with FotoWare, to take the image without having to expose anybody else to the virus, which has been an absolute godsend.
We can use the app on Trust-approved devices; we capture the image there, capture the consent, and everything is uploaded into our FotoWare image database straight away. Advice can be given directly to the wards for wound care without needing to see the patient. They can also have MDT meetings and discuss what’s needed to treat them. It’s great—they absolutely love it.
What it’s also done is allow us to provide a 24/7 service, which we’d looked at prior to getting the app. Years gone by, we used to have an on-call service, so we’d have photographers on-call 24/7 on rota. That was very costly and we haven’t got the staff to provide this service. Having the app means that all specialties can take images out of hours and at weekends, without too much disruption and at the point of care.
You reported having a reduction in staff-patient contact from 3 to 1—do you feel this has impacted the way staff are able to provide care for or interact with patients?
Prior to COVID, to get my team to go photograph a pressure sore, you’d need a nurse to help you remove the dressing and maybe another member of staff to help you if the patient needed rolling. The ward staff are under so much pressure and so busy, they just haven’t got the time to help us. It’s made it easier for the nursing team, definitely. We’re not going up there and taking a nurse or a couple of nurses away who are caring for another patient.
It’s making our lives a lot easier too because we don’t just cover the tissue viability side of things; we’re a teaching hospital so we have a lot of specialities that we cover. Neuro, plastics and burns, vascular…we have a vast array of specialties, even orthodontic patients. So for us, giving away some of the tissue viability work, skill-wise it’s one of the easier jobs for the photographers to do but it’s made a big impact on us and on the nursing side of things. A patient is being looked after and cared for by a specific nurse, and that nurse can take the image there and then when changing the patient’s dressing. Sometimes, they would call us once they had dressed the patient and put a fresh dressing on, and it would then mean we’d have to ask them to remove the dressing again which is costly, takes time and causes discomfort for the patient.
Could you take me through one of your projects—what was the challenge that the project sought to address and how did you overcome it?
Our FotoWare image database segregates images in specialties, so if a patient gives their consent, they’re only consenting to the clinician that’s looking after them for that particular episode seeing those images. You could be talking about, for example, a child that had intimate pictures taken due to a sensitive condition that comes in to maybe have some dental work. Now, if they were using something called PACS (picture archiving and communication system), that clinician could get those images up and see everything, whereas on our system, because of the information governance that we have, that consultant who only wants to look at the dental images can only see the dental images.
From getting the app to getting it up and running, it only took three weeks, which was brilliant.
How have the team adapted to the software? Has it been easy for them to get used to?
The team got used to it very quickly; the app is easy to use and has step by step guidance within it telling you how to use it. I’m in the process of producing a simple guide because it’s being rolled out to a lot more staff now. Critical Care is using it, and a lot more wards. A lot of the COVID wards use it now too. After they’ve done it once or twice, they get used to it very quickly, so it has worked out well.
What’s next for the programme? What’s coming up in the next 12 months?
What I’m looking at now is rolling the app out to all specialties within the hospital. Orthopaedics are very much wanting to use it because they have an issue with open fractures; if somebody comes into A&E with an open fracture, that needs to be imaged and the consultant that’s on call needs to decide if maybe they need to have something done there and then, and what advice they need to give the registrar.
I want to get rid of all the managed cameras. I’ve managed to get rid of two, but there’s still one that is being used in theatres for out-of-hours use. Once the app’s made available to all the specialties this will no longer be used. The hurdle I’ve got with setting this up is some legacy issues with the way that the image database was set up by my previous manager, so I’m working with IT and MediaLogix now to do some data mapping so that we can roll this out to the whole Trust.
What do you predict for 2021 in terms of health tech?
I think there’s going to be a big push—and I’m already seeing a big push—for more imaging and for how images can be used more for patient care, planning and treatment. Because of COVID, and the way GPs are now referring patients, there are less face to face appointments, so GPs are asking patients to take their own images and attach them to their referral. This has increased the need for patients’ own images being added to our existing image database. Some of the images are of poor quality and make it difficult for clinicians to make a diagnosis, so I’m working with Manchester Royal Infirmary to produce some guidance for patients, and for clinicians taking pictures, on how to do this well.
I have found that my profession have really embraced the new technology and way of working during the COVID pandemic with others taking images and clinical photographers being the experts that provide help and guidance. We are all highly trained specialists and as such we are best placed to move this forward and utilise new innovation for our patients and clinicians.
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