FHIR UK Core Hackathon: improving patient visibility on virtual wards

Some of our team recently headed down to Digital Health Rewired in London to take part in the FHIR UK Core Hackathon with INTEROPen, answering a brief to hack virtual ward use cases.

Our CEO Paul, and Healthcare Growth Director Pad, joined developers Ryan and Owen to take on the hackathon challenge. The team had just two days to create an end-to-end virtual ward app utilising FHIR UK Core, working through the full virtual ward cycle covering admission, monitoring and submitting observations, and discharging patients.

We caught up with Ryan and Owen to learn a bit more about the hackathon and what they built.

What’s the background to the Hackathon?

Owen: “The UK FHIR Hackathon was run by INTEROPen as part of the Digital Health Rewired event. The purpose of the Hackathon was to build something using UK Core FHIR based on the different use cases provided – and our work focused on virtual wards. We built our solution and then delivered a demonstration at the end of the two days to the other competing organisations.”

How did you approach the brief?

Owen: “We looked at the brief and decided to tackle all of the use cases available to us to give a more detailed view of how our proposed solution would work in practice. Our solution centred around improving the visibility of patients on a virtual ward to outside clinicians, as this is an issue that’s been flagged with virtual wards. For example, GPs don’t currently have a simple way of confirming whether or not a patient is actually on a virtual ward.”

What were the virtual use cases?

Owen: “NHS England supplied four distinct use cases, covering each patient’s journey from referral right through to discharge from the virtual ward. The objective was to use the core profiles provided to demonstrate the technical feasibility of a standards based approach using FHIR.”

Below is a summary of the use cases that our team were briefed to use:

Use case 1 – sharing data for admission/discharge process: The clinician, who is not involved in the virtual ward delivery, can easily refer a patient to a virtual ward and share all relevant medical data with the virtual ward team regarding their admission.
Use case 2 – patient care setting/location markers: The clinician, who is not involved in the virtual ward delivery, can view a patient’s medical record and easily confirm whether they are currently on a virtual ward, so they are aware of the current care provision they’re receiving.
Use case 3 – real-time/spot observation data sharing: The clinician on a virtual ward can automatically view structured observations in the main clinical record taken by their patient using a remote device without having to copy data over manually.
Use case 4 – real-time/spot observation data sharing: The clinician on a virtual ward can generate a summary of key data from the remote monitoring platform that can be shared with the main and locally used clinical systems when the patient is ready to be discharged.

Tell us about the solution you developed?

Owen: “Ryan created the frontend of the solution which displayed all of the patients on the virtual ward. This was essentially a simple mock up, pulling all the data from the backend which I built, which then pulled data from their servers. This meant that we were then able to add observations to each patient record, such as heart rate and blood pressure, which would be needed on a virtual ward.”

Ryan: “As Owen said, I built the frontend of the solution using Blazor to create a virtual ward, and we were given four NHS patient numbers to use. We then assigned each patient to the virtual ward and included functionality to add new patients as and when needed. They also provided a frontend to view the data and this gives you an idea of what the FHIR objects look like under the bonnet.

In our app you could search by a patient’s NHS number and then add the user to the virtual ward. Doing this creates an ‘episode of care’, confirming the user has been assigned to the virtual ward, which then notifies other clinicians that the patient has been registered and assigned to the virtual ward. Within the app we built, there is the ability to add observations about how the patient is responding to treatment, and a score is calculated based on the information that has been input to determine the most appropriate course of treatment or whether the patient can be discharged.”

What did you learn, and what would you do differently next time?

Ryan: “The Hackathon was a great opportunity to experiment with the different ways we could interact with a FHIR server using various industry standards provided by NHS England.

If we had the chance to tackle the brief again, I think we could have used an open source FHIR frontend server instead which would have sped up the development process of Blazor, as well as enhancing the overall look and feel of the frontend. Another thing we could have done differently is explore multiple methods of gathering observations for the data e.g. via smart watch or mobile phone.”

How was your solution received?

Ryan: “After two days of development each competing organisation had the chance to deliver a short presentation, demonstrating how their solution would work. Everyone in the room then had the chance to scan a QR code and cast a vote for which demonstration impressed them most. We finished in the top 3 so I’d say we did pretty well!”