“This work has only been possible in partnership with Intelogy and it has been a pleasure to work with them on this aspect of our digital transformation project.”
– Mike Christian, Doctor and Research & Clinical Effectiveness Lead with London’s Air Ambulance and Barts Health NHS Trust
Infographic created by Natalka Design
London’s Air Ambulance has multiple logistical, operational and governance processes that they must manage alongside their on-call duties, primarily relating to the documentation of non-patient data. One of the primary challenges facing the team operating from the helipad was a lack of electronic information management as information was split across multiple channels and systems, including external sources, which made it difficult to gain visibility of and report on progress and activities.
A high proportion of operational time was spent on manual information capture and data-processing, which was predominantly paper-based, and hindered situational awareness. The reliance on physical records prevented remote access to data, and many data-sources such as laminated checklists, equipment whiteboards and paper-based template forms necessitated an on-site presence. This paper format also meant there was an inability to automatically enforce the integrity of data-points, especially those required for real-time audit purposes such as checkboxes and signatures.
Processes with scheduled components, such as daily, weekly, and monthly checks, had to be intentionally coordinated and there was no automated system by which to manage priorities, handle deadlines and ensure compliance.
In the event of unexpected interruptions, documents did not get saved or sent, and sometimes lost. After a mission call-out, the staff would start the process over again, which was a source of frustration and could cause duplication of documentation.
There was also limited visibility of valuable insights such as equipment and vehicle statuses, making it hard to know where key equipment, medical bags and apparel were located and when equipment for both rapid response vehicles and helicopters needed restocking.
By cooperating closely with LAA, Intelogy was able not only to recreate digital versions of the paper-based processes, but also to facilitate the opportunity for optimisation of the core business processes themselves. By empowering LAA with knowledge and awareness of the capabilities of Microsoft Power Platform, Intelogy was able to go above and beyond a like-for-like digital recreation of the previous processes, and to identify and implement a number of substantial improvements to operational procedures. Ultimately this resulted in the creation of a suite of apps built using Power Apps to support a range of activities the team conducts on a daily basis.
Equipment Checklists apps
The first step of the digital transformation effort was to replace the paper-based Equipment Checklists. Each checklist was implemented as a separate Power App and would store its data in the LAA Helipad Operations data model hosted in Microsoft Dataverse. By adopting a multi-app approach as opposed to a single, monolithic Checklist and Equipment Tracking app, it facilitated individual checklist delivery, simplified long-term servicing, and eased concerns over release management.
By looking into the current processes and checklists, Intelogy realised that many of the checklists shared similarities in their structure and layout. After a high-level view of the current structure, it became clear that the checklist information could be stored centrally in a database and each app could pull its specific structure and information data and thus dynamically generate the checklist upon request.
The layout of each checklist was dependent on the individual requirements that each existing checklist had, however, it was intended that each app would apply a consistent user experience to ensure familiarity with the processes and reduce confusion. Each checklist has been recreated as an offline-capable, touch input application available on any device to ensure a simple data entry and process flow.
Each app starts with a dropdown list to allow the person completing the checklist to choose the piece of equipment against which they are running a checklist. While aircraft and vehicle checks have a static design, for medical equipment bags there are two checklist types to select from: Restock and Full Check. A Restock allows for people to navigate through the checklist a lot more quickly and identify which sections of the back require re-stocking as a result of use on a previous mission, whilst a Full Check requires every item and all expiry dates be checked fully.
To complete a checklist, all the paramedic needs to do is indicate the status for each item in the checklist using a simple toggle switch, indicating whether an item meets the expected criteria or not. If the expected condition is not met, then a decision can be taken as to whether this represents a critical failure. Where the decision is that this represents a critical status, then the equipment is marked as out-of-service and flagged so that it will not be used until it is replaced/restocked and returned to an operational status. Even if critical failures are encountered, completing the checklist helps ensure that the re-stocking process can be more efficient as a complete picture of the required replacement supplies is obtained. Additionally, if a user tries to leave the checklist without checking all the items, they will get a warning to prompt them to come back into the list and to check the unmarked items.
Another valuable efficiency feature of the app is the function which allows a section to be marked as “sealed” and relates to how certain sections of the physical equipment bag use plastic pull-through seals to indicate whether that section has been opened. During a Restock check, the seal indicator allows the user to move swiftly through the checklist by being able to confirm that sealed sections have remained unused and thus does not require each individual component within the sealed section to be assessed. Conversely, the Full Check mandates that sealed sections must be re-opened so that expiry dates can be assessed, and the app additionally reminds the user to re-seal the section using a plastic tie and requests confirmation of this status.
Finally, at the end of the checklist process, the names of the team members who conducted the check are recorded, a summary of the checklist information is presented highlighting any non-conformance and where required, physical signatures can be captured on the touchscreen and a final confirmation button will commit the checklist data. In the event that the checklist is being performed in a location with no or intermittent network access, then the app will support storing the completed checklist offline until such time as network connectivity is re-established and the checklist data can be submitted.
Equipment Tracking apps
With 2 helicopters and multiple rapid response vehicles in service, keeping track of the location of individual pieces of equipment is a constant challenge for the team. Add to this the effect of operational use and the need for re-stocking used equipment and the challenge becomes even greater. In response to this need, Intelogy developed a series of Power Apps that provided the operational team with a comprehensive overview of equipment location and status.
An equipment tracking Power App was developed to allow the team to view the status and location of all equipment items and combined the data captured via the checklist apps to provide an up-to-date representation of the status (i.e. operational/out-of-service) of each item of equipment with the ability to drill-down into the checklist data of any piece of equipment to assess any advisories placed on that item.
To facilitate the quick and reliable identification of equipment, within the central equipment management database, each item is assigned a unique QR code (much like a barcode) which is printed, laminated, and attached to the corresponding piece of equipment.