Pathways Alexander Gamble Henry Scott-Green Iustin Sibiescu Access via: https://mighty-castle-7537.herokuapp.com/ April 2015 UCL CS & NHS | 1
The Problem What does Pathways solve? April 2015 Section 1 of 6 UCL CS & NHS | 2
Guy’s and St. Thomas’ NHS Foundation Trust • Guy’s and St. Thomas’ NHS trust is world -famous for cutting-edge research and innovation • 1 st Trust Value: Put patients first • 1 st Trust Pledge: Improve patient involvement in the decision making process Source: Guy’s and St. Thomas’ NHS Trust April 2015 UCL CS & NHS | 3
The Problem Information Delivery • Guy’s and St. Thomas’ NHS Trust identified a weakness in information delivery • Critical treatment, symptom and nutritional information was delivered via paper handouts • Information was lost and patients were confused • The solution? UCL Computer Scientists! April 2015 UCL CS & NHS | 4
Research What do patients want? April 2015 Section 2 of 6 UCL CS & NHS | 5
Trust Research Respondents to application survey Patient Relative Would you like an app: Would you prefer a website: Conclusion: Half of trust patients and 75% of relatives want a mobile app or website Source: Guy’s and St. Thomas’ NHS Trust Internal Research April 2015 UCL CS & NHS | 6
Platform Research Clinic visit Response Do you own a smartphone? If yes, is it iOS or Android? Do you have access to a laptop? Conclusion: Smartphone ownership is mixed, laptop access is commonplace Source: Development Team Clinic Visit; GSTT Research April 2015 UCL CS & NHS | 7
Research Conclusions What do patients want? Patients want: • A replacement for paper handouts • A product accessible to everyone with no technical requirements • A product that is easy to use, even with minimal experience of technology Source: Development Team Clinic Visit; GSTT Research April 2015 UCL CS & NHS | 8
Objectives What were our priorities building Pathways? April 2015 Section 3 of 6 UCL CS & NHS | 9
Requirements Pathways must… Help patients make informed treatment decisions • Introduce no risk of data security issues • Contain customisable information for every patient • Place no financial strain upon patients • Allow patients to view all treatment information ever assigned • Allow professionals to add and edit information at any time • Reduce patient stress • Remove the need for inefficient paper based systems • Offer logs of every action taken for accountability • Source: Interviews with the Guy’s and St. Thomas’ clinical teams April 2015 UCL CS & NHS | 10
The Solution What is Pathways? April 2015 Section 4 of 6 UCL CS & NHS | 11
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Decision Making Process Where does Pathways fit? Pathways provides an end-to-end information delivery platform to assist patients throughout the decision making process Treatment decision Discussion made with friends and relatives Review of treatment option information Initial consultation April 2015 UCL CS & NHS | 21
Key Features Pathways features… • Personalised treatment information • Full treatment history • Device agnostic • Strict access controls • Team management • Live data set • Action logs for accountability • Intuitive user interface • Extensibility via API April 2015 UCL CS & NHS | 22
Development How did we make Pathways? April 2015 Section 5 of 6 UCL CS & NHS | 23
Project Management Engineering Methodology Waterfall • Step-by-step progress through deliverables • Ineffective at handling requirements churn Management • Intensive 3-7 day SPRINT sessions Agile SCRUM • Daily progress meetings on Slack Methodology • Co-located team to improve communication • Rapid product iteration Continuous • Efficient identification and resolution of bugs Integration • Automated testing to validate builds April 2015 UCL CS & NHS | 24
Tool Chain Pathways deployment process From commit to production in 2 minutes Release is live on Azure Tested build is deployed automatically Build is by automatically Capistrano tested via CircleCI Code is Slack pushed to Integration Slack Github Integration Developer Slack makes a Integration commit locally Team-wide notification April 2015 UCL CS & NHS | 25
Collaboration Tools Communication & Development • Version control Github • Internal bug tracker • ‘ Git flow’ methodology Axosoft • Client-facing issue tracker April 2015 UCL CS & NHS | 26
Collaboration Tools Communication & Development • Internal communication Slack • Standup team meetings • Git & CircleCI integration • File-sharing between the Dropbox team April 2015 UCL CS & NHS | 27
Technology Stack Development Framework • Large number of powerful gems to more easily implement Framework: features • Rapid prototyping thanks to semantic syntax Ruby on Rails • Excellent community support • NHS data security compliant Hosting: • Toolchain integration for automated deployment via Capistrano & CircleCI Microsoft Azure • Pay for what you use, cheap for beta tasting, easy to scale Hosting: • Saved the day when Microsoft turned off Azure • No patient data – hosts demonstration only Heroku April 2015 UCL CS & NHS | 28
Libraries We used… • Automated testing Rspec + Capybara • Code quality analysis Rubocop • Mass data generation for testing Faker Capistrano • Automated deployment • Image hosting Paperclip • Front-end development Bootstrap • Rapid prototyping Slim HTML • Continuous integration CircleCI Jquery • Date section • Automated system diagrams RailRoady Devise • Authentication and access management • Gem for interfacing with Postgres database PG April 2015 UCL CS & NHS | 29
Testing How do we know Pathways works? • Automated testing: Rspec + Capybara Test cases Results April 2015 UCL CS & NHS | 30
User Acceptance Testing Project evaluation • We provided Pathways access to the trust team for user acceptance testing • Issues, bugs and feature requests were raised by the clinical team through the client-facing ticket tracker • Tickets were then tracked in the internal tracker and fixed April 2015 UCL CS & NHS | 31
User Acceptance Testing Bug management Client facing ticket tracker Internal ticket tracker April 2015 UCL CS & NHS | 32
The Future Where does Pathways go from here? April 2015 Section 6 of 6 UCL CS & NHS | 33
Extensibility How can you use Pathways? • API for 3 rd party applications to use the Pathways backend • Any app or product may send a request to the Pathways API, and if authorised they will receive: • Patient names • Patient module assignment dates • Modules assigned • Full content of every module, with formatting preserved April 2015 UCL CS & NHS | 34
The Future Pathways 2.0 and beyond… • Fully forward compatible with teams and database indexing, easy scaling across multiple NHS trusts • Build upon the powerful backend and API to develop native applications, to allow: • Integration with wearable technology, to track data, deliver symptom information and send reminders • Analytics for doctors to access during consultations to determine activity levels and symptom tracking • Publishing an academic paper April 2015 UCL CS & NHS | 35
Summary • Helping patients make better treatment decisions April 2015 Section 6 of 6 UCL CS & NHS | 36
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