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The healthcare sector is a highly regulated environment that is subject to numerous constraints. Standards around medical protocol, medical device certification, and data protection ensure that the wellbeing and privacy of patients is protected during all encounters with the healthcare system. However, a gap has opened up between the need to meet these constraints, improve performance, and also deliver good patient experience. For example, the medical protocol for hypertension during pregnancy establishes a set of clinically validated treatment guidelines, but does not consider the unique nature of patient experience. We assert that design research principles can be used to create visual tools that pay homage to these constraints and performance improvement goals without compromising patient experience. In this paper, we describe such a tool that has been developed during a healthcare project using a human-centred design research approach. The integrated tool for patient journey mapping addresses the shortcomings of existing methodologies by supporting multidisciplinary practitioners in designing healthcare solutions that meet the demands of existing constraints, performance improvement, and patient experience. In addition, we document how patient journey maps were used on the project to facilitate collaboration among a team of multidisciplinary stakeholders.

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Blockchain, Smart Contracts and other forms of Distributed Ledger Technology provide means to ensure that processes are verifiable, transparent, and tamper-proof. Yet the very same enabling features that bring decentralisation also pose challenges to providing protection for the various users and stakeholders. Most jurisdictions which have implemented regulatory frameworks in this area have focused on regulating the financial aspects of cryptocurrency-based operations. However, they have not addressed technology assurance requirements. In this paper we present a world-first technology regulatory framework.

Background and study aims Colonoscopists with low polyp detection have higher post colonoscopy colorectal cancer incidence and mortality rates. The United Kingdom’s National Endoscopy Database (NED) automatically captures patient level data in real time and provides endoscopy key performance indicators (KPI) at a national, endoscopy center, and individual level. Using an electronic behavior change intervention, the primary objective of this study is to assess if automated feedback of endoscopist and endoscopy center-level optimal procedure-adjusted detection KPI (opadKPI) improves polyp detection performance. Methods This multicenter, prospective, cluster-randomized controlled trial is randomizing NHS endoscopy centres to either intervention or control. The intervention is targeted at independent colonoscopists and each center’s endoscopy lead. The intervention reports are evidence-based from endoscopist qualitative interviews and informed by psychological theories of behavior. NED automatically creates monthly reports providing an opadKPI, using mean number of polyps, and an action plan. The primary outcome is opadKPI comparing endoscopists in intervention and control centers at 9 months. Secondary outcomes include other KPI and proximal detection measures at 9 and 12 months. A nested histological validation study will correlate opadKPI to adenoma detection rate at the center level. A cost-effectiveness and budget impact analysis will be undertaken. Conclusion If the intervention is efficacious and cost-effective, we will showcase the potential of this learning health system, which can be implemented at local and national levels to improve colonoscopy quality, and demonstrate that an automated system that collects, analyses, and disseminates real-time clinical data can deliver evidence- and theory-informed feedback.