This post is theoretical.

A long time ago I worked in a small hospital with a smattering of clinical systems. At the time, Power Automate was a new and unregulated beast in the Office 365 system of NHSmail. Its functionality then was relatively limited compared to now - there are wide variety of connectors that did not exist back then.

But I was working at a hospital that used a service for its clinical handovers which was - controversially I know - a relatively simple HTML/JS website. Admittedly a SPA, but nonethless browser rendered. This obviously made it a potential target for crawling, because as we know ward rounds are (in terms of time) time heavy due to documentation, but relatively light in terms of thinking and doing time.

This online clinical system contained two things - an electronic handover of PMHx, current diagnosis, patient name/demographics, patient location, and outstanding tasks. This was manually updated on a per patient level by some dutiful F1. Of most interest, was the integration with the observation suite - the last set of observations were visible on the patient's front page.

Therefore I share with you an approach I developed to generate an automated ward round entry using Power Automate. I offer no code as it was deleted in the great PowerAutomate castration of circa ~2024.

• Log into said website with Power Automate
• Load the ward view (a list of patients) and scrape the patient details and location into an excel file
• For each patient above, load their individual record, copy the observations (by HTML scraping) and copy the handover into said Excel document
• Using Power Automate and MailMerge or equivalent, generate an A4 ward round proforma in a predetermined format with the patient's demographics prefilled, diagnoses, active issues and PMHx copied from the handover document.
• Print each individual document and hand complete for the ward round.

To my knowledge this did not and would not break any data protection rules as the information was only ever kept within NHSMail, and the PowerAutomate crawler simply scraped existing webpages so no "hacking" of e.g. API endpoints was required.

At the end of the day the "handover" website was updated in the usual manner and this was then reflected in the notes the next day.

There was something satisfying about printing an entire ward round's worth of proformas in 5 minutes. Ultimately, it didn't catch on. The thought of actually using this for patient notes without departmental sanction seemed unnecessary risk for only marginal gains. If I were to do it again I would print it onto the trust's typical medical documentation notes to make the notes look more "authentic".

In terms of efficiency gains I suspect it saved around 5 minutes of work per patient (less than you'd expect because now extra time is needed to update the handover website properly) but the cumulative savings were significant.

At some point I will try to write down my thoughts about the educational value of ward rounds in the 21st century in a world where technology like the above exists. For now though, just consider what could have been.