It is easy to see why the 130 midwives working for Portsmouth Hospitals NHS Trust are happy with their new BlackBerry-based note-taking system.
It saves them having to write up their notes three times; it saves them having to carry a heavy diary; it leaves them more time with their expectant mothers, and their information is a lot more secure than it used to be.
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The project is the brainchild of Richard Sargent, who arrived at the Trust two years ago, charged with the task of bringing mobile technology to staff.
At the time, whenever a midwife went to visit an expectant mother, she would have to write a record of the visit in a book which the mother retained, then make a copy of the notes in her own diary, and then update the Trust's digital records when she returned to her office: clearly, an inefficient (and insecure) method of patient data collection.
Sargent examined a wide range of portable devices that could be used by clinical staff, including laptops connected via 3G networks, tablet PCs, iPhones and other PDA devices.
Some managers already used BlackBerrys, and it was during a meeting to renegotiate the BlackBerry contract with one of his communications suppliers that Sargent spotted something new. "Our O2 account manager was writing on a paper pad with a digital pen. I asked him 'What's with the fat Biro?'"
The device in question was a mobile digital pad and pen that could record what it wrote and then upload that data to the BlackBerry. Sargent saw the potential to adapt it to his needs, and organised a demonstration of a range of products to the Trust's managers. The midwifery department immediately volunteered to pilot the digital pen.
The pen itself is made by Anoto Group AB of Sweden and supplied by specialist integrator PaperIQ Ltd., based in Hampshire. The technology works by using a special stationery pad that is printed with a faint, unique pattern of dots. As the user writes, a tiny camera in the pen registers its movements across the surface of the paper, using the dots as coordinates, and creates a digital image of exactly what is written with each pen stroke.
In the Portsmouth implementation, the book supplied to the expectant mother now is pre-printed using the specialist stationery, but, in most respects, looks just like the document the midwives worked with before.
Each midwife writes in the book just as before, and, as she finishes each page, she ticks a "send" box, which transmits the information via a Bluetooth connection to her BlackBerry device. At this stage, the data is in XML format and represents a series of penstrokes and coordinates taken from the stationery.
The information is then emailed to the Trust's BlackBerry Enterprise Server and into the PaperIQ server, where the coordinates of dots are converted into meaningful information.
A software template enables the system to interpret what the marks on each individual page of the notes means – for example, an NHS number, a tick in a box, or some freehand text that can be interpreted (with 98% accuracy) by optical character recognition software. The system also retains an image of each page of notes so that they can be viewed centrally.
The effects of the new system have been dramatic. Before implementation, each episode of care – the visit, note-taking, travel and updating the IT system – took an average of 98 minutes. That has now been reduced to 48 minutes. "The birthing rate in Portsmouth is currently increasing between 15 and 20 percent annually," says Sargent. "Beforehand, the midwives were very stretched. Now they are able to spend more time with the mothers.
Confidentiality, integrity and availability
The new system provides increased security on multiple levels.
The BlackBerry device is password protected, the data is encrypted, and a lost device can be remote-wiped as soon as a loss is reported. By contrast the annual diary, which the midwives used to keep, contained details of their visits and patients, and so posed a serious risk if one were ever lost. Also, if a mother damages or loses her copy of the notes, they can easily be recreated from the central system.
The new system also aids business security by protecting the Trust against malicious lawsuits. "Maternity is a big area for litigation," says Sargent. "Because the notes stay with the mother, it could be quite hard for us to control. This new system gives a full record of everything that has happened. It creates a version history as well, so it will also record where corrections have been made and by whom."
The personal safety of the midwife and patient are also enhanced. Every set of maternity notes now has an activation button: If the midwife ticks a particular box, this will activate a set of emergency procedures, operated through Belfast-based service company Guardian24, to ensure the user gets the help she needs: The centrally managed diary and GPS signals taken from the midwife's BlackBerry show her exact location.