Mobility is one of the big drivers in the NHS. Rather than type up paper notes, mobile devices allow clinicians to access patient administration systems directly.
Cornelia Wels-Maug, senior analyst in healthcare technology at Ovum, says: “Consumers drive the need for ease of use and instant availability. This translates into healthcare, which follows the consumerisation trend. There is a time-lag in healthcare, however, as data needs to be digitised, which is driven by adopting electronic health records.”
A few years ago, state-of-art in the NHS was the so-called Computer on Wheels or CoW, basically a laptop on a trolley which clinicians could wheel around wards. CoW was positioned as the system that provided clinicians with bedside access to the clinical IT system.
The Royal Free Trust in London used three CoWs per ward. However, they were not being used because the trolleys were too large, according to Will Smart, IT director of NHS Royal Free Trust.
“It was almost impossible for clinicians to get the trolley to the bedside,” he says.
The trust is rolling out a ruggedised Windows tablet called the Motion C5v as an alternative to the CoW, to connect to Cerner, the clinical system the trust deployed in 2008.
The tablets run standard Windows XP using a security model based on smartcards. They connect to the hospital-wide secure wireless network.
The device is ruggedised and has been checked by the trust’s infection team to ensure it meets the level of hygiene required in clinical areas. According to Motion, the tablet can survive a 1.5m drop.
Smart has yet to test this: “We have not had any tablet failures yet.”
Along with greater accessibility, the tablet device made IT part of the clinician’s day-to-day work.
“We spend a lot of money on IT. By changing the device, the applications becomes more accessible. This drives up usage,” says Smart.
In fact the Motion tablet removes a lot of paperwork.
“Nurses used to capture data on pieces of paper, then went to a workstation to input the information into Cerner. Now they can use tablets directly,” says Smart.
But the system is not only being used as part of patient care.
“We had anticipated the tablets would be used in clinical systems. But ward managers are using them to log calls with facilities for minor repairs,” says Smart. “They would previously have taken notes on paper.
“We’ve found the impact goes way beyond efficiency – it has improved the quality of care delivered and opened up options for how we work.
“And this is just the start, we have plans for dynamic, responsive operation scheduling, based on anaesthetists being equipped with the tablets and deploying the technology in pre-operative assessments.”
Each ward has five to six devices and a rack called the pizza box, which automatically charges the tablets when they are not being used. Due to the design, it is also possible to hot-swap batteries and Smart’s IT helpdesk will keep batteries on charge just in case one of the tablets runs out of power.
Since it runs the same application, training clinicians to use the device was straightforward, according to Smart. He says: “The main issue was change management, how the technology fits into the work process.”
The trust has done some work to make Cerner as friendly as possible to use on the tablet. “People use a soft keyboard. We also created new forms in Cerner, that use button input, which works quite well with tablets.”
But not everything in Cerner can be achieved using a push-button interface, which means tablets may not be suitable for all areas in the trust.
Smart says: “We won’t replace all desktops with tablets. We want to ensure clinicians have the right device at the right place to do their job.”
This means the trust will need to look at smartphone connectivity and how to use iPhones as part of its technology roadmap.
Smart says the trust is planning to roll out 150 tablets this year across its 30 wards. It will also pilot their use in A&E and look at other key areas such as anaesthetics.
Beyond this the trust will review whether the PCs on the ward are no longer needed.
It is no surprise Research in Motion’s BlackBerry is deployed in healthcare, since the BlackBerry platform is established in enterprise, thanks to its strong levels of security.
University Hospitals Birmingham NHS Foundation Trust has developed a series of applications for the BlackBerry platform that enable it to deliver mobile access to core patient services for clinicians.
Stephen Chilton, director of IT services at the trust, says: “What we’ve really tried to do with the BlackBerry environment is create the ability for us to deliver applications, to supplement traditional phones, scheduling and e-mail capability.”
One such applications, Norse (neurological referral system), enables specialist neurological team to better respond to requests for advice and guidance from other hospitals.
“We may get a request in from another hospital following a road traffic accident. Wherever they are, our specialists can now use their BlackBerry to look up a patient’s records, provide informed guidance and then append their recommendations directly to the patient’s record,” David Rosser, medical director at University Hospitals Birmingham explains.
“It has dramatically improved the inter-hospital interactions that were often the problem points in a patient’s care.”
Beyond the BlackBerry and specialist mobile platforms, there is an almost grassroots movement to bring IT consumerisation to the NHS.
The cardiology department at Great Ormond Street Hospital for Children is using iPads and iMacs for instant access to 3D images of a patient’s heart while planning for surgery, or even in theatre.
Mark Large, IT director at Great Ormond Street, believes mobility is vital. Clinicians need to be able to access data and update records in real time, at the bedside, to ensure each patient can get the best care.
For many nurses and allied health professionals (AHPs), an iPod Touch is ideal because they can simply slip it in a pocket when it’s not in use.
For others, such as doctors using complex clinical software, the larger screen of the iPad works better.
“Mobility is part of a wider journey, one that involves the move from paper to electronic medical records, so mobility has to be ready and working for that transition” says Large.
Great Ormond Street recently upgraded its cardiology MRI Pacs (picture archiving and communications system) system. The tool, which was deployed by Kanteron Systems, enables clinicians to access 3D images of children’s hearts, using Osirix 3D medical imaging software.
When the surgeon goes into theatre they can call up the images directly from central storage onto an iMac workstation in theatre.
South Warwickshire NHS Foundation Trust (SWFT) is another organisation deploying the Apple tablet. Here, the trust is digitising its paper-based library of medical records. It is providing staff with mobile devices to access the information from the bedside in hospitals or while in the community visiting patients at home.
Duncan Robinson, associate director of ICT at SWFT, says the plan will change the way staff work.
“Whether in an acute or community setting, there is significant duplication of information. Paper can’t be in two places at once. Ultimately, flexible, simultaneous electronic access to the latest patient information will free up clinical time and improve patient care,” he says.
Computer Weekly’s sister title, SearchDataManagement.co.uk, recently covered how three NHS Trusts connected iPhones to Oasis’s patient administration system (PAS). Thirty hospitals in the UK use Oasis PAS.
“The mobile system provides the right information to the right people at the right time so that they can make decisions,” says Robert Campbell, managing director of Ecommnet, a mobile application specialist that implemented the business intelligence application.
He adds: “The consultants can identify those patients whose results are out of kilter so that appropriate action can be taken.”
Putting mobile technology in the hands of clinicans is the way forward for healthcare IT in the UK.
The starting point for a mobile strategy is ensuring patient records are digitised. Clearly hospitals also require robust wireless networking, since poor networking limits will impede the way clinicians access medical data.
Virtual desktop software, such as Citrix or the BlackBerry Enterprise Server, can widen access to clinical systems from a secure mobile environment, but devices will need to be managed, which is what Great Ormond Street Hospital does with the iPads it issues to clinicians.
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