Mobile technology gets poor reception in Torbay

Torbay Care Trust wanted the benefits of mobile working for its community health delivery but faced a major obstacle. Much of its local area does not have 3G mobile coverage and the mobile operators seemed to be in no hurry to improve coverage. But after a number of unsuccessful trials of mobile devices the trust, which commissions both health and adult social care services for 140,000 people in the Torbay area of southern Devon, has now piloted a system that has delivered the benefits it was seeking. "A couple of years ago we did the mobile working pilot where we tested an awful lot of equipment to try to do it through 3G and in a big part of this area you cannot get any connection," says Vanessa Dunn, the trust's chief information officer and head of IT and telecommunications. "We looked at digital pens, we looked at tablets, we looked at different types of phones and we were thinking what else could we try? "We had to think about how we would deal with this because we are never going to have an always on connection. We had to think of something where, whether it was on or offline, staff would be able to see the same information." The trust designed its own system, based on laptops. Community matrons take a laptop out to patients and can access information and previous notes offline. On return to the clinic or hospital, the laptop is docked and the information synchronised with that held centrally. "Our aims were that they only had to input the information once, that they had the most accurate and up to date information at all times and that it was an easy enough system to be used and didn't get in the way of their main focus of looking after the patient," says Dunn. The system has been set up so that the changes staff make are auditable and they are accountable for them. Records are put into chronological order: "If for instance I was in the office updating the same patient record at 10 o' clock but they had made their visit at half past nine, when they go back online that record would then go in for half past nine so that historical information is all in the right chronological order," she says. From paper to pilot The system was piloted for six weeks beginning in January after six to eight months' development. "We took a very small selection of our staff who weren't using any system at all – they generally used a spreadsheet and paper," says Dunn. "Community matrons work with complex people with quite complex needs and they also touch a variety of other roles within health and social care, like end of life and district nursing. We were looking at a system that would allow them to do a health needs assessment with single assessment process, something that would do the scheduling for them, take a referral and when they were going out they could do the TPRs, the temperature pulse and respiratory, and be able to track that as you went so if you were seeing a patient on a daily basis they can get a clear chart of where that patient was at any particular point." The system was designed to be easy to use online or offline: there is just one button to press to select on or offline mode, and staff responded well to it. "We only did this as a six weeks trial, however some of the matrons who have never used anything to do with IT before while working with patients were able to go out and work with everyday laptops after two hours training," says Dunn. "That was magnificent for us and they really didn't need much more support than that." This is in contrast to earlier pilots of mobile devices two years ago. "At the time it was seen as about 50:50 successful," she says. "I would say that the support side of it, if you weren't standing next to the person who was doing the work it was unlikely they would use the device. "The software that was used before needed to be always on, you couldn't have the offline capability so by the time you had tried to get a connection – which could have taken four or five attempts – you then went to talk to your patient and lost it again. It was very frustrating so they would give up." Torbay Care Trust now plans a scoping exercise to decide where it goes from here, according to Dunn: "Because of the success of this we would like to put it further into practice. The laptops were heavy and we would look for something a lot smaller and lighter in the future." Torbay Care Trust will be speaking about its experiences using mobile technology at Smart Healthcare Live, at 11am on Wednesday 16 June. Click here to register free for the event.