At home with the upwardly mobile

Home-based care could save the NHS more than £1bn a year, according to a report by Dr Foster Intelligence for Healthcare at Home. But effective community healthcare depends on wider availability of the clinical information used by practitioners in hospital. For health service organisations, this means providing mobile access to clinical and patient information. Early adopters in the NHS are using mobile devices ranging from smartphones to ruggedised laptops to near field communications (NFC) enabled mobile phones for monitoring, time and location recording. "In my experience, the use across the UK of technologies to support mobile working among nursing staff is patchy," says Nicholas Hardiker, eHealth adviser to the Royal College of Nursing. "While there are excellent isolated examples, it is frustrating that the majority of front line community staff still do not have the basic technology they need to do their jobs." Portsmouth Hospitals NHS Trust, with funding from South Central strategic health authority, is introducing BlackBerrys with pen input across its midwifery service from the beginning of March, following a pilot. The so-called 'digipen' technology transmits handwritten patient notes to electronic hospital files. Deputy head of midwifery Jayne Jempson says: "Our service has 6,000 births a year, about a quarter of which occur in the community, which is very unusual for a maternity service. It could easily be expected that a woman may have between 15 and 20 contacts during the course of her pregnancy and postnatal period so it is those that we are really trying to capture with the digipen. "We would anticipate that this would really improve patients' experience by giving midwives time to be with them," she adds. "Also, we can better capture the activity that the midwives are doing for payment by results for which maternity services get their funding." Previously, midwives were required to make multiple copies of patient notes. The project aims to eradicate duplication of data entry and errors, as well as providing real time mobile access to patient data. In the run-up to its full introduction, 130 clinical staff are training on the new system. "The majority of these will be midwives but there will be some obstetric colleagues, because there are obstetric clinics that take place that need to be recorded, as well as some of the support staff," says Jempson. "People are looking to see what results we get, how it works and take it from there." Lincs to the community As director of informatics at NHS North Lincolnshire, Trevor Wright was responsible for deploying mobile technology to support service transformation of community services. He implemented ruggedised laptops developed in conjunction with Panasonic and based on a BT mobile contract that includes special arrangements with other mobile service providers. This model of mobile working is being developed nationally according to Wright, who adds: "It is fair to say that Yorkshire and Humber have led the way." Wright now works for NHS Yorkshire and Humber, the local strategic health authority. It has expanded the use of mobile technologies in the community into other primary care trusts including NHS Calderdale, NHS Kirklees and NHS Sheffield. "North Lincolnshire uses about 600 devices for community based treatment, accessing clinical records while out in the community. It was the first full scale deployment and we have learned lessons from that," says Wright. The lessons mainly revolve around transformational change and technology: "The transformational change issues are primarily about ensuring that the organisation owns the deployment and the deployment is service-led rather than technology led." "Initially in North Lincs we put it straight in – give the equipment to the staff and it will deliver," he says, but adds: "That is not the case. The need for a transformational change programme is the first serious lesson." "With training there was an expectation that staff were well versed in IT," Wright continues. "They were using IT but the introduction of mobile devices and the use of IT in different settings brought with it different challenges so there is certainly a significant need to increase support both in terms of training and technical support. "Secondly there was a need to review business process and ways of working so rather than just doing the things they used to with the aid of technology there was a need to spend the time reviewing the way they do things to optimise the use of technology." The biggest technical problem was network availability. "A certain amount of effort in every deployment now goes into testing different service providers and you cannot guarantee good coverage anywhere. What we now advocate is to only assume that this will work 75% of the time," says Wright. "We are now working with suppliers to develop their applications so that they will work in a disconnected way." He cautions: "Mobile access to clinical systems is very helpful, however you must have robust clinical systems to access to make it worthwhile." * Portsmouth Hospitals is among the trusts presenting its work at Kable's Mobile and Wireless Healthcare event next week, on 24 February in Birmingham. For more information, click here.