In line with other public sector organisations, the NHS is required to make savings over the next few years. In total, these savings will amount to approximately £20Bn and are expected not to come from front line services, but rather to be found in rationalisation and efficiency savings across the board.
One way in which Acute Trusts and Mental Health Trusts are seeking to meet this challenge is to undertake Estates Rationalisation Programmes. Many organisations have a number of sites which are extremely expensive to run and are often providing limited services which can be carried out better in the community or linked with other NHS delivery to bring efficiencies.
For example, at some Trusts Community Nurses are based at a site where they have to attend each morning to log in to systems and collect their workload before setting off to see patients. At the end of the day, the clinician is required to return to the site to input the results of each clinical session undertaken, as well as ordering any follow ups required. This seriously impacts on the total time available to clinicians to meet with patients.
Technology can help. By making clinical systems accessible over mobile and wireless technologies in a completely secure and safe manner ensures that the clinician is able to access notes and patient details at the point of care. In the case of areas where mobile and wireless coverage is far from perfect (anything from rural areas to city centre housing estates and high rise blocks for example) systems can be made available in an “offline” mode. In this mode, the clinician still has access to information which is at most 24-48 hours out of date, but still very relevant to the patient.
The ability of these mobile clinicians not to have to come in to a “base” on a daily basis will reduce the amount of wasted time in travelling, and will increase total clinician-patient face time on a daily basis.
But Trusts need to think carefully about how this is achieved. Requirements of the Data Protection Act, the underlying principles of Caldicott and other NHS specific regulations around patient data security cannot be dismissed. The ICO (Information Commissioners Office) has been fining NHS organisations large sums for the loss of data, and so Trusts must ensure that data is fully secured both at rest and in transit.
Solutions will need to ensure that mobile devices (including BYOD devices) are properly secured and can be centrally managed – including full remote locking and remote wipe. In the case of clinical information, there is a requirement that the information is encrypted at all times. Furthermore, IT Directors and CIOs will have to ensure that such solutions are not open to “screen scraping” technologies.
But it is not only the information which needs to be secure. We also need to secure our staff. Clinicians are already vulnerable when out working in the community. Some are seen as targets for FP10 forms (prescriptions) or for possible drugs they may be carrying. Others invite attack simply for being a clinician. Equipping these staff with expensive mobile devices may increase the risk of muggings etc.
To prevent this, Trusts must employ strong lone worker solutions. A number of these are available ranging from solutions which are manual – based on mobile phone usage – to technically adept solutions which track locations (GPS) and have two way radio built into them which can be operated without patients/citizens being made aware. This then allows an emergency call centre to listen in to the situation and summon the appropriate assistance. The small costs of such systems and the decreasing costs of mobile solutions is quickly saved in the ability of organisations to reduce their estates footprint and to treat more patients in a shorter time.
But a word of warning. It is easy for CIOs and IT Directors to over-promise ROIs and perceived benefits of such systems. Any such implementation should be done in a phased approach allowing impact on services and savings to be correctly measured and monitored before a whole systems roll out. There are issues around ICT training, availability of hardware and solutions, security and even clinical adoption which need to be carefully ironed out before any programme is initiated. And one of the major reasons for failure of IT Programmes in the NHS? Clinician Engagement – the Trust must ensure that key clinicians who represent their areas are involved in the design and build of any mobile solution.
As an IT person, I can design a technical solution which will best meet the technical need – I cannot design a solution to be used in clinical areas without clinical input. I will only look at the technology, I need the clinicians to tell me how they work to ensure that workflows are logical to the use cases. Running a Proof of Concept with a partner of choice who is technology and vendor agnostic will allow Trusts to mix and match all solutions available to find the best approach for their specific clinical and business needs. Not all mobility solutions are the same, and not all security solutions are designed with the mobile workforce in mind. Overall, Trusts need to ensure that they select the right partner who is able to work closely with them to assist them in achieving their goals.