Empowering the mobile frontline

From the Frontline – a new semi-regular series of blogs featuring independent thought leadership and comment from a range of leaders that span the healthcare industry.

The demands on the NHS are increasing and evolving. With the NHS workforce strategy now due in 2023, there’s the need for healthcare staff to be better supported by technology and enabled to be more productive. How can IT advances best be leveraged to support an increasingly mobile health and care workforce?

The changing disease landscape

When the NHS was set up a major focus was on the treatment of acute diseases. The model was that people were well, then fell ill and came into hospital for treatment for cancer, heart attacks, flu, broken bones, burns etc. They then recovered or did not. Now that as a population we are living longer, thanks in part to our success in treating acute illness, the disease landscape is changing and chronic conditions are demanding more NHS funding and focus, with significant and increasing levels of funding going to long term care of chronic conditions.

The increase in conditions such as obesity, diabetes, and dementia drive the trend away from hospitalisation as the default response. This fundamental change requires an evolution in the way the NHS works. The frontline increasingly needs to be beyond the hospital gates. Different patient/disease profiles lead to care needing to be delivered in a variety of settings. This requires the application of the very best technology to empower and enable a mobile workforce, while maintaining safety, security and auditability standards.

Enabling the mobile workforce

There’s evidence that caring for people in their home environment as much as possible can deliver better outcomes for chronic conditions. This approach is also more cost effective. But if we’re going to increase the time spent by clinicians beyond the hospital gates and take more health and care into people’s homes, we need to support them with the right technology.

The mobile workforce needs the right toolkit including lightweight but sturdy, hygienic devices which can access EPR speedily and securely. Staff not only require the ability to view data but to update it in situ with the patient. They need to be able to interact, initiate and complete healthcare workflows, for example, being able to order tests and see results while on the move. The healthcare applications and devices need to be intuitive and ‘just work’. This is not a new challenge but needed now more than ever.

What is IT’s role?

A large part of the user experience for the clinicians and patients is the ability for the applications to be ‘always on’ and for frontline staff to be able to log on and switch between systems, rapidly and securely. The mobile workforce needs to feel confident and that their actions are audited to protect against claims of negligence when treatment is given beyond the traditional boundaries.

This all requires an evolution in the way IT departments support their clinician colleagues. IT must provide appropriate reliable devices and a flexible technology infrastructure to support fast access by utilising, for example, single sign on (SSO) to access multiple systems and data, and virtual smart cards to ensure security and auditability. The old ways of enabling mobile working such as recording and storing data on laptops and USB sticks is no longer fit for purpose. Future elegant mobile solutions will separate front end apps from data held securely in the cloud, so that user interfaces can be upgraded easily as technology advances.

Mobile clinicians will find new ways of working

Taking more healthcare beyond the hospital walls should bring initial improvements if done well, but over time it’s likely we’ll also find clinicians using their new mobile toolkits in innovative ways. This should bring advantages but could also introduce new challenges and unintended consequences, which will need monitoring.

Bob Wachter, The Digital Doctor, who writes about the adoption of digital health and care, cited how digital solutions changed the work processes of radiologists in the USA. Traditionally radiologists would interpret X-rays and groups of junior doctors would attend the Radiology Department each day to see the developed film on light boxes on the wall. The doctors would learn about a wide variety of conditions and radiologists would get personal feedback and appreciation.

Now image reporting systems have been introduced with results sent to junior clinicians’ inboxes. There’s no need for the daily briefings. Removal of wet film processes has brought financial savings and reduced the usage of dangerous chemicals. In some cases there’s no need for radiologists to come into the hospital. They can work remotely from home and clear their workload early – but they no longer get their feel good moments from working with colleagues and feeling part of a team. Digital solutions have enabled them to create new ways of working but healthcare organisations need to keep a watch not only on what has been gained, but also if anything has been lost.

Enabling patients

The first decades of the century have seen large parts of the population increasingly managing their lives via mobile devices and apps. This has created an expectation that clinicians should also be able to provide care beyond the hospital via solutions that ‘just work’ and utilise the power of the cloud. Making more healthcare mobile can also harness the power of patients and their carers to participate in their care – for example, collecting data, performing tests, accessing their own records and supporting each other via online patient communities.

UHS Southampton created a solution which supported prostate cancer patients. Originally if the prostate had been removed, over the following five years ten follow up outpatient appointments were scheduled - one every six months. The hospital created a solution called My Medical Record which enabled men to access their own PSA test results and if these were raised they could initiate a telephone consultation which would determine if an outpatient appointment was needed. There was also the facility to connect with other patients in a similar situation. This online community led to improvements in morale and general wellbeing.

Next steps

Empowering the mobile frontline for clinicians is key to the future of efficient health and care provision. To find out more, download Imprivata’s “unlocking the power of mobile” clinical checklist and IT checklist.