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Transforming community care

Chris Gregory, head of clinical systems for LGSS Local Health and Care Shared Service — a public sector organisation providing back-office services including IM&T to local government and health organisations across Northamptonshire, Cambridgeshire, Buckinghamshire and Norfolk — explains how mobile solutions are transforming the work of community-based health teams.

As the IT provider to Northamptonshire Healthcare NHS FT, LGSS has been involved in delivering mobile working solutions to a number of community-based health teams, including health visitors and district nurses, and for providing similar solutions in local government. 

The trend towards delivering care closer to home to meet both patient aspirations, and the need to deliver savings through the reduction of estate, means that increasing levels of flexible working are being demanded across the NHS. If done successfully, mobile working can help to deliver the type of service that patients tell us they would like from their health service. 

Patients typically want greater involvement in their care, with care delivered in more convenient locations and a safer service in which staff are equipped with an accurate and timely clinical record. Often patients being treated by multiple care staff express their wish to tell their story only once and be assured that all subsequent care workers have access to this information. Mobile working, facilitating the provision of up-to-date clinical records to care staff, is one of the most effective tools in meeting these aspirations, and this article describes some of the ways in which we have attempted to achieve this in Northamptonshire.

Northamptonshire Healthcare has always had a large percentage of its staff operating in the community, delivering services such as health visiting, district nursing and community mental health services. Whereas staff in these services tended to start and end their working days at central bases where clinical systems running on desktop computers would be consulted and updated, this data is often now reviewed and updated on mobile devices while the staff are out and about. In practical terms, this means trying to find the right combination of device and application to meet the needs of this busy and highly distributed workforce.  

As with many IT services we’ve had a few attempts at delivering practical mobile working solutions, each based on and constrained by the technology available at the time. Prior to our latest deployment, we asked staff what they needed from a mobile device. Overwhelmingly, those who responded wanted: 

• A small form factor: There is plenty of other equipment a district nurse needs to carry so devices need to be small, as light as possible and certainly no more awkward to carry than the files of paper notes previously used
• Sufficient battery life to get through an entire working day
• A fast start-up: Ensuring that as little of the precious contact time with the patient was spent waiting for the technology
• Versatility: Multiple means of inputting data, suggesting the need for both touchscreen and keyboard input 

Another element our mobile users were clear about was that they didn’t want to see the full desktop version of the patient record. To this end we deployed the SystmOne Mobile Working application, allowing us to present a cut-down version of the record tailored to individual staff cohorts and offering semi-connected working meaning that, in areas where a good 3G signal was available, updates to the record would be live — whilst in areas with poor or no reception, data could be recorded offline and forwarded to the database once a signal became available.   

Connectivity challenges have represented a significant limiting factor in previous deployments. Northamptonshire has a number of rural areas where obtaining a reliable 3G signal can be practically impossible, often in spite of what provider coverage maps claim, hence the importance of our semi-connected patient record. Similarly, timing the procurement of mobile devices was difficult. At the point of our purchase the device we selected was the only one on the market that ticked all of our boxes in terms of functionality and meeting our user requirements. Within a short time the market had caught up somewhat and our device had been overtaken by better, faster and more reliable models. 

Buying relatively new products we deployed tablet devices running Windows 8, but there was little information at the time of purchase to indicate long-term reliability or the problems that might develop over time. Deploying a thousand such devices to a workforce relying heavily upon them will unearth these issues rapidly, so you need to be creative in deploying updates, advising on usage and issuing workarounds as required. 

Critically, you’ll need to ensure that a thorough training and business change process for end users is in place. Don’t forget also the cultural change aspects of mobile working. Staff visiting base less regularly are missing out on some of the more pleasurable parts of coming to work – catching up with colleagues, feeling part of a team and sharing best practice with team mates — and you’ll need to consider ways to offset this isolation. 

Clearly it’s worth persevering with these measures to ensure a better experience for patients and staff, as well as the achievement of organisational goals around data quality and a versatile workforce. 

Mobile working gives staff the option to start and end their working day from home, removing the need for visits to base at either end of the shift – offering organisations the opportunity to reuse the time saved. We’re not entirely there yet in Northamptonshire, but we’re moving forward with the next challenge being the integration of health and social care records to deliver further benefits to our population.