Wireless isn't the future: it's already with us
Mobile Technology: Special Report
Jon Hoeksma
Wireless-enabled healthcare isn't the future, it’s already with us. Almost every health professional already uses a mobile phone, and many also have laptops, notebooks or PDAs with at least the potential to be linked wirelessly.
The potential of wireless technology in health comes from enabling health professionals to conveniently access information and knowledge, irrespective of their location. In hospitals this may be at the patient's bedside while for a health visitor this could be in a client’s home.
As the NHS ramps up its investment in IT infrastructure and clinical systems mobile technologies represent a vital part of the jigsaw, particularly in the area of enabling clinicians to access clinical data and information more easily.
Wireless healthcare promises to make it far easier for health professionals to access and record patient information and clinical knowledge resources at the point of patient care, and work more effectively as part of an extended team of professionals delivering more effective care to patients.
Already leading clinical software providers like iSoft, IDX, Cerner, EMIS and InPractice Systems provide the ability to access systems, or deliver information and data to mobile devices
How mobility fits with CfH plans
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"There is considerable use of mobile technology across the NHS today, be it mobile phones, PDAs or laptops and that is set to keep growing" -- Mark Ferrar, director of infrastructure, NHS CfH |
Mark Ferrar, director of infrastructure for NHS Connecting for Health, explains how mobility forms part of the NHS IT modernisation programme: “What we are conscious of is that there is considerable use of mobile technology across the NHS today, be it mobile phones, PDAs or laptops and that is set to keep growing.”
He says that a standard GP practice has three doctors and 20 peripatetic health workers. “In the future we expect them all to use care records, so mobility is a theme that is set to grow.”
Ferrar explains that CfH is working with a range of hardware, network and software suppliers in what it describes as a ‘facilitating’ role to help the NHS gain the maximum benefits from mobile technologies. “All of the LSPs (local service providers) are interested in this area.”
He stresses that mobility in healthcare is not just about devices, but about the wireless networks and applications as well: “It’s not just about putting something in someone’s hand, there is a whole eco-system of infrastructure to consider. How, for instance, will you get sufficiently high bandwidth to nurses in the field?”
Communications with patients
Wireless technologies are also already making it far easier for health professionals to contact patients – by sending them text appointment reminders, or to track valuable equipment using radio frequency identification devices (RFID).
Using text messages to remind patients to attend appointments or come in for check ups or flu jabs is already routine in a growing number of PCTs and hospitals. Addenbrooke’s Hospital NHS Trust and Glasgow’s Royal Hospital for Sick Children, Yorkhill, have both adopted SMS reminder systems.
PCTs have been even more enthusiastic adopters of SMS to communicate with patients. Mobile health specialist, iPlato, has worked with a number of PCTs to enable them to send out text reminders to patients for appointments, invite them in for vaccinations or flu jabs.
Other applications of wireless technology that looks certain to have a big impact are location services, such as RFID with the ability to track patients and valuable equipment. Pharmaceutical companies are already beginning to make use of RFID, with Pfizer recently announcing that it will begin adding RFID tags to shipments of selected medicines.
Benefits of wireless technology
A 2005 study carried out by Intel, jointly commissioned by George Eliot Hospital NHS Trust in Warwickshire and NHS Connecting for Health, into the impact of mobile technology in acute clinical environments identified significant potential time and resource savings.
The study indicated that investment in mobile networks, devices and wireless-enabled applications can deliver a measurable return on investment (ROI) for healthcare organisations by helping streamline processes.
The feedback from the George Eliot study is that having access to information at the point of care both increased productivity and was much less stressful for patients, explained Intel’s director of UK public sector Tristan Wilkinson.
Mobility and productivity
Wilkinson adds that part of the business case for wireless investments must take into account efficiency and productivity gains: “A wireless environment allows you to do things in entirely different ways, making workers more productive and efficient.”
Specific benefits delivered to clinicians included reductions in the amount of time spent locating pathology results; a reduction in the community monitoring of patients with chronic conditions; less time taken to retrieve surgery notes at follow-up; and reductions in the time taken charting patients.
One of the largest investments in wireless networks so far made by an acute trust has been by University College Hospitals NHS Foundation Trust (UCLH), which has installed a high-speed 54Mbs network at UCLH's eight hospitals, including its new flagship £422 million hospital on Euston Road, London.
The highly secure network is also designed to support fully converged communications and is fully ready for VoIP (voice over internet protocol) over wireless.
"Moving away from paper-based patient records to a wireless-accessible electronic system really frees up the way that medical staff work - not only is information more accurate, but notes can be referred to and updated in real time from anywhere in the hospital," UCLH's then IT director Kevin Jarrold told E-Health Insider.
A 2005 study at St Mary's Hospital, Paddington, found that surgeons whose pagers were replaced with PDAs combined with mobile phones responded to calls more quickly, improving communication between clinicians.
Decisions over devices
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"We may have a situation where devices like tablets come to be treated as just another piece of equipment in a hospital, with very little data directly held on the device" -- Mark Ferrar |
While wireless network technology is progressing rapidly, mobile devices suitable for healthcare are evolving even more rapidly. For some clinicians PDAs provide the way ahead, for others wireless computer trolleys offer the best solution, others favour laptops, smart phones or tablet PC devices. Other organisations, including UCLH, are experimenting with mobile cart PCs linked to a wireless network.
According to CfH’s infrastructure director, one of the key considerations in choice of device is security, ensuring that patient data is only securely accessed by authorised clinicians. This means that devices both need to support CfH’s security and access model, such as supporting smart card access, and only hold a small amount of patient data at any one time. This way, patient confidentiality is not compromised should the device be stolen or picked up by someone else.
“We may have a situation where devices like tablets come to be treated as just another piece of equipment in a hospital, with very little data directly held on the device, so it’s almost a utility computing model,” explains Ferrar.
Another issue being examined by CfH is how a mobile device will work in a clinical environment. “One of the things we are interested in is to ensure that devices are easily cleanable – we’ve got into this area very early working with microbiologists on issues like MRSA. This is part of the discussions we are now having with suppliers.”
The reality is that different devices are likely to work best for different health professionals depending on their role and location. Ferrar describes this as “striking a balance between reducing diversity [and cost] and satisfying individual user needs.”
A GP looking to check a prescribing guide in a patient's home may well find a PDA suits him best, her counterpart in a busy hospital may find that a tablet PC offers the best way to call up a patient's electronic record and show them details such as diagnostic images.
Building for a mobile future
Another aspect of mobility that is often not considered, says Ferrar, is creating an infrastructure that enables hot-desking, allowing clinicians to log-on and access information and applications at terminals on any given ward or location in a hospital.
A huge range of mobile applications are possible, says Nokia’s Arjen Soetekouw, “but they require a government with the vision to implement”. He says that so far it is Scandinavia, UK and Germany that are leading on mobile technology in healthcare, but overall the healthcare sector still lags behind sectors like financial and professional services and logistics.
Soetekouw says that the Department of Health has expressed great interest in the application of mobile technology and applications once the initial phases on the National Programme for IT are successfully in place.
Ferrar concludes “Mobile technology is a very important and expanding area. We expect to work very closely with the clinical community and vendors to exploit the opportunities that arise.”
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