Smart Healthcare: Mobile | SmartHealthcare.com

Trusts to put secure bleep service on mobiles

Wed, 08 Sep 2010 23:05:00 GMT

Salford Royal NHS Foundation Trust and Stockport NHS Foundation Trust plan to implement a secure interactive web-based messaging system

The new technology, which will be rolled out at the end of September, enables doctors to use mobile phones to access the hospital's secure wireless network to receive messages.

A similar iBleep system, designed to contact doctors on call and communicate critical information gathered on hospital wards via wireless or mobile telecoms network, has been in use for a number of years.

"The phone is configured the first time it is used and each time the doctor tries to connect to the network, with a user name and password, we assess security," said Roy Walters, managing director of iBleep.

"Doctors log into iBleep using a PDA or a smartphone. When a call is sent, an alert sounds at regular intervals until the call is read. These alerts change in volume and frequency according to the urgency of the call."

Calls can be made by nurses at a patient's bedside or on a ward computer, and can be ranked red, amber or green according to the urgency of assistance required, with red being the most urgent.

Commissioning a bridge for GPs' information gap

Michael Cross — Wed, 18 Aug 2010 08:00:00 GMT

The government's white paper does not recognise how important IT and data will be to GP commissioning

When the Department of Health asked the leaders of GP practice-based commissioning pilots carried out under the former government what they thought of the experience, information emerged high on the list of wants. Only 51% of leads rated as good the format and quality of information and data they received from primary care trusts (PCTs); 42% said the same of its timeliness.

Yet the government's white paper setting out plans to move the English NHS entirely to GP commissioning makes scarcely any mention of the need for information technology to plan health needs, measure outcomes and to manage the contracting process.

To judge by the white paper, there is little sign that senior policy makers have given any thought to filling the information hole left by the abolition of PCTs, let alone to the demands of new GP-led innovations. Yet as a recent Department of Health report Sustaining innovation in telehealth and telecare makes plain, information is vital if commissioning is going to lead to innovation. "Commissioners need a certain level of evidence to adopt a new approach to care, particularly when they may have to decommission or redesign an existing activity to accommodate it," it says. "This requires sophisticated systems for assessing population needs and making appropriate commissioning and decommissioning decisions."

For firm signs of how the government intends to fill the information gap, we must await the new information strategy to be published in the autumn. Some indication of what the strategy will need to tackle appears in a document published in July by the IT trade association Intellect.

The paper, Care commissioning in England – an Intellect perspective on the challenges ahead, warns that commissioning as a discipline is still a relatively new process, with PCTs still in the early stages of developing strategic capability. If GP consortia are to take on the role, they will access to information about the health of their populations and performance of their healthcare providers in a much more seamless way than today. It proposes that systems to support GP commissioning will:

- Provide access to data residing in provider organisations' system, directly or indirectly, in anonymised form.
- Set standards for data, based on existing initiatives such as the Secondary Uses Service and the proposed NHS Interoperability Toolkit.
- Enable business intelligence and data mining. Administrative and clinical data currently locked up in isolated data stores could be made available as a web service to commissioners and be put to use detecting patterns and trends "to enable funding for prospective care instead of the current situation of contracts being funded by retrospective episodes of care".

Commissioners will also need support for assessing the risks of different decisions and modelling the outcomes. The Intellect paper stresses the need for support in contract negotiation and managing performance.

With an eye to the political wind, the Intellect paper stresses that these functions can be achieved largely with existing systems: "These are not 'big ticket' new investments," it says.

From gap to gateway

In one sign of IT suppliers anticipating the new world, the two firms responsible for systems in 75% of GP practices, Emis and INPS, have announced a joint venture known as Healthcare Gateway, through which their systems will interoperate. The Medical Interoperability Gateway would exchange electronic discharge summaries and other documents.

One commissioning decision that will frequently come to the fore in the new climate is when and how to embrace telemedicine and telecare. Over the past few years, the vast majority of such initiatives have been led by PCTs. A new Department of Health study of these schemes casts doubt on whether the costs and benefits of different breeds of telecare are well enough understood for GPs to go it alone. The DoH briefing paper on the topic warns that for telehealth and telecare to survive and thrive in a cold financial climate, the use of such technologies "needs to be integrated into commissioning plans and local area agreements rather than being stand-alone programmes or pilots".

But it adds: "The process of scaling telehealth service remains a barrier to innovation, technology adoption and service transformation. New procurement models and risk-sharing will be needed to support local business cases unless there is significant take-up through the consumer market."

All this amounts to a major challenge for the debutantes of the GP commissioning world. While the findings from the practice-led commissioning leads may suggest that almost any innovation will be an improvement on the service they feel they get from PCTs, it is quite likely that perceptions of the usefulness of PCTs will rise when the new regime is in place - especially among the sceptical mainstream of general practitioners.

Michael Cross

Buying Solutions chooses telecare suppliers

Thu, 12 Aug 2010 12:45:26 GMT

The Cabinet Office's buying agency has appointed 61 suppliers to its assistive technologies framework

The two year framework, which will be worth up to £300m and ready for use by public sector organisations from 16 August 2010, is predicted to be worth between £50m and £300m.

The suppliers include IT vendors including Accenture, Cirrus Communication Systems, Hewlett Packard, iSoft, Red Alert Telecare, System C Healthcare and Telefonica O2. It also includes phone and web advice service NHS Direct, as well as several housing providers.

The contract is divided into six lots. The first covers telecare products, including base units connected to a telephone network or broadband, call monitoring, and personal telecare products such as activity monitors.

The second is for call monitoring and response services. Lot three provides remote monitoring hardware and software, home hubs and other personal application hosting and communication devices, such as PCs with an internet connection and smart phones.

Lot four is for off the shelf equipment, rather than bespoke technologies covered elsewhere in the contract.

The fifth lot is for video or audio conferencing between patients in the community and clinicians or care services to support the delivery of health and social care. It includes the installation and hosting of services.

Lot six, for managed services, covers the management of accounts, customer liaison and training.

Chris Pennell, principal analyst at Kable, said: "We still feel that while the framework covers some interesting areas around telecare, the value range indicates uncertainty about demand for this type of service."

Lincolnshire send A&E waits by text message

Wed, 11 Aug 2010 11:34:11 GMT

NHS organisations in Lincolnshire have created a text message service to update A&E patients about waiting times

The service, created by United Lincolnshire Hospitals NHS Trust, NHS Lincolnshire, NHS Choices, Directgov and Businesslink, was announced on 3 August 2010.

It provides patients with a free mobile service that replies to a text message with the word WAITING sent to 64746 with the latest waiting times at accident and emergency departments in Lincoln County Hospital, Pilgrim Hospital, Boston and Grantham and District Hospital and at the Lincoln walk in centre.

The NHS in Lincolnshire and NHS Choices have also created a desktop widget which provides guidance about getting the right treatment in the Lincolnshire area. They claim the downloadable tool, available on the United Lincolnshire Hospitals NHS trust website, is the first of its kind in the UK.

If a patient decides medical assistance is needed urgently, the widget also displays current waiting times in the same way as the text message service.

Peter Buckley, emergency care programme director for United Lincolnshire Hospitals NHS trust, said that both tools are designed to improve patient experiences.

"As the numbers of patients attending our A&E departments continues to rise, caring for the clinically most needy and vulnerable patients is a priority." he said.

"We hope that when patients use the waiting text alert and dashboard they can and will make more informed decisions about whether alternative care, of similar high quality, that is available throughout Lincolnshire might well be a better choice for them.

"This will free up the time of our clinical staff to concentrate on those that really need the services of an A&E department."

Kirklees replaces offices with laptops

Steve Gold — Wed, 11 Aug 2010 08:00:00 GMT

Health visitors in one Yorkshire PCT are improving patient care and saving money by handling patients' data on the move

Remote working in patient care, with staff 'hot-desking' using mobile broadband-enabled laptops, is a proven cost-saver for the NHS. But the idea has been met with caution by some trusts owing to the limitations of 3G mobile reception.

However, one primary care trust, NHS Kirklees, has embraced the technology by deploying around 600 Panasonic Toughbooks, supplied and serviced by BT Health. The staff are, in the words of Robert Flack, managing director of Kirklees Community Healthcare Services (CHS), "loving it".

Flack's NHS organisation is the provider arm of NHS Kirklees, which employs more than 1,200 staff to meet the healthcare needs of more than 400,000 people across Dewsbury, Batley, Spenborough, and central and southern Huddersfield.

The area's topology is quite diverse, ranging from the university town of Huddersfield to open areas of countryside – and owing to the proximity of major towns and cities, almost all of the Kirklees trust area gets good 3G cellular reception.

But, says Flack, the technical aspects of laptop-toting members of clinical, nursing and administrative support staff is only part of the equation. Improvements in patient care in the field are what is driving the project forward.

The last 12 months have seen Kirklees CHS steadily introducing 600 laptops to staff in a variety of healthcare environments, including health visitor services, to patients in their own homes.

"The fact that it involves the patient working with NHS professionals to determine how their healthcare will progress is the really great thing. We've had 25 (in-depth) interviews with patients about the new system and they all love it," says Flack.

The use of laptops at the clinical coalface - in the patient's home - has been especially successful, says Flack, particularly on family partnership work. "This is where the NHS works with teenage mothers to ensure that mother and baby get the best start in life, and the system allows staff to fill in the health record with the mother," he says.

As well as tangible cost savings - NHS Kirklees is saving around £600,000 year in travel costs, as staff no longer need to return to base or the GP surgery to pick up notes - the use of remote working laptops has changed the way people work. Staff spend less time at base and increase their productivity when out and about.

Vision for faster healthcare

And, Flack says, it also increases the speed at which patients can receive their treatment. "We had one patient, a mother whose a baby had crossed vision. The treatment usually involves a visit to the GP who then registers an appointment with the local hospital, a process than can take a few months.

"With the laptop in the patient's home, the health visitor looked online and saw that the GP was also online - and was able to interact directly with him from the patient's home. The GP realised that it was in the patient's best interest to refer, and immediately made an appointment with the local hospital," he adds.

As a result of this immediacy of response, Flack says that the baby was given a hospital appointment to start treatment within three weeks, which is a much faster response than would have been possible under the old manual regime.

"The message here is simple - the technology is simple to deploy and use. It saves money and just works," he says.

BT Health provides the laptops to Kirklees CHS, as well as supporting staff in the field with remote access technical support or, where required, providing replacements on a next-day basis. Jon Moggridge, a BT spokesperson, says that the scheme has been well received, with the Toughbooks being kitted with integrated high-speed mobile broadband facilities and an integral NHS smart card reader.

The laptops are pre-configured and supplied by BT against an agreed standard build that includes the SystmOne clinical records application, as well as mobile Internet and email, using a secure mobile virtual private network connection to guard patient confidentiality.

Back at Kirklees CHS, Flack says that the plan is to deploy a further 50 Toughbooks to those staff that need them, with more in due course. With this further deployment, he says that his team are looking at a leasing arrangement to allow the trust to pay for the laptops out of operating expenses, rather than minor capital fund allocations.

Kirklees CHS has been working with BT Health to calculate the true cost benefits of the Toughbooks and has developed a 'benefit output tool' that can quantify how much money the mobile health worker solution can save in both direct and indirect terms. BT Health says the likely cost savings for Kirklees CHS is likely to be around £10m a year.

NHS Kirklees says that the next stage in the project is to carry out a study into whether the trust can reduce its property estate, as there are fewer staff to house in their offices.

The Toughbooks are provided under a centralised agreement for mobile health workers administered by the Yorkshire and The Humber strategic health authority. According to Trevor Wright, its deputy chief information officer, it is recognised that mobile health working gives clinicians the ability to make more informed diagnoses, more able to recommend the most appropriate courses of action and therefore deliver higher quality of care.

"However, as you would expect in the current financial climate, the key driver for mobilising our clinicians is centred on increasing productivity and reducing costs," he says. "The business case for mobile health working has been proven with a number of deployments across the region that have demonstrated an increase in clinician productivity and significant cost savings, including reduced travel costs and a reduction in unnecessary hospital admissions."

Steve Gold

Orange launches health-specific service in UK

Fri, 16 Jul 2010 15:35:49 GMT

The mobile network provider has launched a service allowing calls to be redirected to available members of a team

The Orange smartnumbers service is a telephone number routed to a series of other phone numbers within an NHS organisation. It enables patients to call a number and automatically redirects their call to another relevant staff member if the first person of choice is unavailable.

It is the first time the company has delivered health specific technology, but it has worked with local authorities and the NHS for a number of years, providing core mobile services and connectivity. The business has outlined plans to deliver further health services in the future. "Over the coming months, you'll see more from us in this space," Michael Lawrence, head of corporate propositions at Orange UK told SmartHealthcare.com.

He described smartnumbers as "a very simple service," adding: "You could have a group of midwives, which are covering a specific area and there would be a number that would be shared with the patients. If there were any questions or issues, then they could call that number and would get through to a midwife. If that midwife is off her shift then it would go to the next midwife that's available."

He said that Orange had discovered from NHS staff feedback that employees "want to be nice" to patients, but don't want to give out their personal numbers.

The company has sold its first smartnumbers package, but would not reveal the name of the NHS organisation in question. Orange is working with Resilient Networks to provide the service.

NHS 24 opens £100m voice and data tender

Fri, 16 Jul 2010 10:24:09 GMT

Scotland's web and phone health advice provider has published a tender for a 10 year managed voice and data service

In an advertisement in the Official Journal of the European Union, published on 16 July 2010, NHS 24 says the contract is part of its Strategic Frontline Applications Programme. The programme aims to procure infrastructure and managed services for voice and data to support its advice services.

It expects the value of the contract to be between £50m and £100m over 10 years, with a potential break after seven years.

The deal is divided into two lots. The first focuses on patient contact and triage management applications. NHS 24 says: "This application(s) is a key enabler for NHS 24 to provide timely, safe and efficient patient clinical assessment, advice and referral services."

The second is for additional infrastructure and managed services. The supplier may also be expected to provide "first line" support and application hosting for the clinical applications outlined in lot one.

According to the tender notice, the suppliers could be required to provide systems to other NHS organisations, in particular the Scottish Ambulance Service. Payments will be made through NHS 24.

Scotland has been increasing its investment in electronic health projects, including NHS 24. In October last year the Scottish Government announced a 40% increase in funding for telecare and the transfer of the Scottish Centre for Telehealth to NHS 24.

Victor Almeida, senior analyst at Kable, said: "This is a large budget, especially for a region the size of Scotland. The scope of lot one is vast and may include elements of Pas and electronic patient records, both of which are very much needed in Scotland.

"It is likely that more than one vendor will tackle this opportunity, which will probably set the parameters for data sharing in Scotland's NHS."

Patient from Hell: The roller-coaster ride of an exhibitionist

Dick Vinegar — Wed, 07 Jul 2010 08:00:00 GMT

The Patient from Hell goes from despair to hope at last month's Smart Healthcare Live conference and exhibition

As you know, I suspect all the time that NHS computer systems are not designed for patients, but for hospital administrators, cabinet ministers, DoH bureaucrats, hospital IT departments, pathology labs, consultants and GPs. Not for me, the geriatric patient.

So, I went to Smart Healthcare Live to see whether the speakers and the exhibitors were at all interested in my welfare, or just pushing their own agendas. I asked a lot of questions and got replies: some disquieting and a few encouraging.

It was a roller-coaster ride. I became elated and then downcast within half an hour, and then uplifted again. Let's deal with the downer bits first.

I have hoped for the last 15 years that telehealth and telecare are just around the corner, because I don't want to get MRSA in hospitals or swine flu in my GP's surgery. I want to be monitored for all my ailments in my own home. To me, this a no-brainer. The NHS must roll this out, now.

But no. The London borough of Newham, which has been taking part of a mass pilot for telecare, clearly felt that the business case had not been made. This is despite reporting several cases where telecare had stopped unnecessary admissions to hospital.

I asked a question, complaining that I had come across telecare pilots for about 15 years – mostly in northern snowbound countries where, if you don't have telecare in the winter, you die – but I wanted a roll-out, not just a pilot. The speaker said that pilots would continue, because the technology and cost of sensors and communications were forever changing. I found his attitude depressing. I need a roll-out now.

And there were no stands in the exhibition offering telecare solutions. It is probably a sensible decision by those companies that could supply kit, because they realise that there is no will in the NHS or among doctors to create a telecare world. Clearly, as an octogenarian, I will not see telecare helping me in my lifetime.

Attentive readers of this column will have read about the distress encountered by my contemporaries, waiting every morning by their front door for the life-or-death snail-mail letter from their hospital concerning a test or consultant's appointment to plop through their letter box, a week or two after the event. This when my contemporaries' natural mode of communication with everybody is email, arriving in minutes.

I was therefore incensed that there was no discussion at Smart Healthcare Live about what I consider a scandal: that in 2010, correspondence between doctor and patient should continue by snail-mail. How can the medical establishment, who are supposed to care for patients, defend this archaic mode of communication which causes such distress?

I was therefore taken aback by an argument I had on a stand at the exhibition with the manager of an identity and security specialist, who contended that a nationwide email system with 50m patients would be hopelessly insecure, and therefore unfeasible. I objected that I carried out secure transactions on Amazon and many other websites daily. Why could the NHS not do the same?

I had a good moment during the conference when, in his interview with SA Mathieson, the chief executive of NHS Direct Neil Chapman batted away the recent allegation by the chair of the BMA's GP committee Dr Laurence Buckman that the cost-effectiveness of NHS Direct "has so far not been properly evaluated".

Chapman pointed out that of the 5m patients each year who contact NHS Direct, 60% do not go on to face to face contacts with GPs and Hospital A&Es. The savings are immense. Chapman laments that many people in the NHS have an ingrained feeling that remote care is somehow second-rate, cheap and nasty. I suspect that this prejudice is what is holding up telecare as well.

The speaker who turned me on more than any other was Dr Paul Hodgkin of Patient Opinion. He contended that the patients can create more change in the NHS through their suggestions than NHS executives can do through their complex bureaucratic organisations. He hopes to generate 100,000 patient stories a year, 10% of which will result in improvements on the wards. These changes may be in the design of loo-seats in disabled toilets. But they are improvements, and they could change the culture of NHS staff towards innovation.

He believes that politically, his time has come, because what he is doing is an embodiment of the coalition government's Big Society. I hope he is right, and that the patients' voice will become the loudest in the land.

Dick Vinegar

Trust extends mobile clinical management

Tue, 06 Jul 2010 23:00:00 GMT

District nurses in Cumbria are soon to be given remote access to the Emis web based clinical management system

A spokesperson for the company told SmartHealthcare.com that the 100 strong team in the South Lakeland area will begin to use the system in August as the next phase of its implementation.

"The district nurses currently use a mixture of paper and office based PCs," the spokesperson said. "They provide general nursing and palliative care to patients in their homes. With Emis Web they will be able to use a single system, both mobile (netbook) and PC based, to streamline their work."

NHS Cumbria has been using the system in South Lakeland for a year, providing mobile clinicians such as community physiotherapists and specialist respiratory nurses with access to about 75,000 patient records from 13 GP practices. They are able to view a summary of a record with the patient's consent during home visits and input data using special templates.

Out of hours GPs and members of the trust's primary care assessment team are also accessing the system through its interoperability with the Adestra system that they use.

The spokesperson said that, while the implementation was launched as part of the Department of Health-backed Integrated Care Pilots, the trust now considers it an established part of its work.

"The PCT is taking an overview of progress and outcome, hence the pilot view, but there is no backward look to unpick what has already been achieved, and the number of in-scope services is increasing," she said.

Preston telehealth pilot goes live

Mon, 28 Jun 2010 23:05:00 GMT

NHS Central Lancashire Primary Care Trust has launched a 12 month telehealth pilot for chronically ill patients

The technology is being piloted in Preston with 40 patients with chronic obstructive pulmonary disease, a condition that affects more than 3.7m people in the UK.

As well as allowing patients to measure vital signs including blood pressure, pulse and weight, the technology includes videoconferencing to enable them to communicate with the community matron team.

It is aimed at helping them to recognise symptoms early, thereby reducing hospital admissions.

If the pilot, which began in June 2010, is successful the trust plans to expand telehealth to chronic illness patients across central Lancashire.

Anne Walton, NHS Central Lancashire's community matron locality lead, said: "My team and I have been working very hard to get this pilot up and running and we are getting lots of positive feedback from patients.

"This new technology allows patients to take a more active role in their own care and to learn more about their own condition. This will hopefully teach them how to spot signs of symptoms so they can act sooner to avoid being admitted to hospital.

"If this pilot is deemed a success it will potentially open up a new way of working for community matrons and other services, helping to improve the existing quality service we provide to our patients."

The pilot uses telehealth units supplied by GE Healthcare and will run will run for 12 months, with regular assessments of its performance.

North Yorks expands telehealth

Mon, 28 Jun 2010 10:55:27 GMT

NHS North Yorkshire and York Primary Care Trust is to purchase 2,000 telehealth systems to support patients with chronic conditions

According to the trust, the new units will make its telehealth programme the largest in the UK.

It has signed a £3.2m contract with North Yorkshire based telehealth provider, Tunstall, for the provision of the equipment.

The expansion of telehealth follows an eight month trial. "We currently have 61 units and feedback from patients and clinicians has been overwhelmingly positive," a spokesperson for the trust told SmartHealthcare.com.

The programme will focus on patients with chronic obstructive pulmonary disease, chronic health failure and diabetes. In 2008-09 more than 6,000 patients in North Yorkshire and York were admitted to hospital with respiratory or cardiac problem.

It is designed to identify and act on any deterioration in a patient's condition before they need hospital admission. It can also be used to facilitate early discharge from an acute setting.

David Cockayne, director of strategy for NHS North Yorkshire and York, said: "We are delighted to announce this significant investment in telehealth which we, and local clinicians, believe will continue to make a huge difference for patients living with a long term health condition."

The development is in line with the trust's five year strategy, published in April, to provide care closer to home and improve the quality of life for patients living with a long term health condition.

King's picks cows for its wards

Sade Laja — Wed, 23 Jun 2010 08:00:00 GMT

A south London hospital has concluded that computers on wheels (cows) and laptop trolleys suit e-prescribing better than handheld devices

Electronic prescribing is becoming more prevalent within the NHS and is generally viewed as a more convenient way to dispense prescriptions to hospital patients. But finding the right technology to facilitate it on wards is not always easy.

Mobile clinical assistants (MCAs) have been chosen by a number of NHS organisations due to their lightness and compact nature, but not by King's College Hospital in south London.

"They were lightweight, they were handheld, and you'd think that they were ideal, but they weren't for us," said Ben Fidler, team leader of the electronic prescribing and medication administration (EPMA) team at the hospital.

"Unfortunately for us the screens were a little bit too small. Our application has a lot of data, you have to display lots of information about drug charts and prescribing and our users felt that that they were just a little bit too small," he told the Smart Healthcare Live conference on 16 June 2010. Fidler added that there were also issues around reliability.

With hospitals increasingly looking for smaller and more mobile technology, shirking devices like MCAs in favour of something larger and less portable sounds like a counter-intuitive move by King's. Staff at the hospital are temporarily using computers on wheels (cows) until a decision on what technology to use is made.

Cows for courses

Fidler said that the cows are "ideal" for wards which use patient lockers, but are problematic for staff that use drug trolleys. "Obviously they don't fit on the drug trolley. For wards that do use drug trolleys, you're pushing it around and you're pulling a cow, which our users do not like," he added.

Choosing the right e-prescribing technology is proving to be quite problematic for King's College, which has trialled more than five different products in two years. The hospital originally started a wireless technology pilot to replace paper drug charts in November 2008.

"Our standard was to have two or three desktop PCs per ward, but essentially what was happening was that on a ward round doctors were going backwards and forwards between the nurses' station and wherever the PCs were located to find information," director of ICT Colin Sweeney told Smart Healthcare Live.

Wireless requirements at King's vary from ward to ward depending on whether the staff administer medication using a wheeled trolley with all the drugs inside it or keep all the medication in a locker for each patient. There are 10 wards at the hospital which now actively use e-prescribing, with 30 to go.

After the failure of MCAs, King's tried small ruggedised laptops, on the basis that they were portable. However, staff flagged up the same problems they had with MCAs – small screens and lack of integration with the trolleys. "You had to tie them on a tray on the side and you had to tie them to the top of the drug trolley. They (staff) weren't overly keen on them," Fidler said.

The hospital had one final stab at using laptops, testing an XT2 touchscreen model which could be folded into a tablet shape. But there were problems with wireless connectivity and some staff were having trouble documenting everything with only a touchscreen.

"Laptops weren't really working, so we went back to the drawing board," said Fidler. As a result the hospital is now testing a small drug trolley with a built-in computer from Parity. The lighter design eliminates the problem of staff having to pull around a cow. The hospital will also test a similar recently released model from RDP Health and decide which one it prefers. Using laptop trolleys rather than cows will save around £1,000 for each unit.

Fidler and Sweeney both emphasised the importance of hospitals thoroughly testing equipment before making decisions on what technology to implement. But Sweeney acknowledged that financial cuts may force hospitals to review their spending. "I think it's going to be very difficult in the current climate to to put a lot of investment in for the implementation of systems like these, so you do need to have a good case."

Technology implementation is "horses for courses", said Fidler, adding that different hospitals have different needs. He cited Salford Royal foundation trust's extensive use of MCAs as an example of organisations' different preferences.

Despite past problems with smaller devices, Fidler is not completely ruling out the use of touchscreens and PDAs in the future, but said it is not something the hospital is currently considering.

"For our use at the moment the keyboard and the mouse is the way forward," he added.

Sade Laja

NHS Direct plans to increase remote working

Tue, 15 Jun 2010 15:52:49 GMT

The chief executive of NHS Direct has said that it can increase productivity by allowing more staff to work at home

Nick Chapman said that pilots carried out by NHS Direct have shown that as well as being cost effective, remote working could help reduce staff turnover. He did not rule out the possibility of closing customer contact centres when the measures are introduced later this year.

"We have an overall turnover of over a quarter of our staff leaving in their first year, and actually that means huge expenses and a huge trade off in quality terms because you're continually having people who are climbing up the experience curve," he told the Smart Healthcare Live conference in London on 15 June 2010. "So we think that home working is likely to be a real win for us."

Chapman cited an equivalent service run by McKesson in Australia and New Zealand as an example of successful remote working. He said it has a waiting list of staff willing to work remotely and that the service has "no turnover."

"The technology is now well able to support somebody sitting in the comfort in their own home as if they were working in a call centre environment," he added.

Chapman said there was much potential for more remotely delivered care within the NHS, but added that there was a cultural barrier from professionals. "I feel I can say these things because I've worked for the NHS for 30 years. The NHS regards remotely delivered care as inherently and by definition second rate, cheap and nasty and potentially unsafe."

But he said that NHS Direct plans to add more automation to its service, by encouraging more patients to look online before they call. "What we want to do is get people to look on the web first. A large number of people are actually very comfortable with going onto the internet and looking for services."

He added: "There are a lot of people who now are their own banker, they are their own travel agent, because that's the way they expect to do business and we want to encourage that."

Mobile clinical assistants: assisting your choice

Steve Gold — Wed, 09 Jun 2010 08:00:00 GMT

MCAs are now commonplace in the NHS, but what are the choices? We look at products from Advantech, Motion, Panasonic and Tabletkiosk

Mobile Clinical Assistants (MCAs) have been around in the NHS since the early 2000s, mainly as a result of devices such as Blackberry smartphones and modified laptops being customised by systems integrators. But the technology really started to develop when computer chip giant Intel unveiled a reference design in late 2006/early 2007.

The Intel MCA was developed in conjunction with NHS Connecting for Health, as well as vendors of electronic patient record systems such as Cerner and iSoft, to ensure software compatibility. After three years of development, including a pilot at Salford Royal NHS Foundation trust, the first MCA was unveiled by Motion Computing in February 2007. Since then, several vendors have developed their own versions, most of which are based on the Intel reference design.

Processors vary between various MCAs - and there numerous options from most vendors - but the primary features of an Intel-based MCA typically include an integral bar code reader for patient wristbands, pharmacy and other patient treatment products, plus Bluetooth wireless compatibility for other portable patient diagnostic devices. There is also normally an optional radio frequency ID (RFID) system for localised wireless scanning of suitably equipped staff badges and other authentication devices.

MCAs, like most pieces of clinical kit, are significantly pricier than even the more expensive equivalent consumer devices, such as Apple's iPad. The devices typically cost from £1,500 to £2,500, owing their required robustness and conformity to NHS Connecting for Health guidelines, as well as certifications such as UL60601-1, EN60601-1, and ISO 13485.

Advantech (site)

Like many MCA vendors, Advantech is a US-based supplier with UK partner distribution and support. The firm has two MCAs: the Mica-101, a fanless unit, and the MT-100, which is both fanless and lightweight. Both devices feature a 10.4 LCD display, with the Mica-101 certified as an IP54 dust and water-splash proof sealed system with Bluetooth plus WiFi connectivity. There is optional 3.5G mobile broadband connection.

Other features include an integrated camera/scanner and RFID reader, as well as an optional image-based (non-laser) barcode scanner, webcam and fingerprint reader. The MT-100 is a lighter version that is also IP54 dust and water-splash certified, and includes a WiFi connection for simple connectivity. Customised versions are available but it seems that the MT-100 is best viewed as one-size-fits-all MCA, rather than a unit that can be optionally upgraded.

Motion Computing (site)

This firm was first out of the gate back in early 2007 with an MCA, since when its range has been expanded to include two main models, the C5 and F5, with battery life claimed to be three hours on both units. It is another US vendor with UK distribution and support: its US pricing goes upward from $3,300 mark (£2,300, although hardware often costs more in the UK).

The C5 is a standard MCA with a choice of an 160GB magnetic hard drive or a 64GB solid-state drive. Motion has included 3.5G mobile broadband as standard plus WiFi connectivity. This makes the MCA useful for domiciliary visits, as well as other mobile usage. Weighing in at around three pounds, the sealed C5 is IP54 rated for moisture and dust resistance. It can also be dropped from a height of 36 inches (MIL-STD-810G certification). Options include an integrated digital camera, and barcode/RFID scanner.

The F5 is a semi-rugged slate and is best described as a more robust version of the C5. Both units have optional mobile docks and carry case systems and are Windows 7-based (XP and Vista also available) with native handwriting recognition and auto-fill for form filling.

Motion also produces a J3400 tablet PC with a 12.1-inch display and a higher-powered processor with optional 3.5G mobile broadband. Although not based on the Intel MCA design, the unit is an interesting alternative.

Panasonic (site)

The firm has UK offices but also supplies through partners. Its CF-H1 unit is based on the popular Toughbook design with a 10.4 inch screen with touchscreen features. Tipping the scales at 3.4 pounds, the $2,999 unit has hot-swappable twin batteries, for six hours life between charges, and a shock-resistant 80GB magnetic hard drive as standard.

Designed to military 810F rugged standards the MCA has a magnesium alloy chassis and is robust enough to be dropped from a height of 36 inches (MIL-STD-810F certification). Features include an integrated barcode scanner plus a fingerprint scanner. Unusually for an MCA, Panasonic offers a contactless smartcard reader on the unit, as well as GPS facilities, Bluetooth. 3.5G mobile broadband is an optional extra.

Other features include a 2 megapixel camera with what the firm calls the ability to scan most items. Because the item is sealed, like most MCAs it is fanless, but Panasonic claims the unit has a totally smooth surface with sealed buttons, a gapless LCD screen and no exposed ports. Its warranty is, again unusually for an MCA, three years, perhaps reflecting the robust nature of the CF-H1.

Tabletkiosk (site)

The firm is another US vendor with international distribution and support. Its main offering is the Medislate MCA i1040XT, which is billed as the only MCA with a sunlight readable 10.4-inch resistive touchscreen. Like most units, it is based on the Intel reference design and is designed to interface with most popular EPR systems.

Claimed to IP54 standard for spills and dustproofing, as well as 36 inch drop-protected (MIL-STD-810F standard), the unit features an integrated barcode scanner, 2.0 megapixel camera, fingerprint reader and an RFID reader built into its handle.

The firm is pitching the 3.25 pound MCA firmly into the clinical care environment, allowing professionals to enter data, verify patient identification, verify themselves as authorised care givers, and scan pre-printed labels from patient ID bracelets, medication packaging and blood vials and other sources.

Standard features also include an 80GB magnetic hard drive or 32GB solid-state drive – the firm has opted for 2GB of memory on the i1040XT, rather than 1GB as seems standard on most MCAs – as well as hot-swappable twin batteries giving a battery life of 4.5 hours. The MCA is Windows Vista-driven (Windows 7 soon) with an optional Windows XP downgrade if required.

Resellers

The most important aspect of the MCAs featured here is that specifications are constantly changing and, if your order is potentially for several units, most MCA vendors can customise the units as required. It may also be worth talking to resellers, such as the following selection:

- Aerohive Networks (site), which recently supplied a major wireless MCA deployment for NHS Mid-Essex.
- DevelopIQ (site), an Anoto digipen and BlackBerry smartphone specialist, which also supplies MCA systems.
- HD Clinical (site), which recently supplied wireless systems to Frimley Park Hospital.
- Kelvin Connect (site), a Scottish PDA/systems integrator.
- NDL-Metascrybe (site), a wireless healthcare integrator which has completed a flagship installation at NHS Rotherham.

Finally, it's also worth noting that the NHS has itself developed wireless tablet computing systems, such as Gateshead Queen Elizabeth Hospital, which has developed one for wireless pharmacy drug dispensing.

Steve Gold

Shifting care could save billions, says McKinsey

Thu, 03 Jun 2010 11:24:43 GMT

A new consultancy report says the NHS in England could cut between 15% and 22% of spending from its 2008-09 figures

Commissioned by the previous government, the report says it would be possible to make the savings through efficiencies from providers, no longer commissioning treatments seen as ineffective and providing more care outside hospitals.

But health secretary Andrew Lansley has distanced himself from the advice, claiming it is indicative of a "top-down" approach that would not achieve its aims.

The Department of Health released the plan, Achieving World Class Productivity in the NHS, under Freedom of Information on 2 June 2010. Dated March 2009, it had not previously been made public, although its proposals to cut 137,000 posts were leaked last year.

On shifting care from hospitals to cheaper locations, McKinsey says the key opportunities include increasing use of self care, including telecare techniques such as home testing of blood pressure, and better management of chronic diseases, partly through using databases of patients. It reckons that, based on experiences in the US and Germany, these two techniques would save between £1.9bn and £2.5bn annually.

The report argues that US integrated healthcare providers save money due to their incentive to treat patients at the cheapest effective location. One of these, Kaiser Permanente, is 20% cheaper than the average US healthcare provider.

It also says that the UK is second only to the US in its spending on hospitals per person among rich countries, spending 32% more than France and 57% more than Germany on a purchasing power parity basis. Although the UK has a low average cost for each hospital case, it has a high level of usage.

The report also says a more "comprehensive" approach to procurement could save money on areas including IT. Using McKinsey's own data, it says that IT maintenance costs can be cut by 30% through such an approach, with IT programming charges reduced by 22%, computer equipment by 15% and telecoms by 14%.

Despite the spending cuts in most areas, including 11% to 13% from estates and 6% to 11% from supply chain optimisation, the report assumes the same £2.6bn annual spending on IT at the end of the process. "It is assumed that savings will be reinvested," McKinsey says, mentioning IT as a key enabler with low current spending.

Andrew Lansley criticised the style of the report, but emphasised the need to make efficiency savings. "As part of our drive to make government more transparent, I am publishing this report that was commissioned by the previous government. It is indicative of a top-down internal process intended to cut spending by cutting staff, including frontline staff," he said in a statement.

"It is important to cut the costs of bureaucracy, so we can sustain and improve frontline care. So, instead of drawing conclusions from top-down analysis, people should examine the unacceptable variance in performance and focus on how staff can be redeployed in order to drive up standards."