BASINGSTOKE, UK - (HealthTech Wire / Opinion by Graeme Woodcock) - The consumerisation of IT through handheld devices and a pervasive Internet has driven massive interest in UK healthcare markets for the same high availability of information and user-friendly devices to be made available in daily clinical operations. Clinicians and other professionals’ fast adoption of mobile devices and demand for flexible information access in key patient care and ancillary services has already spawned the concept of mobile health, or mhealth. mHealth is described by the Global Observatory for eHealth (GOe) as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices”.
While mhealth has to an extent been consumer driven, with 91% of adults in the UK using mobile phones, UK healthcare has considerable scope to capitalise on the potential of these technologies. The World Health Organisation (WHO) estimates that two-thirds of all mobile health programmes are in the pilot or informal stage [1]. Although Britain’s healthcare institutions are making considerable strides in changing their daily operations through mobility strategies, there is still considerable scope to support improved healthcare outcomes while delivering operational efficiencies. UK healthcare bodies have considerable potential to join a pre-existing culture of fluid mobile interaction and collaboration which would benefit both healthcare professionals and those for whom they care.
The coalition Government’s rapid pursuit of NHS reform with a core focus on patient choice and cost efficiencies has only increased the pressure for innovation. As a result, there is unprecedented interest in harnessing workplace mobility — in both the clinical and operational spheres. While the most eye-catching developments involve initiatives like smartphone apps for the public that build dialogues with patients and preventative health campaigns, this new mobility offers considerable opportunities for healthcare organisations and their supply chains to drive operational efficiency. mHealth helps by streamlining daily operational processes such as patient monitoring and flexibility of treatment as well as improving information access from medical electronic records and e-systems. With the NHS required to meet ambitious targets of £20 billion in efficiency savings by 2014 [2], one of the most important opportunities for achieving efficiency areas is in the rationalisation of ancillary services such as procurement, asset management and administration of supplies.
So, while the end goal is to take mobility to the point of care, mobilised information and applications will be critical in delivering the frontline and back-office system improvements. To make this happen they will need to be implemented to work within health trusts’ and hospitals’ existing ICT infrastructures and legacy applications. This will require particular know-how, not only in the development of new software applications for m-health, but also in the operating systems and devices that these innovations will work on, as well as their integration with legacy ICT systems.
mHealth in operational and clinical departments
A look at the operational and clinical ‘divide’ shows the potential of mhealth applications, environments and devices. Operational departments’ mhealth needs might in theory be simpler than those of the clinical counterparts. This is partly because NHS and private healthcare organisations have invested in modernising supply chains, logistics, stock control and asset management. They have responded to successive efficiency drives and most are already working with private sector providers to enhance and rationalise operations. They have streamlined and automated areas such as stock taking, which can now be done faster, work scheduling on PDAs and automated check-ins using barcodes.
Developing mobile applications for clinical operations is much more difficult than for the operational side, as the provision of healthcare and clinical practices is more liable to change and is regulated by procedural and quality control requirements, legacy IT systems, as well as a short-termist, reactive approach by health trusts.
If real-time access to computer-based systems is not available, information must be moved manually, creating the potential for human errors and excessive administrative needs, prolonging everyday non-productive processes. Medical staff are forced to collect and verify handwritten and verbal information. Information on paper forms must be entered into the computer after the patient visit, a double-touch of data that only increases the burden on staff and the potential for error.
The need to carry out bedside checks on vital signs, or to verify patient information, pathology tests, and medication needs on the ward may be part of legacy processes to deliver operational, financial and quality controls. mHealth can help spark system and process redesign, enhancing patient care and its administration, driving cost efficiencies and reducing system errors.
The mobility learning curve
To achieve true mobile health capabilities for their organisation, it is essential for healthcare ICT decision makers to understand the need for devices’ operating platforms and applications to be designed in relation to each other as well as to enhance patient safety. Many IT departments are under pressure from clinical staff to deliver “quick wins” such as smartphones that give patient details in the treatment room. These advances, driven by software vendors and developers to meet a short-term need, have often struggled to deliver the resilience and application functionality to deal with the daily demands of hospital operations. Devices have broken and applications have failed to cope with users’ demands. In clinical operations, these barriers need to be overcome before mobile applications are truly reliable and mhealth becomes feasible.
Despite limitations, the potential benefit of software applications is clear. Accessing information in treatment rooms or checking linen store stock levels direct from servers and making it readable in a variety of buildings and physical environments is problematic. Because of this, there is a temptation for ICT teams to compromise by providing clinicians with a lower cost web-enabled front end for devices, rather than bespoke, robust applications. Merely displaying information on an iPad is not enough — the information may be portable but it isn’t properly mobilised.
Another issue with mobile devices can be a lack of enterprise-grade resilience — clinicians find the devices break down, become unreliable and require regular updates — they may have low entry costs, but ownership costs need to remain low as well if they are to be a cost-effective investment. Investment in a short term ‘fix’ or a special telecommunications package on cost basis alone is not sufficient to meet healthcare professionals’ needs — it may be a false economy. For users to enhance patient care and their own personal efficiency they have to be prepared to invest in combinations of enterprise-grade specialised, rugged devices with flexible connection deals as well as dedicated software applications. Importantly for hospitals, these robust devices are easier to maintain than non-specialist mobile devices.
As a result of the constant pressure to provide colleagues with rapidly mobilisable information, ICT experts and clinicians have had to resolve a variety of performance and integration issues. Some observers believe that trouble-shooting and maintaining patched-up devices has consumed greater cost and staff resources than the original limited projects envisaged. It is also debatable whether short-termism has delivered ROI or patient care improvements. Front-line staff and ICT staff have been through this ‘learning curve’ on mobilising information, with healthcare professionals acknowledging that wireless connectivity is a mission-critical service and no longer an add-on. This painful learning experience can be averted.
Cutting out the learning curve
To cut out the 'learning curve', health trusts’ clinical and operational divisions need to recognise several strategies. Working with expert partners, such as device manufacturers, who are well-versed in healthcare equipment specification will help healthcare organisations develop bespoke mobile applications with an effective bridge to their main software platform. Alternatively, organisations can begin to work with carriers that embed consumer devices into an effective service wrap.
Understanding the daily needs of your staff is key. For example, a tablet that may make an excellent mobile device for home use will not have the same effectiveness in a healthcare environment. Imagine, for example, how long an iPad would stand up to the daily rigours of a hospital. Additionally the iPad uses a touchscreen technology that will not work if you are wearing latex gloves. Staff will need user-focused mhealth applications such as patient tracking, mobile voice, charge capture and schedule management, in a combination of robust operating systems and rugged devices. These devices need to deliver real-time information and operational efficiency, such as community task worker applications or bedside patient management applications. These tasks can be completed using barcoded wristbands, or blood tracking solutions combined with voice connectivity to allow staff to communicate using caller groups for voice and texting.
If the Department of Health is going to find the £20 billion savings expected of it by 2014, whilst maintaining standards of care, then there is a pressing need to cut out the learning curve in mhealth so that savings can be made at the earliest opportunity. Healthcare practitioners will have to work closely with ICT experts, equipment providers and application developers to avoid costly development programmes. Working with expert partners allows those on the front line of healthcare to avoid the waste and pain of the learning curve.
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Source: Motorola Solutions
Graeme Woodcock, Motorola Solutions
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