Healthcare is mobile


Healthcare workers live and work in a mobile environment.  By that, I mean they are constantly walking, running or driving around as part of their jobs.  A nurse in a typical hospital walks 3-7 miles per shift.  GP’s, Midwives, Community Nurses and others may have to make several home visits by car per day.  Add to that, the Department of Health’s advice to walk more and take stairs rather than lifts, and it’s pretty easy for most frontline NHS staff to clock up the recommended 10,000 steps per day! 

In such a mobile environment, it’s not difficult to see why working with a computer can be seen negatively by healthcare workers.  It often involves duplication of effort and can get in the way of providing patient care.  It becomes an additional burden in an already stressful job.  Not only that, but it can distract them from their primary task of hands-on care with the patient.  It just doesn’t make sense for doctors and nurses to have to return to static desktops – or even laptops – to enter data into a computer. 

Yet, I notice that, like me, most of my colleagues carry a ‘computer’ around with them all the time.  They may not see it as a computer, but a mobile phone, in particular a modern, ‘Superphone’ such as the Apple iPhone, Motorola Droid and the BlackBerry is, in reality, a small computer.  By the end of 2010, manufacturers had introduced more that 60 new smartphones with a host of must-have features.  For many, especially the younger, more tech-savvy professionals – often referred to as ‘Millennials’, or ‘Digital Natives’ – have grown up on mobile phones and social media and couldn’t imagine not having ready access to information.  Don’t expect them to work without a smartphone or similar device close at hand!

So, is there some way to combine the ubiquitous utility of a smartphone with the organisational needs of a busy hospital, GP surgery or community nurse?  I think there is.  Information mobility is destined to become part of healthcare, just as it already is in many other enterprises.  Tablets, pads and touch-screen phones are not just fantastic toys, they are already proving themselves as essential business tools that could help overcome the fragmentation of care delivery, provide patient information at your fingertips and enhance patient safety.

Consider the ‘Safari’ ward-round.  This is the phenomenon of a small group of doctors, usually (but not always) led by a Consultant, that moves around the hospital ‘hunting’ for its patients.  Patients are admitted to the hospital under the nominal care of a specific Consultant.  Most will be found on a particular ward, but frequently they may have to be accommodated on other wards depending on various factors, such as, availability of beds, severity of illness, age, sex, etc.  Sometimes they will be transferred from ward to ward several times.  Thus, tracking down patients can be easier said than done and planning subsequent care quite a challenge. 

This kind of challenge could easily be helped by technology that can track and locate ‘high-value assets’ (e.g. patients!).  Moreover, a sorted list of patients relevant to a particular Consultant, with the ability to ‘drill-down’ to detailed patient information would be really helpful.  Add to that, being able to make evidence-based decisions, order investigations, see results, obtain expert guidance, update the notes and capture patient feedback in real-time would mitigate against unnecessary delays.  Job done!  All this, and more, could be achieved now with mobile devices integrated into modern clinical IT systems. 

Many clinicians I know already utilise their own devices to ‘Google’ unfamiliar illnesses and check recommendations for treatment options.  Some download ‘apps’ that they find useful and hundreds of new applications are appearing all the time.  Of course, there is potential danger in the ungoverned use of personal ‘bring-your-own’ devices, so healthcare professionals and organisations will have to ensure that sensitive data is secure and patient safety assessed.  Consideration of security policies, encryption and hosted options, such as managed mobility, and the ability to remotely wipe data from a device that is lost or stolen, will become essential.  Fortunately, these must-have components are becoming widely available.

Mobility reduces administration.  A good example is digital dictation, which is now becoming the norm in the NHS.  Voice recognition is coming on in leaps and bounds.  Don’t forget, you could use your phone for digital dictation rather than have to be fixed to a custom device.  The uses and benefits of healthcare mobility differ from one user to the next.  And, it’s not just clinical users.  Managers and executives too, will be able to make faster and better decisions with access to operational intelligence data that was previously impossible to find.  You’ll be able to think of more examples yourself; indeed, one of the interesting aspects of such functionally-rich, always-on devices is discovering novel things to do with them.  It won’t take long for bright clinicians to find new and exciting ways of using mobile clinical information.  From industrial studies, increased productivity leads the list of benefits that mobility brings.

Closer to the patient

The concept of ‘near-patient testing’ is well-established in clinical practice as a way of reducing administration, increasing data accuracy and minimising delays.  This principle applies equally to any type of clinical information.  Sharing information with patients in real-time has significant value.  Being able to show patients their blood results, medical images and other data will make communication easier, help respond to increasing patient expectations, and enable the quicker resolution of issues.  This leads to fewer complaints and an improved patient experience.  All of this is sure to become part of national quality frameworks, which will not only affect the bottom-line performance of healthcare organisations, but also provide data for individual clinicians’ annual appraisals and subsequent professional revalidation/recertification.

Easier for the clinician

You may be thinking, ‘This is all very well, but I don’t need a smartphone.  It’s just a gadget and a gimmick; it’ll be out-of-fashion just as quick as it arrived’.  Wrong.  It’s not the particular device that’s important, it’s the ready availability of reliable information and communication.  The ‘best’ device is the one that’s most convenient.  For younger clinicians, the Internet and mobile phones are taken for granted, like electricity or water – you expect it to be there whenever and wherever you need it.  ‘Baby-boomers’ (like myself) are usually just happy that the technology actually works!  As Muir Gray wisely said, ‘For the Victorians, the provision of clean, clear water was a major public health prize.  For us, it’s the provision of clean, clear data that’s equivalent’. 

What is the right device anyway?

Whilst the trustworthiness of the underlying data is crucial, there are important considerations for the actual device.  However, these may vary between users.  A mobile phone is great for certain things, but a 3-4 inch screen will always be inadequate for, say viewing X-rays.   But a 7-10 inch screen ensures that the image is easier to view, applications work well and you don’t get lumbago from carting it around!  I am constantly reinforcing to my technical colleagues that data entry is a key barrier that needs to be overcome for the mobile healthcare worker.  Mouse and keyboard combinations located out of the line-of-sight of the patient, just don’t cut it.  Touch-screen on a tablet is an obvious solution and permits easy bi-directional exchange of information.  Data can be entered and retrieved conveniently and as part of the delivery of care.  This means that duplication of tasks is avoided and data is assimilated as a by-product of care, not as an additional task.

The future

Globally, healthcare is discovering the potential benefits of mobile, electronic working.  The ever-spiralling costs of healthcare and the need to move to a more effective, efficient way of delivering care makes the adoption of mobile health solutions more compelling than ever.  The productivity and quality gains seen in other industries can, and must, in my opinion, be realised in healthcare.  So, grab your ‘Playbook’ and let’s go see some patients!