Hospital psychiatrist Joe McDonald can click into his patient’s records 24/7 from anywhere in the world. “So long as I have my smartphone and a 3G connection I am connected to my patients around the clock. I’ve even logged on at 35,000 feet,” he says. In the future, McDonald, who works at Northumberland, Tyne and Wear NHS foundation trust, is confident that having a consultation with a patient via videoconferencing could become routine: “My job as a psychiatrist is to see how a patient is feeling, so I don’t necessarily even have to be in the same building as my patient to carry out a consultation.”
McDonald’s working day is being transformed by mobile technology. And he is not alone. Paramedic Mike Earl uses his NHS-issued iPad to check a diagnosis or clinical guideline when he is on a 999 call. He also completes the electronic patient record online with data going directly to his ambulance trust and emailed on to A&E or other NHS sites. “I no longer have responsibility for the paper record as I would have had in the past; it’s quicker to type than write and it’s legible.” The system, which is being rolled out to 200 ambulance clinicians across Thanet, Kent, boosts patient safety. Karen Mann, IT development project manager at South East coast ambulance NHS foundation trust, says: “We no longer have to keep the records in a paper folder in the back of the ambulance which somebody then spills their coffee over. We are improving the quality of patient care and I think in the long term it will save the NHS money because we now have access to information which is all in one place which we can analyse and discuss.”
Better for patients, better for GPs
Earl is also part of an NHS vanguard site where paramedics carry out home visits that traditionally would have been done by GPs. The iPad is central to this new model of care; Earl has secure online access to the patient’s care plan and patient record, which he can update in real time. GP Dr John Ribchester, clinical lead for Encompass – a group of 16 practices involved in the vanguard – says the scheme has reduced hospital traffic by 15% and is now being rolled out across East Kent: “That has economies for the whole health system. The patient journey is also better because they can stay at home, GPs have a few less home visits and it gives us more head space.”
Community nurses are also pushing back the barriers. The charity Marie Curie, which cares for the terminally ill, has used £1 million from the government’s nurse technology fund to help connect its workforce.
Some 2,100 nurses and healthcare assistants now use mobile tablets, which improves the immediate support they can offer patients and keeps staff in touch on night shifts when they can often feel isolated. Jo Stradling, its divisional general manager for central and eastern England, says: “In the past they would have written something down on a piece of paper for a patient or carer. Now they have the whole world at their fingertips.”
Keeping people out of hospital
In Sunderland care home staff are using a tablet-based system to monitor residents in another vanguard scheme developed by the clinical commissioning group. The programme generates a patient score with a traffic light system alerting staff if a resident’s health has deteriorated; the data is fed into a cloud-based system accessible to GPs and nurses if necessary. CCG telehealth lead and project manager Rachael Forbister says: “We are keeping people out of hospital and enabling them to stay in their home more appropriately, and, if we keep that person out of hospital then it’s also going to save us money.”
Matthew Honeyman, policy researcher at the think tank The King’s Fund, says the adoption of mobile technology has been led by ambulance trusts and community nurses. But more hospital trusts are coming on board: “One of the issues in the past has just been the scale of the hospital systems. That is now changing and where that’s happening it’s often down to a clinician or other professional who has that technology enthusiasm and leadership.”
The number of NHS organisations that employ their own chief clinical information officer (CCIO) – clinicians who lead on IT and the use of data to improve patient care – illustrates just how fast that change is happening. Four years ago there were only six CCIOs in the entire NHS – today there are more than 400. McDonald, who chairs the national CCIO leaders network says: “I think we are on the cusp of thinking in a radically new way. If we can ‘EasyJet’ the NHS we have the potential to save a fortune. But I think one of the biggest challenges is lack of money; another is having enough CCIOs with enough time to transform services in the way that we need.”
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