The National Programme for IT NPfIT

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• The National Programme for IT (NPfIT)
• Mobile Medicine

Thursday 23rd April 2009
The future is bright, the future is mobile
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An Case Study - Northern Lincolnshire

• Trevor Wright
• NHS Yorkshire and the Humber
• Strategic Health Authority

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• Andrew Johnson
• BT Health
• Chris Wood
• Healthcare Sales Manager
• Panasonic Computer Products Europe

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Agenda

• Consider how to successfully trial and implement
  a safe and effective mobile working solution for
  clinicians in the community
• Discuss strategies that will ensure mobile
  workers are equipped with fit for purpose
  solutions that enable them to deliver the highest
  standards of care in a safe and effective way
• Explore the Northern Lincolnshire experience with
  a focus on barriers, benefits and service
  improvement

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Yorkshire and the Humber SHA

• A population of 5.12 million
• We cover an area of 15,510 square kilometers
  including major cities, such as Bradford, Hull,
  Leeds, Sheffield, Wakefield and York, as well as
  a number of large town and rural areas with
  scattered populations, especially in North
  Yorkshire.

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Northern Lincolnshire

• North Lincs PCT
• 156,000 population
• Rural community centred around Scunthorpe
• 22 GP Practices
• Been using SystmOne since 1999
• Organisation is financially challenged

• North East Lincs CTP
• 170,000 population
• Community centred around Grimsby and Immingham
• 36 GP Practices
• Been using SystmOne since 1999
• Excellent record regarding joined-up
  working/services

• Northern Lincolnshire and Goole Hospital, NHS
  Foundation Trust
• 3 Sites
• Diana Princess of Wales Hospital, Grimsby
• Scunthorpe General Hospital
• Goole District Hospital
• Integrated Community Services

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NHS-CRS Important Issues

• Integrated care needs integrated systems
• Patient centric services, not Organisation
  centric
• Too much time spent recording information
  impact on clinical time
• Limited resources need for efficiency and
  effectiveness

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Can it be done without a Mobile Solution?
We dont think so! Early pilots suggest The
future is bright, the future is mobile
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Why Mobile working?

• Accessibility
• Convenience
• Contemporaneous Records
• Data Quality issues
• Reduced duplication
• Real-time intelligence and decision making
  capability

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Mobile Working Enhancing the Benefits

• Productivity Gains
• Reduction of Travel
• Better Decision making
• Avoidance of inappropriate Referrals and
  Admissions
• Job satisfaction and Staff Well-being
• Improved Data Quality

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Realising the Benefits(if we get it right)
Who?
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Realising the Benefits the Patient

• Improved safety
• Access to integrated records and assessments
  reduces risk and raises the awareness of possible
  conflicts in treatment
• More legible documentation reduces the likelihood
  of errors which improves patient safety
• Less risk of transposition errors from
  handwritten notes or memory
• Ability to monitor adverse events

• Improved quality of care
• Integration of services inc. electronic referrals
  and notifications
• Convenience associated with interactions with
  services
• Ability to provide care closer to the home
• Clinicians have more comprehensive record -
  leading to increased confidence in the service
• Single point of data capture

KD
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Realising the Benefits the Clinician

• Improved Decision Making
• Greater availability of information ensuring the
  latest situation is known at point of contact
• Ability to respond effectively to unplanned
  requests with live information.
• Ability to process actions / interventions more
  quickly for more effective care management and
  improved user experience.
• Ability to make informed decisions to benefit
  patient care

• Staff Wellbeing
• Increased staff satisfaction through better
  access to systems as a standard part of the
  professional work environment
• Improved work / life balance with more
  flexibility, more control and less stress
• Productivity gains increase opportunity for
  personal development

KD
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Realising the Benefits the Business

• Service Improvement
• Data collection at the point of care to support
  resource planning/management
• Improved co-ordination of appointments and
  planned care, with access to full patient record
• Access to more accurate and complete information
• Supporting the development of services
• Improved control and accountability

• Productivity/Financial
• Improve capital administrative efficiency
• Real-time (single) data capture - Reduced need
  for duplicate entry
• Reduced printing / paper / cartridges
  requirements rationalisation of record keeping
• Notifications and Referrals
• Reduction in unnecessary admissions

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The Northern LincolnshireExperience
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Strategic Partners
BT Health
A managed service provision from BT Health,
complimented by local IT support services
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Key Issues - Partners

• BT Health
• Expertise in agile working
• Experience of supporting solutions
• Commitment to NHS / NPfIT
• Panasonic
• Toughbook products
• Commitment to NHS

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Key Issues - Toughbook

• Lightweight
• Battery Life
• Semi-Rugged
• Touch Screen
• Hibernation / Session Persistence

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Mobile Working Community

• Successful proof of concept project
• Full-scale deployments (Phase 1)
• NEL GRIMM Commissioning Locality (85 units)
• NEL CTP Corporate users (25 units)
• NL Select Community Services (50 units)
• Phase 2 deployment on-going now (200 units)
• 4 Phase Deployment of 800-1000 units
• Phase 1 report recently published

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Mobile Working Findings

• Patient Care
• Overall, 53.2 of respondents agreed or strongly
  agreed that the mobile working solution had had a
  positive impact on the care they were able to
  give to their patients, while 31.2 disagreed or
  strongly disagreed and 15.6 didnt know. In
  terms of whether it had created an overall
  improvement in the service offered by their
  department, 46.9 of respondents agreed or
  strongly agreed, while 40.7 disagreed or
  strongly disagreed and 12.5 didnt know
• The ability to access clinical information and
  patient records while out of the office was
  recognised as a strong benefit. When asked
  whether better access to clinical information
  enabled better informed clinical decisions, 77.5
  agreed or strongly agreed, while 12.9 disagreed
  or strongly disagreed and 9.7 didnt know. And
  when asked whether mobile working improves
  patient safety by providing access to real time
  patient records, 71.9 of respondents agreed or
  strongly agreed, 18.8 disagreed or strongly
  disagreed and 9.4 didnt know.

KD
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Mobile Working Findings

• Patient Care
• Users were also asked to consider whether the
  mobile working solution had helped them reduce
  unnecessary referrals or admissions for patients,
  or improve patient safety. In terms of preventing
  unnecessary referrals/admission to other
  services, 15.6 agreed or strongly agreed, 34.4
  disagreed or strongly disagreed and 50 didnt
  know. These findings highlight the fact that new
  ways of working (incorporating the mobile
  solution) will take time to deliver benefits
  associated with inter-agency working.
• 2 Clinicians had already found that access to the
  patient record at the time of consultation had
  avoided a serious untoward incident.
• While the Proof of Concept showed that mobile
  working should increase the amount of time
  clinicians can spend with patients, only 19.4 of
  the survey respondents agreed or strongly agreed,
  while 67.7 disagreed or strongly disagreed and
  12.9 didnt know.

KD
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Mobile Working Findings

• Productivity Gains
• The survey covered various aspects of improved
  efficiency. Firstly, in terms of accessing
  records, 68.8 of respondents agreed or strongly
  agreed that the mobile working solution improved
  access to patient information generally
  18.7disagreed or strongly disagreed and 12.5
  didnt know. More than half (58.1) agreed or
  strongly agreed that mobile working increased
  access to patient information out of hours 9.7
  disagreed or strongly disagreed and 32.3 didnt
  know.
• And in terms of updating records, 75 agreed or
  strongly agreed that mobile working allows more
  timely updates to patient records 12.5
  disagreed or strongly disagreed and 12.5 didnt
  know. Additionally, 54.8 agreed or strongly
  agreed that mobile working reduces time spent
  updating clinical records whilst in the office
  35.5 disagreed or strongly disagreed and 9.7
  didnt know.

KD
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Mobile Working Findings

• Cost Avoidance
• It should be noted that reductions in unnecessary
  referrals/admissions and serious untoward
  incidents not only directly improve patient care
  but also result in significant cost savings for
  the Trusts.
• The Proof of Concept suggested that access to
  patient records at the time of consultation
  should lead to a reduction in clinicians travel,
  but the survey found that so far only 17.2 of
  respondents agreed or strongly agreed, while
  82.7 disagreed or strongly disagreed.

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Mobile Working Findings

• Staff Wellbeing
• In addition to a direct question regarding
  work/life balance and wellbeing, it was felt that
  questions relating to personal efficiency gains
  would help measure staff wellbeing.
• In terms of whether the mobile working solution
  had had a positive impact on their work/life
  balance and wellbeing, 28.2 of respondents
  agreed or strongly agreed 53.1 disagreed or
  strongly disagreed and 18.8 didnt know.
• 51.7 agreed or strongly agreed that the mobile
  working solution had positively impacted on their
  working practice, while 42 disagreed or strongly
  disagreed and 6.5 didnt know, and 29.1 agree
  or strongly agreed that it had positively
  impacted on their job satisfaction, while 58.1
  disagreed or strongly disagreed and 12.9 didnt
  know.
• When asked whether mobile working helps them
  organise their day more efficiently, 28.2 agreed
  or strongly agreed, 62.5 disagreed or strongly
  disagreed and 9.4 didnt know.

KD
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Mobile Working Findings

• Technical Issues
• Users were asked to rate their experience of the
  technical aspects of the mobile working solution
  on a scale of 1 (very poor) to 5 (excellent). The
  average rating for all clinical respondents was
• 2.78 for network coverage,
• 2.05 for time to connect to applications,
• 2.39 for speed when connected and
• 2.43 for reliability of connection.

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Mobile Working Findings

• Panasonic Toughbook
• In order to assess whether the Toughbook was
  felt to be fit for purpose, the users were asked
  to rate various aspects on the same scale of 1
  (very poor) to 5 (excellent). Clinical
  respondents average ratings were
• 4.28 for portability (weight/size),
• 3.06 for reliability,
• 3.58 for battery life
• 3.24 for overall ease of use.

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Our Experience Key Issues

• Network Coverage
• Need fit for purpose Client solution
• Light-weight
• Session persistence
• Battery Life
• Input Modes
• Connectivity
• Robustness
• Support
• Change management - a new way of working

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Mobile Working the challenges

• Managing the change
• Nurses want to nurse, not play with IT
• Deployments need to be service-led
• Network coverage
• Supporting mobile solutions is different

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Thank You for you interest

• Any Questions

How will we know if we get it right?
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Making the Business Case Why Invest?
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Making the Business Case

• Benefits Realisation
• Service Improvement
• Productivity
• Cost Efficiency Savings
• Return on Investment/Total Cost of Ownership

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Group Work(based on a clinical setting or
environment)
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Total Cost of Ownership (TCO)

• The life cycle cost view of owning an asset,
  which includes acquisition, setup support,
  ongoing maintenance, service and all operating
  expenses

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Return on Investment (ROI)

• A performance measurement used to evaluate the
  efficiency of an investment or to compare the
  efficiency of a number of different investments.
  To calculate ROI, the benefit (return) of an
  investment is divided by the cost of the
  investment the result can be expressed as a
  ratio