Going mobile with community health records - observations from the journey

Our conversations with these organisations highlighted both the challenges and benefits in moving from paper based processes to a mobile EHR. We found consistent reference to the importance of clinical and executive leadership and effective programme and change management.

Other providers are benefiting from mobile technology by rolling devices out across their workforce as well as finding innovative ways to use mobile technology.

The challenge

Getting through the potentially tough times in the early days of mobile usage to sustained use and adoption. Understanding and successfully addressing concerns and embedding significant change while faced with staffing and financial constraints.

What helps

Strong leadership which empowers individuals at all levels, clear understanding and communication of the importance of the change, and focus on the benefits.

Successful organisations:

• communicate the vision for all members of staff and demonstrate executive sponsorship and clinical leadership
• understand, articulate and manage the magnitude of the change for the individual, team and organisation, and make realistic plans
• empower staff and don’t underestimate the influence an individual can have
• build strong clinical engagement

The challenge

Finding the best combination of device, functionality, configuration and connectivity for all types of use and users.

What helps

Piloting, user involvement and use case mapping.

Successful organisations:

• listen to users, learn and have flexibility where required, such as in the type of device offered or the sequence of rollout
• manage connectivity pro-actively

Even with disconnected working, connectivity remains critical and often takes several iterations to get right. Good communication helps, such as providing users with maps of connectivity blackspots or lists of usable hotspots while changes are being made.

The challenge

Supporting and enabling significant change while both technology and support models may be new to the organisation.

What helps

Going slow until confidence in processes and the solution is established. Making training and support as mobile and accessible as possible.

Successful organisations listen and respond to differences in support and training requirements

They ensure appropriate training and support are in place to assist changes to working procedures, at go-live and beyond. Go-lives tend to be more successful and lead to sustained use if they have intensive support, such as dedicated and visible support at important sites, as well as going out with the user when they first start using their device. This helps users, IT and project managers to get comfortable with the solution and pick up issues more quickly. Drop in sessions for questions and quick fixes have also proved successful. ‘Hot swap’ capability - immediately replacing a non-functioning device with a new one - also encourages uptake and in some cases is critical to safe clinical practice.

Successful organisations understand that they need to build trust in the solution

It has to be as simple and intuitive as possible, and the system, device and work process should all fit together seamlessly.

The challenge

Exploiting the change for improvement and innovation. Keeping users engaged and keeping the momentum. Realising the benefits.

What helps

Clinical engagement, regular reviews and additional training as required.

Successful organisations:

• understand that the initial rollout is only the start and will need to be followed by stabilisation, optimisation and innovation as well as adaptations to respond to service changes
• continually monitor uptake and usage, and re-visit services 6 to 12 months after deployment
• apply lessons learned throughout the process and stabilise use - using focused surveys helps in planning to address any specific issues; drop-in centres for targeted training and e-learning help make it accessible
• exploit the new ways of working through clinically led reviews and service improvement - they measure benefits as well as usage to assess if the change is delivering the expected benefits

Overcoming the challenges and successfully using an EHR at the point of care can lead to great benefits.

Users confirm the crucial benefits are:

• improved productivity
• improved patient safety
• improved patient care and service design by having more up-to-date and richer information

Improved productivity

1. Less time spent looking for information.
2. No journeys to base just to collect or update a patient record
3. Better overall communication releasing time to care or better work/life balance.

For example, having mobile access to the patient’s record means that all previous visits and plans can be confirmed and clarified without waiting to either contact, or return to, the office and then update the record later.

Improved patient safety and quality of care

1. Visibility of past and planned care, and use of templates at the point of care, improves decision making and reduces duplication, making care more consistent and safer.
2. Access to patient history and other vital patient information reduces clinical risk.

For example, being able to see when other teams are visiting or have visited and what they did, means better co-ordination of care and that the patient doesn’t have to answer the same questions several times. Having access to rich guidance and all tools in one place can act as a useful reminder and supports confident and consistent care.

More up-to-date and richer information

Having more up-to-date and richer information leads to improved patient care, better service design, improved business planning and enables informed contractual discussions with commissioners. For example, a mobile solution can allow an overview of resources in real time. Demand and capacity can be managed whilst ensuring the nurse who is most appropriately skilled visits the patient, maintaining continuity of care and improving lone worker safety.

Optimising the investment: workforce productivity and estate

Mobile access to the EHR also allows providers to explore more flexible working for staff, leading to further improvements in work/life balance for staff and potential estate/office space reconfiguration.

Optimising and standardising patient care

A mobile EHR allows timely recording of richer data and more detailed activity. This in turn provides better analysis of activity; a stronger basis for accurate reference costs and discussing activity levels and income with commissioners. This allows healthcare providers to look at:

• how increased contact rates translate into improved patient outcomes
• the optimum ratio of face-to-face and phone contacts in different services

Enabling more integrated care

Having a mobile EHR available and updated at the point of care is the start of the process.

With appropriate data sharing, consent and integration, benefits can be multiplied through co-ordinating care across agencies. For example, integrated working across primary care, urgent care and social care supported by visibility of the EHR has the potential to significantly reduce emergency admissions.