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Going mobile with community health records - observations from the journey

We have gathered rich and compelling insight from eight community healthcare providers by looking at some of the challenges they encountered when deploying mobile electronic health records (EHRs).

Together these organisations have over 6,000 users including community nurses, health visitors, integrated care teams, staff in community hospitals and specialist nurses, mostly using laptops for clinical applications.

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 benefitting from mobile technology by rolling devices out across their workforce as well as finding innovative ways to use mobile technology.

Leadership and change

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

“Changes like this need ownership and engagement of frontline staff from the start. There needs to be strong support and regular sharing of the common goal of better and evidenced based patient care to make the journey smoother and implementation more successful.”

Heather Mitchell, Chief Executive, SEQOL

“There is a real practical limit to the change that people can deal with. And you need all of them to be on board, not just the technologists. Find your leaders and champions: if you have someone who is a champion in an area, you are much more likely to succeed and to be innovative.”

Graham Sykes, Project Manager, Livewell Southwest

“Before deployment some staff had used solely paper records and many had not previously used computers at all in work or at home. We found support of the team leaders and managers to be key and the deployments with fewer issues were those that had this support. Changes to practices and ways of working need to be made through clinical redesign to ensure ownership and workable processes are in place.”

Tracey Paton, Deputy Director of Informatics, Sussex Community NHS Trust

Connectivity and devices

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.

“One size does not fit all. We are now offering people a choice of a bigger laptop/screen to accommodate different types of use and working habits.”

Graham Sykes, Project Manager, Livewell Southwest

“We are working with our CCG to put secure Wi-Fi access into all GP premises in our area to ensure our staff are never far away from a usable connection.”

Jo Elliott, Clinical Lead, Dorset HealthCare

Training and support at go-live

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.

“We used a strong team approach with clinicians and IT specialists working side by side. Flexibility was key, such as when adapting the system during go-live with configuration staff seeing how it was used in real work situations. We found that leaving a gap between planned end of training and the next deployment allowed us to provide additional support when required. Flexible training slots for staff worked well, allowing staff to book suitable time slots and to swap if necessary.”

Tracey Paton, Deputy Director of Informatics, Sussex Community NHS Trust

Ongoing change and improvement beyond rollout

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

Realising the 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.

Observations from the journey: benefits

”Mobile working allows me to do my visits for the day without going into the office. Completing records at the time of seeing patients makes it safer and means I do not have to return to the office to record my afternoon visits. This means I can see more patients, I finish on time and I feel less stressed.”

”Great move forward that the whole of my team can access and handover to other clinicians via the system – a more consistent approach as notes are visible in the system.”

”I took some pictures with the device and my colleague was able to review the wound the same day via the system. I am very impressed with the efficiency of being able to do this rather than wait to book a joint visit.”

”The templates encourage a holistic assessment and I believe that this has improved our wound assessments and individualised care planning as well as prompting regular evaluations.”

”I can now reliably reach each member of staff by e-mail when needed. Staff also have access to our intranet and electronic expenses and this has been a big step forward.”

”As a manager I have found that the quality of nursing assessments and the information that the nurses are recording has improved and I now have information available for all of the patients that we see, which really helps with investigations.”

Observations from the journey: what’s possible?

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.

Last edited: 18 March 2019 4:20 pm