A Future without Desktops - Addressing Real Clinical Needs in a Mobile NHS

Opinion Article by Matthew Kybert, Systems Development & Integration Manager at The Hillingdon Hospitals NHS Foundation Trust.
When clinicians in Hillingdon became the first in the country to access patients' Co-ordinate My Care alerts through a mobile application, there was an immediate impact. For the first time, doctors, nurses and other healthcare professionals in the hospital were presented with important flags and information on their iPad Minis, telling them which patients were on end of life care pathways and details of individual wishes.

Clinicians can now recognise palliative care patients at a glance, and, as a result, can more immediately understand each patient’s needs and circumstances, to ensure that appropriate and compassionate care is delivered at a crucial point in those patient's lives.

Mobile access to this information in an integrated view, alongside other clinical information, has ended a reliance on an earlier time consuming and less reliable process of manually placing flags on patient systems and in notes, arduously retrieving information.

Patients should spend the end of their lives with dignity and in the place of their choosing, and can do so when the right information is placed directly into the hands clinical staff, so they can make the right decisions based on a view of the individual's care journey.

This is just one of a wide number of very real and important clinical priorities now being addressed through the mobile Hillingdon Care Record (HCR), a project that is delivering mobile access to integrated information from a wide range of systems into clinicians' palms, and allowing care to be better co-ordinated both within the hospital and beyond, into the community.

A mission to mobilise clinicians
The Hillingdon Hospitals NHS Foundation Trust has been on a mission to mobilise our clinicians, and allow them to securely access a local digital care record on any device, any platform and anywhere.

We are moving away from the days of clinicians queuing to access PCs to retrieve information from different screens that demand impractical multiple log-ins.

Working towards our informatics strategy, the Trust has deployed a mobile app platform that allows staff to see one, central holistic record of a patient, known as the HCR, with encounter history from the Trust Patient Administration System (PAS), clinical documents and letters from a variety of systems.

Diagnostic results for pathology and radiology, and the GP summary record have also been made securely available through the app to authorised users, and the benefits for clinicians and the patients they serve has been significant.

Access to information in a mobile form is addressing real clinical needs. Bringing information from Co-ordinate My Care into the app is only one example of this, although the Trust's palliative care professionals are now amongst the highest users of the app.

We have improved patient safety. Access to crucial information from the Medical Interoperability Gateway (MIG), for example, is of particular benefit to staff working on the acute medical unit, in A&E and our pharmacists, who can now quickly understand, from local GP records, a patient's current medication and drug allergies when they arrive at the hospital.

Integration of this type of information along with clinical correspondence, diagnostics, and other crucial intelligence all in one place, is allowing nurses and doctors to find out about their patients' existing conditions far more quickly. Our staff in A&E now avoid the delays of logging onto in-demand PCs, meaning faster information at the point of care when emergencies arrive.

The importance of this mobile data goes beyond the hospital. Email alerts are sent to staff when patients arrive in hospital who are managed in the community, providing staff with relevant information needed to enable necessary care to take place and then for more timely discharge to the most appropriate care settings.

How we got there - developing Trust in-house mobile capabilities
At the start of this journey, the Trust did not have the toolset needed to develop secure mobile applications so we needed to find a way to develop our internal capabilities to quickly replace paper and desktop processes with mobile solutions.

The Trust was looking for more than a standard, off-the-shelf mobile system. So, we built the HCR app by working in collaboration with our mobile partner CommonTime, utilising a mobile application platform called mDesign. The mDesign platform has been pivotal to the HCR app project that allows us to build sophisticated applications quickly and responsively to the Trust’s needs.

Throughout the process of building the mobile HCR app, Hillingdon developers have continued to gain new mobile skills and can now confidently make future developments in-house through the platform. This has placed the Trust in a strong position moving forward to swiftly respond to changing clinical priorities.

We are already providing mobile access to the Trust’s PAS, as well as our discharge system, radiology information system, pathology results, clinical documents, GP information, palliative care records and more, so that information which has been joined together by our integration engine can now be made genuinely useful.

But as we continue to engage clinical staff to steer our informatics projects and to understand where we need to refine our mobile offerings to the frontline, the Trust is now in a stronger position than ever before to achieve this, in a responsive, timely and self-sufficient manner.

Investing in more than solutions, the in-house capability of Trusts can be a powerful mechanism to meet real clinical needs.

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