Mobile deployment is not just about the technology. Finding and supporting the users is critical to ensuring success. Health Business summarises the recent National Mobile Health Worker Project progress report

The use of mobile devices in clinical care has long been touted as a cost-saving, productivity-enhancing solution for clinicians, and in particular for community clinicians who provide daily care in patients’ homes, at clinics, schools, nursing homes and other such disparate locations. However, very little in the way of quantifiable evidence has yet been recorded, making it more difficult for service managers to put forward the case for investment.

The National Mobile Health Worker (NMHW) project set out to capture quantifiable evidence to support the case for investment in the use of mobile devices in clinical care. The overall aim was to better understand the requirements for mobile working, and to demonstrate increased productivity and efficiency by reducing clinician travel time to and from community bases, and by making changes to working processes. Led by Kathy Drayton, a team of technical and clinical specialists supported by BT and Panasonic selected 11 pilot sites to examine the technical and business change aspects of mobile working deployment.

The initial capital cost of devices was funded by the DoH, with an understanding that the sites involved would take on the associated revenue costs of the devices in their project with the BT Managed Health Service Contract. Capital costs included the device with a smart card reader, N3 token set up costs and Microsoft office licence, with both the Project and business management and the training associated with deployment, and any changes required to the standard Gold Build on the device. The revenue costs included encryption, SIM Rental, BT Helpdesk, Mobile express connection and N3 Token rental.

Extensive data
In total, the MHWP team collected more than 11,500 days’ worth of data from 311 clinicians in 16 different clinical services. Over 50,000 contacts and 49,000 journeys were recorded in this manner with over 800 comments from clinicians and more than 150 comments were received from patients.

Clinicians using the mobile devices were asked to record some simple metrics around their daily activities, both before and after the deployment of the equipment. These metrics were collected and collated by the MHWP team in the hope that they would provide an insight into the difference the devices could make to the daily working practices of the many different kinds of clinicians taking part in the pilot. Data was collected in such a way that it was possible to analyse it not only by site, but also by service, allowing study into the ways that mobile working affected clinical working within different clinical practices.

Varied results
Results varied significantly across the pilot sites and services, but the majority of sites demonstrated increased productivity after mobile devices were implemented. More time was spent with patients following deployment of mobile devices, and journeys and total journey time were increased, although to a lesser degree than activity, indicating improved efficiency. Clinicians across the eleven pilot sites estimated that the devices allowed them to save 507 referrals, equating to a saving of nearly nine percent across the pilot period. They also estimated that the devices allowed them to avoid 49 admissions.

Whilst there are some clear financial benefits associated with the adoption of mobile working, it is stressed that just as the solutions are not ‘one size fits all’, neither are the benefits. Financial savings will vary greatly across different sites and the different services within them.

The MHWP pilot study highlighted several key points for consideration when implementing mobile solutions. Frustrations with connectivity and session persistence are the major barriers to smooth adoption of mobile devices. Therefore projects must be willing to experiment with different network providers to find the best levels of coverage for users, and to centrally coordinate the development of robust connections.

In addition to improving the connectivity of devices, the applications that run on them must be developed further to support mobile services through use of approaches such as 'store and forward'. This would allow clinicians to work seamlessly, even during periods of time when they are out of range of network signal, with data being temporarily held locally and securely on the device and uploaded to central servers when an internet connection becomes available.

Lessons Learned

The differing results achieved across the MHWP pilot sites illustrate the range of possible changes that can be effected through the adoption of mobile working. The disciplines that fall under the umbrella of Community Services are necessarily diverse, and the adoption of one single type of device or one way of working with that device will not necessarily prove to be the most effective for all service types.

Analysis of the metrics returned from each site begins to provide an insight into the possible benefits to be unlocked for the different service types, and further work through the MHWP – the transformation of full teams of clinicians – promises to reveal further possibilities for the identification of savings and efficiencies through mobile working.

Although the Transforming Community Services (TCS) programme, which ended in March 2011, has now drawn to its conclusion, the Mobile Health Worker Project will run into 2012. The team is continuing to work with the 11 sites to evaluate the use of the devices over a longer period of time, to build up a long term picture of the effects of the devices understanding how the benefits may change and whether the process changes become embedded. They are also working with six of the pilot sites from within the existing cohort to implement whole-service transformation; identifying full teams that would benefit from the deployment of mobile devices to all clinicians. The are NHS South West Essex, NHS Tower Hamlets, North Tees and Hartlepool NHS Foundation Trust, NHS Calderdale, John Taylor Hospice and the Avon IM&T Consortium.

Mobile devices are key to ensuring that community services don’t get left behind as the NHS undergoes changes in the way care is commissioned and provided. Mobile devices will bridge the information gap that currently exists around community care, making the forthcoming Community Information Data Set (CIDS) far easier for organisations to collect and submit.

Measurements will continue over a longer period of time. A follow-up report detailing this work is expected to be published by the DoH in 2012.

Behind the project
Kathy Drayton, National Clinical Lead for mobile solutions, has spoken at numerous event throughout the course of the year, explaining the strategy and execution of the mobile health worker pilot project.

The full National Mobile Health Worker Project Progress Report is available on the DoH website, and contains data analysed by the NHS Information Centre for Health and Social Care.

Report collated by Ruki Tech Ltd.