Technology is pushing back the barriers in healthcare. How are community practitioners responding?
Rima Evans reports.
Digitisation is a core strand in modernising the NHS, using IT to innovate and remodel the way patients are cared for. But it’s been a less than straightforward path. Last year’s Wachter Review (Department of Health, 2016) acknowledged the failure of the National Programme for Information Technology, halted in 2011, while also pressing home that its ultimate goals remain crucial to an effective, efficient healthcare system and should not be left to stagnate.
The issue may now be back on the agenda at national level but at grassroots, progress has been picking up pace for a number of years now, with pioneering work taking place across various disciplines.
As part of a pilot scheme at Glasgow’s Royal Hospital for Children, for example, nurses have been trained in using video technology that allows parents of premature babies in the neonatal intensive care unit to be remotely updated on their child’s health.
In Surrey, a ‘test bed’ project is underway, led by Surrey and Borders Partnership NHS Foundation Trust, which aims to help dementia patients live in their own homes for longer. It will use the ‘internet of things’ (where devices, sensors and even wearables are connected to the internet and each other) allowing carers and health professionals to monitor patients’ health at home.
A digitally driven evolution (rather than revolution) has also been taking place among health visitors, and community and school nurses. Teams are embracing mobile technologies, social media and online platforms in a bid to be able to deliver a better quality and more personalised service to a growing population.
Is all this change having an impact on practice? Harry Evans, policy researcher at The King’s Fund, highlights that mobile working technologies, where practitioners are equipped with tablets or laptops connected up to electronic health-record systems, is particularly significant and a trend being led by community nursing.
‘It’s easy to see what the benefits of this way of working would be, especially in a sector where time is squeezed,’ he says.
‘It increases efficiency, because records can be updated directly without the need for paper notes to be made first. More importantly, it means they have access to real-time patient records at the point of care, improving the service they deliver.’
Inevitably, he says, adapting to these changes is a gradual process, partly because digital investment is not uniform across the country, and partly because technology is not just about processes but also a cultural and mindset shift that can take longer to bring about.
‘Some regions are more advanced,’ Harry says. ‘Those areas leading the way are using the technology to promote good care, and have implemented it in as useful a way as possible and in a way practitioners want.’
In the East Riding of Yorkshire, community practitioners have been using electronic records since 2009, working mobile with laptops since 2015 and have full access to patient records, explains Su Davis, senior clinical governance manager and clinical safety officer at Humber NHS Foundation Trust.
There are many advantages to this, she says, including the fact that colleagues can more readily share information with each other without having to meet in person or travel back to base. ‘With patient records at their fingertips, they can all see the same information and discuss concerns,’ says Su.
Still, Su warns that such benefits can take time to filter through because working with mobile technology has implications for the way practitioners do their job, which can be slower to embed.
‘During the initial stages, navigating around an electronic system and keyboard typing rather than using pen and paper, which many of our workforce are used to, may be slow and reduce productivity. As skills develop, however, it increases efficiency.’
Working with electronic health records is also about change management, a process that cannot be rushed, especially in respect of those less eager to embrace new ways of working.
‘It’s not as simple as digitising a paper form,’ says Su, herself a former health visitor. ‘There has to be proper understanding of system functionality and how best to capture and use information. It has to be fit for purpose to ensure that it supports clinical practice and record-keeping standards.’
The less palatable side, which can discourage practitioners, is having to get to grips with information governance standards and issues and grasp how these affect their day-to-day job. ‘It is a huge and difficult agenda,’ admits Su. ‘Application of Caldicott principles requires practical examples to be worked through to enable practitioners to manage confidentiality appropriately.’
Another big barrier continues to be the interoperability of different systems around the country, which means that electronic records can’t easily follow a patient who moves out of the area.
Digitisation goes way beyond electronic health records, however. Community practitioners are harnessing technology to radically rethink the way they engage with patients, delivering care using modern methods more suited to the way society now lives and communicates.
One example is exploiting social media. Some health visiting teams have set up Facebook groups to connect with clients and be able to share news, educational resources or important information more easily. They are also using it for their own education, sharing good practice, for example.
Initiatives such as the eRedbook, currently being trialled, aim to widen choice for new parents in how they access information and organise and keep their child’s healthcare records.
Meanwhile, school nurses in several areas are adopting techniques teens may feel more comfortable with, running ‘e-clinics’ that allow 11- to 19-year-olds to talk through problems with their school nurse via secure text messaging (see panel above).
Sound and vision
A space that may soon be occupied by community practitioners is also video conferencing. At Pennine Care NHS Foundation Trust, there are plans to introduce a cloud-based video conferencing solution that will allow healthcare professionals, including health visitors, and community and school nurses, to hold multidisciplinary team meetings remotely and, where appropriate, hold consultations with patients.
Andy Comrie, health informatics programme manager, says: ‘It’s a more efficient way of delivering services. Right now, we are still training people and getting the equipment to people. Healthcare professionals seem very keen to get access to new technologies. We can’t deliver it fast enough.’
‘Video conferencing could enhance what would otherwise be just a telephone call,’ says Su.
‘It could be useful.’
Can this sort of interaction replace face-to-face? ‘Face-to-face is still important, of course, but we are all on shrinking budgets and resources. From a health perspective, we have to respond to the demands of our population, delivering services in the way they would like. I think we are on the brink of digital becoming the norm,’ says Su.
To influence and be a part of the digital agenda, the CPHVA Executive Committee is looking for members to nominate themselves for its Informatics Expert Reference Group. The group requires members with particular expertise in informatics so they can participate in the debate, and formulate and produce resources for the guidance, advancement and education of the membership. If you are interested, email email@example.com.
You will then be sent the terms of reference and more details to guide your application.
Department of Health. (2016) Making IT work: harnessing the power of health information technology to improve care in England. See: gov.uk/government/publications/using-information-technology-to-improve-the-nhs (accessed 26 June 2017).