Community and Mobile Working National Mobile Health Worker Project

CCIO Annual Nursing Conference

13th June 2013

Kathy Drayton

National Clinical Lead Mobile Solutions

The landscape 2010

• Limited ability to access Electronic Clinical Records

• Poor data quality

• Poor transposition of data

• Loss of valuable data if not correct at the time of collection

• Clinical assessments performed with dual entry taking place often at a later date

• Data entry being performed by non clinical staff

• Wide variety of data capture requirements within services

What was needed

• The need for efficient and effectiveness services with limited resources

• Improved capital & administrative efficiency

• Clinicians to be equipped with solutions that enable them to deliver the highest standards of care in a safe and effective way

• Real Time, single point capture of all data

• Reduce need for duplicate entry

• Improved information for patients / public

NMHW Project

• 11 organisations took part representing 8 SHA's

• The organisations were chosen to represent a wide range of services, geography and clinical applications.

• The 11 sites covered a multitude of applications including : Systmone, iPM, e-CAF, Care FX Portal, Summary Care Record, Rio, Emis Web and gave access to decision support tools and web based applications through internet access such as NHSmail, Electronic Document Management, Pathology Results, Ordering of Equipment and Patient Satisfaction Feedback

• The services included were: Palliative Clinical Nurse Specialists, Palliative Multidisciplinary Team, Children's services, Podiatry, Drug Alcohol and Rehab members, Rapid Response, Cardiac Rehab, Speech and Language Therapy, District Nurses, Community Matrons, Health Visiting, Pulmonary Rehab. Hospital at Home.

Mobile Health Worker Sites

Ashton Leigh and Wigan IPM

Birmingham East And North Systmone Palliative Care

Stoke On Trent iPMNorthamptonshire Systmone

IMT Avon RIO

Hartlepool Systmone

South West Essex Systmone

Doncaster Systmone

Calderdale Systmone

City and Hackney Rio and Tower Hamlets Emis Web

Statistics of the NMHW Project

Phase One• Ran for a year Sept 2010 – 11

• Returns from 377 clinicians

• 14,560 days of activity

• 65 155 patient contacts

• 64 532 journeys

• Over 1000 comments from clinicians and patients

Phase Two• Nine months concluding Feb 2012

• Returns from 387 clinicians

• 7 910 days of activity

• 42 419 contacts and

• 21,662 journeys

• Over 500 comments from clinicians and patients

A large study with analysis from 22,500 days of clinical activity and over 100,000 patient contacts to understand the requirements for mobile working to support

community service modernisation; as part of the Transforming Community Services Project

https://www.wp.dh.gov.uk/publications/files/2013/01/mhwp_final_report.pdf

The assumptions

• Reduction in no access visits

• Increased patient contacts

• Increased contact duration

• Reduction in travel time

• Reduction in Community referrals

• Reduction of admissions

• Reduced duplication of data recording

Efficiencies• No access visits can be reduced significantly • Northampton saw 37% reduction and Tower Hamlets 50%

• Increases in Productivity are shown by increased activity • Specialist Nurses in Hartlepool 142% and Palliative Services in

Birmingham 83-93%

• Increases in time spent with patients as demonstrated by • Tower Hamlets 104%

• Journeys can be reduced even where clinical activity is increased• Speech and Language Therapists in Hartlepool saw an 8% reduction

and the Specialist Nurses 11% reduction

• Time spent travelling can be reduced, as demonstrated well by • Tower Hamlets - 33% reduction

Cost Savings

• In Northampton there were 86 no access visits saved (compared to Baseline) = £3612.

• This equates to £225.75 per clinician over the 12 weeks, – or £978.25 per clinician per year due to a reduction in No access visits

(16 staff submitted data).

• At Tower Hamlets, there were 51 saved referrals = £ 2142 • This equates to £238 per clinician over the 12 weeks

– or £1031.33 per clinician per year due to saved referrals (9 staff returned data )

• At Tower Hamlets there were also 20 saved admissions = £ 34 700• This equates to £3855.56 per clinician over the 12 weeks,

– or Savings of £ 16 707 per clinician per year due to saved admissions

Travel and Mileage

• Significant savings can be made by reducing unnecessary travel. • At Hartlepool the 33 staff that returned data at Baseline and Benefits 4

in Phase 2 saved 5438 miles – (over a single 1 month period)

• Using the HMRC standard mileage rate of 45 pence per mile, this can be calculated to give a saving of £ 2447

• This equates to £74.15 per clinician over per month, or• Savings of £889.95 per clinician per year due to reduced mileage

“Softer benefits”

• Creation of time efficiencies and Improved use of “dead time”

• Improve patient interaction with patient acceptance of devices high

• Avoidance of duplication – single entry and ease of audit data collection

• Viewing and sharing data and the ability to use multiple base locations

• Improved work life balance, affecting staff retention and sickness rates

• Ability to access organisational / service information workers in remote

locations

Process Changes• Electronic templates created to support services

• Ability for whole service to become paperless

• Direct referral to Equipment loans electronically

• Accessing support information from patients homes

• Faster post discharge intervention to prevent readmission

• Improved confidentiality and transport of patient notes

• Ability to review working patterns with HR

• Ability to maintain business as usual during adverse conditions

Service Change

• Improved communications within teams and the organisation

• Respiratory Team reports that they are now securely emailing all GPs with their interventions

• Rapid web based access to loans and stock levels now allows clinical decisions on care to be made and stock to be delivered promptly

• Services agreeing to meet once a week for knowledge transfer and peer support rather than travelling to the office every day

• Changes in working practice led to improvements in service waiting times, which were noted to have reduced. (clinical time more effective)

• It is now possible to demonstrate that palliative care patients are being seen within one hour of contacting service.

• “

Patient Care

• Improved Referral choice

• Patient engagement

• Improving patient confidence

• Compliance with treatment

• Reassuring patients

• Improved Information improves Outcomes– Accessing and sharing relevant information prior to referral or transfer

Clinical Feedback on how theythe use the Technology

• The tough book has been fantastic enabling me to input client data directly onto the system, without having to carry around coded data and travel around looking for a computer

• Able to utilise short periods during the day to catch up on e-mail etc. Makes e-mail much more accessible as a means of communication

• Used on training course - course was regarding a web based portfolio tool. Course had been oversubscribed, but tough book enable me to have my own access

• Was able to contact the patient over the phone when there was no answer at the door. Where as previously I would have rung back the office to chase contact telephone

Clinical feedback on the improvement in care delivery

• I needed to refer a patient who was v unwell to a respiratory consultant. I was able to get all the info chest x-ray results, clinic letter info on my laptop before referring. They usually ask for many details I don’t have, but I was well prepared. It avoided an admission

• The lap top allowed me to share clinical data with a patient in their own home - this promoted a seamless service - excellent quality of care

• Able to access hospital discharge summaries without having to contact GP surgery for information

• Was able to make a referral for a child to Speech and Language therapy as requested by mum during the visit, so she was able to see referral being commenced

Clinical feedback on the improvement in care delivery

• Very useful to have access to system one via tough book to record critical issues regarding patients and having to pass on and document this information with extensive multi-disciplinary group member across primary and secondary care network

• Able to check blood results on ill patient requiring a visit to check kidney function before prescribing

• Used tough book to show client information about equipment on internet to enable improved choice

• Was able to check hospital appoint as patient has mislaid letter

• Able to check laboratory report and issue correct antibiotics promptly

Clinical feedback on Efficiencies attributable to technology

• The device is now and invaluable part of my working life. It has made working easier and more efficient

• Following a meeting at school, I was able to use the tough book to update RiO and write reports in the school, rather than going back to the office for half an hour

• Staff meeting – Tough book used to access to RiO enabling case discussions

• Additional visit scheduled due to time saved not having to return to base

• Main advantage at present is due to change of hours/ flexible working

• Mobile working device saved me 30mins travel time this enabled me to complete my work load within the time limit of my working day

Patients Comments on the use of Technology

• “Thought tough book was a more sensible approach rather than 'shuffling around with papers”

• All patients have been very positive towards mobile working and they were surprised that it has taken so long to start

• “Efficient, effective”

• Patient made positive comment re how this may make things more efficient

• “Your job is now very easy with your little computer. And thank you for contacting social services”

• Patient was impressed by the level of security required to access patient information on the tough books

Patient Comments on Improvements in Care Delivery

• The patient was extremely pleased to be able to see what the equipment looked like before agreeing to it.

• Client happy - I was able to check the system to confirm further information thus helping to reduce anxiety levels

• “Happy see 'that you now can spend more time with us patients, and save yourself the bother of writing my stuff twice!”

• Patient very impressed when was able to access blood results and educate patient regarding medication in there own home

• Patient appreciated that I could show him the type of prosthesis he had and how it would look on plain x ray.

• Parent commented on availability of checking previous / future appointments with Health Team

Difficulties

• Maintaining “early gains”

• Data Collection over long time periods and issues with data collection tools - excel files and mileage

• Asset Management and staff retention

• Changes in Project Structure, retention of Support service and Project staff along with project status

• Device Choices in a very fast moving Marketplace

• Consistency of connectivity, infrastructure and network access

Staff ultimately have more

freedom to perform their jobs

in the most effective way

Thank You

Any Questions ?