NHS Scotland, wireless ICT and moving paperless,

Sunday 21st June 2009
Conceptual Medical Computer Assistant

Wireless computing and homegrown software turn may turn Scoland's NHS paperless. When PDA's didn't work, Scotland's NHS turned to Intel designed Medical Computer Assistants or Mobile Clinical Assistants (MCA). These together with Coupled or Computer Access on Wheels (COWs) and a lot of local Scottish software may move the NHS to the first paperless health service.

Marina Copping, clinical information manager for NHS Lothian,  said trials using personal digital assistants (PDAs) on wards did not find them suitable. "The PDAs were too small to view sufficient data," and also had problems synchronising with other systems, she told a session at Smart Healthcare Live.

Copping (right) said that MCAs, which were designed by Intel in association with NHS Connecting for Health and include a large touch screen and wireless connectivity, were much better suited to how clinicians work. "It's a PC, but in their hand," she said.

The MCAs provide access to NHS Lothian and NHS Scotland systems, including the patient administration system, test results and Scotland's emergency care record. "The tool allows staff to view any of that data on the screen," she said, and do so beside patients' beds.

This saves staff time, in that test results are available with the patient, rather than someone having to go to a workstation to retrieve information. "Now we have them at the bedside, we can act on them straight away," Copping said.

Following a formal eight week evaluation of the MCAs, NHS Lothian has bought 100 of the devices for use in medical, surgical and midwifery, and introducing them to wards. Copping said that hospital staff ask when MCAs can be implemented, whereas often they need to be persuaded to accept new technology.

"In 10 years of doing this job, I've never seen a tool that has been so readily accepted by staff," she told the audience.

One questioner said that his organisation had found that MCAs were too heavy for junior doctors to carry around wards, and staff prefer computers on wheels,  known as COWs.

"I'd prefer it lighter, I'd agree," said Copping, while stressing the positive aspects NHS Lothian's evaluation had highlighted. However, another audience member said his trust had its cows sitting in corners, preferring MCAs.

NHS Scotland uses Scots for software
In February, the Scottish health service awarded £5m software development and support framework deal to 10 firms All but two of the firms are based in Scotland, but as NHS National Services Scotland received just 10 responses to its invitation to tender, the suppliers were effectively self selecting.

Allthough more than 50 originally expressed an interest, half responded to the questionnaire that  was sent out.  An invitation to tender was sent to 15 firms, and all of those that replied have won a place within the framework.

The companies are Conscia Enterprise Systems (Glasgow), Computer Application Services (Edinburgh), Mastek UK (Reading), Pulsion Technology Edinburgh), Storm ID( Edinburgh), Sword Business Technology Solutions Glasgow, (formerly Ciboodle) The Solution Works (Glasgow), Sopra Group, Tron Systems (Livingston) and User Vision (Edinburgh). They will compete for some work through competitions, but will also be required to provide fixed prices for services, including packages and discounted rates.

According to the contract award notice, published in the Official Journal of the European Union on 23 February 2009, the firms will help Scottish health service organisations with software and web development, as well as maintenance and fixing of software.

Any intellectual property resulting from work will be owned by the commissioning organisation and open for free use across the public sector in Scotland.

Paperless a bit further away
Information is delivered through dedicated hospital wi-fi systems, with access to the most sensitive information restricted to senior medical professionals.
advertisement NHS Greater Glasgow and NHS Lothian have already bought machines, and trials are underway in Grampian, Highland, Western Isles and Forth Valley.

Some estimate the whole health service in Scotland could be paper free in five to seven years. A trial last year at St John's Hospital, Livingston suggested staff saved up to an hour a day using the machines rather than going to desktop computers.

To ensure security, no data is stored on the MCAs themselves, which are used solely to read and update files on remote databases.

Neil Campbell, of Panasonic Healthcare in Scotland and Ireland, which makes MCAs, said Scotland was well placed to be the first country to switch completely to electronic health records. It is already beating England, another world leader, in use of the technology.

He said: "People are getting rid of paper records as much as they can. I'm confident that we in Scotland are going to be paperless within five to seven years. "In England, it's much more fragmented ... but in Scotland there is a consistent approach."

He said prescriptions could also be arranged electronically. "At the moment, the community pharmacies aren't hooked into the rest of the computer system, but once they are, a GP should be able to write a prescription and electronically send it to the pharmacy, and the patient will be able to pick it up without any piece of paper. That should stop people swapping prescriptions, and cut down on fraud."

Seven MCAs were piloted last year by NHS Lothian at St John's Hospital in Livingston, and the health board has now ordered 100.

Martin Egan, (right) director of e-Health for NHS Lothian, said a wider rollout began two weeks ago at St John's, and the Royal Infirmary of Edinburgh and the capital's Western General Hospital will follow. Next month, the technology will be extended to district nurses in East Lothian.

He said: "It's one of the few technologies which had people gnashing their teeth when we had to take them away. The clinical staff felt it saved them a significant amount of time, potentially an hour a day."

He added: "Within the period of a ward round, which might take an hour, data can be updated. Clinicians can also show patients their digital x-rays to explain their condition." But he was sceptical that Scotland would soon be paper-free, because of the time taken to install wireless infrastructure in hospitals.

Theresa Fyffe, (left) director of the Royal College of Nursing Scotland, said it was vital to ensure staff get proper training and are involved in decisions over new technology to ensure patient care remains the priority.

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