Through our live event series HTN Now we hosted a virtual panel discussion focusing on connecting care and extending EPR value through mobility and connected devices. Joined by panellists Andy Kinnear (former chief information officer and independent consultant), Louise Clarkson (chief nursing information officer at Blackpool Teaching Hospitals) and Daniel Johnston (senior clinical workflow specialist for Imprivata), the discussion covered topics such as strategies for widening the benefits of the EPR; how to understand clinical workflows in relation to the EPR; and how to utilise mobile and connected devices for a better user experience.
Andy started the discussion by sharing statistics from KLAS Research displaying the digital experience satisfaction rate of over 40,000 providers, focusing on the clinical end users. Andy highlighted where individuals from the same organisation have reported vastly different satisfaction rates with the same product.
“A lot of effort and work goes into selecting and buying digital solutions, but in truth, your selection is not the key determinant in whether our clinical colleagues are happy and satisfied,” Andy said. “This research shows us that it’s not just about the supplier and the system. It’s largely down to the organisation and the individual – it’s about emotional investment in digital transformation journey, and the support the organisation gives to individual users.”
The state of enterprise mobility
Next the panel moved on to explore the Ponemon report ‘Unlocking the cost of chaos: the state of enterprise mobility in life- and mission-critical industries’ to explore the state of mobile use for frontline staff.
“The report surveyed just under 1,800 members of staff on an IT management and security perspective from across the globe,” Dan shared. “It spanned five industries and explored where mobile is being utilised and how. It looked into what mobile use means in terms of accessibility and usability as well as security.”
Key findings from the report found that IT staff lose valuable time when dealing with lost devices; and that shared mobile devices are often seen as being secure and more cost-effective, but security requirements on shared devices are having a negative impact on clinician workflows. The report indicated that there is inconsistency in strategies and standards used to deal with enterprise-provided mobile device security risks; difficulties around maintaining an available skillset to deliver these requirements; and a lack of comprehension around what ‘usability’ really means for mobile devices.
One particular finding indicates that “only half (51 percent) of organisations can maintain control over who has access to what devices and when they are accessed”; another suggests that only 42 percent of users said that they were satisfied with the access experience on mobile devices. Additionally, 54 percent of the organisations included in the report had experienced a data breach due to unauthorised access to mobile devices, 61 percent said that it is “very difficult” to maintain access controls on shared devices, and 60 percent said it is also very difficult to audit usage across shared mobile devices.
Andy shared some thought on why these numbers seem particularly low. “There’s a real financial argument at the heart of everything in the NHS,” he commented. “If we are willing to take a risk on the amount of clinical provision we’ve got in terms of vacancies, then we can’t really be surprised that we are also taking a risk on some of the IT. Organisations are having to make tough choices over their spend, and that might be reflected here. Also, perhaps there’s something to be said around skills and confidence in this area. People may have become very experienced and familiar in the management of a desktop estate, but less familiar with the management of mobile kit and software.”
Andy went on to pose a question to Louise: do IT and technology departments have different definitions of success to their clinical colleagues?
“I do recognise that,” reflected Louise, “but I also think I’ve seen that changing more recently. The more that you involve clinicians at the start, the more they understand why IT teams do things. Sometimes when you change infrastructure or equipment, from a clinical perspective, it looks like IT is causing chaos on the wards. On the other foot, you have the IT department with a clear objective. That objective can be delivered and it can seem like a success to the IT team, but if the clinicians aren’t taught how to use the equipment that has been installed, then frustration builds. When those two worlds of clinical and digital come together right at the very start and there is equal understanding of roles and objectives, it really helps.”
Dan highlighted further findings from the report, including that “organisations are losing anything from 16 percent to a quarter of their devices annually – that has a significant impact in terms of IT operations but also availability of devices for clinicians, cost, and loss of productive time.” 44 percent of misplaced devices were said to have a direct impact on patient care; 78 hours per week were reported by staff and IT spent tracking down missing devices; and 203 hours annually are spent replacing what cannot be found. The average annual cost of dealing with lost mobile devices is suggested to be around $1.3 million.
Andy pointed out that the heavy workload placed upon clinicians underscores that asset management is often not their priority, and added that the financial challenges facing healthcare come into play here too, as organisations cannot afford to buy more in advance to make up for an expected percentage of loss.
Dan moved on to explore other statistics, such as the fact that 67 percent of respondents said that they needed to be physically onsite to manage so many devices, and that it was becoming difficult to scale. Less than half of respondents said that their strategy includes automation to scale what a small number of IT staff can achieve.
Turning to Louise for her frontline perspective, Dan asked, “What does it mean to have mobility in relation to productivity with an EPR, and what does it mean when those devices are unavailable or not working correctly?”
New projects often bring investment and a sense of excitement, Louise said, but when a project moves into business-as-usual, there are often issues with equipment starting to break or with funding not covering necessary replacements. “It’s a vicious cycle,” she said. “You’ve got to maintain the mobile devices in the background, they have to be working, or people lose confidence in the system and disengage. They need to be trained properly at the start too, or else disengagement will happen there. It helps when you’ve got a really strong business continuity plan, so that if an outage happens, staff are confident in knowing how to keep going.”
She pointed out that technology must enable clinical staff, not hinder them, and Andy agreed. “IT teams can deploy something and feel frustrated when clinical teams don’t immediately and easily adopt it. But adoption is a curve, there’s an adaptive change process.”
Mobility is “very present in our personal lives,” Dan considered, “with very high levels of adoption – but within healthcare, it feels like we are still asking what mobility will really enable. We want it, but we need to know what we are achieving. Can it help me become more than compliant with my fluid balance charting? Will it enable me to administer medications in a more timely fashion? I don’t feel that we have really defined that, and that could also indicate that we are still trying to work out the technical support needed in this area.”
“I think there’s also a perception from a patient side that if you see a clinician on a mobile phone, they aren’t really working,” commented Louise. “Patients often think that staff are using their personal devices and this can arise later in complaints. I think there’s something to be said for the fact that we wouldn’t necessarily assume the same if we walked into a bank and saw someone using their phone – I think we’d be more likely to assume they are checking something, or booking us in for an appointment. In healthcare, it feels like we are in a period of change where mobile devices are becoming more popular but for some nurses it is uncomfortable having that device in hand. They’d be more comfortable on a computer – but looking back a few years, they wouldn’t have been comfortable sitting at a computer. It’s a transition into a digital world.”
Surveying UK clinicians
Dan highlighted how Imprivata ran its own survey gathering opinions from 100 clinicians and informaticists attending a UK health tech event earlier this year.
“70 percent of our respondents said that they still require a username and password to access applications,” Dan noted. “Some have a generic PIN they need to key in, some have personal credentials; 15 percent said that their devices are not locked down at all. This is interesting because there are security standards that we expect on PC endpoints to access patient information, but it’s like we haven’t quite got there with mobility yet.”
Andy raised the possibility that financial challenges are driving healthcare to “settle for barely adequate or just about adequate, rather than optimal”.
Louise said that from her perspective, “every clinician has used a generic password or PIN – because that was just the given thing when you only had one computer on the ward and everybody used it. Now we are transitioning to mobile devices and you need to be accountable for yourself. But the change is a learning curve for staff, and sometimes requirements can be intimidating – for example if something asks for a 12-digit password with an asterisk, a capital, a number and a symbol.”
Aside from increasing staff experience, Andy pointed out that retention should be a driver in encouraging organisations to support staff with IT. “Poor IT experience is really contributing to clinician burnout all over the world. Investing in improving that experience is a way of reducing the likelihood of burnout and therefore avoiding recruitment and saving costs.”
There’s also the matter of defining success, Dan noted. “Is it the fact that your EPR is accessed more frequently on mobile devices, is it that certain workflows are undertaken via mobile? We need to be able to track what a successful mobile device implementation looks like, and I don’t think we are there yet.”
“Fundamentally, the single measure of digital success is how happy clinical users are with it,” concluded Andy. “There’s lots of granularity you can get into beyond that, but the bottom line is: are the staff happier than they were before? That needs to be a base measure of success.”
How to achieve improvement
Andy drew the discussion to a close by sharing the information that was presented to NHS England following the KLAS Research around digital user satisfaction.
“When it comes down to it, there are four recommendations. The first is to ensure that infrastructure is in place to achieve improvement; that means having enough working mobile devices available to clinicians. There needs to be shared ownership of the digital journey between the clinical teams and the IT teams. We need to give end users the training and support to become real experts in the use of these technologies, on an ongoing basis. Finally, your tech stack and the software that you invest in needs to meet expectations and deliver on your organisational needs.”
Many thanks to Andy, Louise and Dan for joining us and sharing their insights.
