Mental health systems

Mobile working surely makes sense for mental health, where so much care is delivered in the community. However, there are barriers to overcome; Kim Thomas discovers.

“There are only three mantras we have: mobile, mobile and mobile.” So says Alan Stubbs, managing director of Servelec, which provides the RiO electronic patient record.

Mobile technology has an important part to play in the drive towards a paperless, more efficient NHS, but it is particularly relevant when it comes to mental healthcare, much of which is carried out in the community.

In the past three years, the end of the National Programme for IT has seen trusts in London and the South successfully procure new mental health systems, while others in the North East, East and Midlands have also come to market.

Vendors were expecting that the market refresh would trigger an uptick in demand for new functionality, including the ability to support mobile working; but this has not quite materialised. Martin Bell, deputy managing director for EMIS Health primary care, community and commissioning, says there has been an “explosion” in mobile working in the broader NHS.

However, he says: “I don’t think that mobile working is yet the norm in community settings yet, though more and more organisations are doing it.” This reluctance is something that George Thaw, managing director of Advanced Health and Care, finds frustrating. The difference a mobile solution can make to a trust’s efficiency is like the difference between “night and day”, he argues.

Big savings to be had

For most trusts, the big saving will come from eliminating duplication; or from entering notes directly into the patient record rather than taking paper notes that have to be typed-up at base.

But that’s not the only efficiency saving, says Bell: “You start the day having synced with your home wi- fi to download your patient list. During the course of your trip, you can have patients added to your list, and you can redirect and reroute.”

The time freed-up by not having to travel back to base also offers the opportunity to see more patients. When Bromley Healthcare implemented EMIS Mobile to 350 community clinicians, it found that each staff member saved an hour a day.

If mobile workers are spending less time at a physical base, substantial capital and operational savings can come from the closure of buildings, says Stubbs: “Estate reduction is a key driver for the NHS at the moment, but they can only do that if they’ve got a really good mobile solution.”

Stephen Hawkins, head of consultancy for health and social care at Civica, notes that mobile technology can also improve clinicians’ ability to do their job. Information can, he says, be “pushed” out to workers on the move.

“We’re able to pre-populate their diaries with plans and interventions. We push out a folio of clinical information about the patient’s current care, the current care plan, the treatment, any risk and contingency plans, any latest MDT notes, any alerts and notifications.”

It means that when the clinician sees the patient, they have the up-to-date care plan and case notes, so that they don’t have to ask the patient for information they’ve already provided – improving the efficiency of the visit but also the quality of the contact.

In return for new ways of working

But implementing a mobile solution can be challenging. Sarah Hibbert, account director and country manager for Northern Ireland at Civica says: “Any time there’s a move to mobile working, there is a complete transformation needed to the person’s working practice, so there is a hurdle to get over.”

Community-based teams, used to a face-to-face meeting every day, will need to find a new model for sharing information, says Bell: “You’ve really got to get into bringing them into the journey of how they might do that differently or less often.”

There’s also the problem that the presence of a laptop, or even tablet, can create a barrier between clinician and patient in a way that isn’t the case for paper note-taking. Bell says some trusts have chosen to adopt digital pens and paper instead, to make notes that can be uploaded automatically.

And, of course, there’s the issue of infrastructure; parts of many towns, never mind more rural districts, have relatively poor mobile coverage; making investment in new networks and/or systems that can work off as well as online imperative.

A more interactive patient experience

The business case for mobile working isn’t just about efficiency, however. Mobile technology can help meet the ‘Five Year Forward View’ aims of improving patient access to their records and their ability to manage their condition.

Patients who can upload their own data to their record through a mobile or tablet become more engaged in their own care, says Hibbert.

“The whole experience of the patient is much more interactive. You’re not just giving them a leaflet and saying: ‘Read that.’ It’s: ‘Let me show you how you can download this, put the information in place, and how we can all get better view of how things are going.’ Having that kind of feedback loop is better for everybody.”

That data could be a diary of how the patient is feeling, or even just a smiley or sad face, or perhaps nutrition or exercise data uploaded from an app. Thaw believes that this can improve the interaction between clinician and patient.

“When you arrive at my [the patient’s] house, you can see my self-assessment of the last two weeks of my general state of mind. To be able to integrate simple things like that gives you richer information that allows you to make smarter decisions.”

Some information recorded by the patient (a series of five sad faces in a row, for example) could create an alert to the clinician.

Ana Guimaraes, mental health product manager for Silverlink, believes this gradual introduction of patient access may shift suppliers’ focus away from apps designed as extensions of existing systems to apps designed for patients.

“The possibilities are endless,” she argues. “They range from simple apps to help patients manage their appointments, view and contact their caseworkers, have easily accessible information regarding their care planning, to apps allowing patients to regularly fill up their assessments to allow mental health services to proactively monitor and provide early intervention on the first sign of crisis.”

Mobile access can also allow patients to share their information with others: EMIS Health now has a feature called “Share my record” that enables patients to view their record from a web portal and share it securely with other clinicians, which has proved helpful for patients travelling in other countries.

The next challenge: integration

The government’s mandate for integration between healthcare and social care is leading to demand from trusts for technology that provides interoperability between different systems, not just with social care but between mental health and primary care.

TechUK has launched an interoperability charter with the aim of delivering integrated care, and there are a number of local initiatives.

However, Hibbert argues that the NHS will have to take a greater lead on information sharing and standards: “It’s all very well suppliers saying: ‘You can access our information,’ but if it’s not standard across the board it becomes quite difficult.”

At the same time, issues about information governance, and about who holds the budget when the NHS works with social care providers, will have to be hammered out before shared access to the patient record becomes widespread.

Stubbs says that in London, where Servelec often has mental health, community health and social services clients in the same geography, those clients have been active in driving forward better information-sharing.

Despite the efficiency savings, and the potential benefits to patient care, adoption of mobile technology in mental health is at an early stage: lack of funding is yet another barrier, as it is elsewhere in the NHS.

But Hibbert is optimistic: “There have been a few pilots, and once they start showing the benefits, that’s when the real push will be. Once people see it working, they’ll come on board.”