Cardiff and Vale University Health Board was established in 2009 through the amalgamation of three NHS organisations in the Cardiff and Vale of Glamorgan area.
The Board supports a population of around 445,000 people living in Cardiff and the Vale of Glamorgan, providing public health and community care services that are used by the whole of Wales.
Having deployed the PARIS Electronic Patient Record system to over 4000 staff in its Mental Health and Community Services, Cardiff and Vale were then faced with the challenge of ensuring that the data kept on the system was up-to-date, accurate and available when and where it was needed most. With nearly 1000 community workers across services, they needed a way to connect all tiers of Child Health and District Nursing with the PARIS system – including community nurses, midwives and mental health workers.
Mark Cahalane, Programme Manager for Cardiff and Vale explains: “Previously, our community nurses would go out to see patients in their homes and be left with a double administration task. They would hand-write notes whilst out in the field – then have to return back to base to input them on to the PARIS system. The efficiency of the model was poor.”
There were also challenges with regards to ensuring nurses could still enable their duty of care – whatever the circumstances. For example, in extreme snow, the nurses may not have been able to get in to the admin base to download or upload patient data.
Cardiff and Vale identified that they needed to make the process more flexible, reduce the admin burden on nurses and enable access to the latest patient data on the move – all whilst ensuring that improving the quality of care was the primary objective.
Mobility and flexibility in the field
Cardiff and Vale began working with Stone as their preferred partner for deploying a mobile working project. Initially, they ran a mobile working Proof of Concept for 20 field nurses, comprising of a 12″ notebook with mobile data connectivity.
As Mark explains, the pilot scheme helped identify some issues: “With a larger footprint and screen size came issues with battery life. The devices also proved too large and heavy for some users and the mobile data signal in our region from the network provider at the time was patchy. Due to the importance of the in-built data provision, it soon became apparent that a standard off-the-shelf offering would not give the bespoke service that we needed for our particular circumstances.”
Stone worked with Cardiff and Vale to assess the variables of the Proof of Concept and address the issues. The data carrier needed a review to assure best performance, so the Health Board went out in to the field with a signal scanning device to help map out the connectivity challenges in certain areas. Field Nurses would try the signal at the point of care, with Cardiff and Vale leaving nothing to chance – testing all 6 of the UK’s major signal carriers.
Attention then turned to the device. With the challenges around size and weight, it was identified – by clinical review – that a Windows-based notebook would be a more suitable fit for Cardiff and Vale. Again nothing was left to chance as part of their rigorous project evaluation. 6 different notebooks of varying screen size, keyboards and batteries were evaluated – with the Health Board finally settling on a Lenovo X240 notebook with 02 connectivity.
After proving a success during the Proof of Concept, the project has provided over 700 devices to date with an in-car charger to Cardiff and Vale’s cross-service nursing team. Each device features a fully encrypted data connection and staff authenticate through Citrix with the ability to save locally to the hard-drive locked down by Stone at the BIOS level as part of the configuration and bespoke service.
Community health workers now have access to real-time patient records in the field and the ability to input more detailed, high quality notes at any time – with no requirement to duplicate work once they return back to base.
The project achieved a return on investment within nine months and has led to 16 percent more visits per day, equivalent to roughly one extra visit per nurse per day.
Although there are “hard”, measurable benefits to the project, a significant additional value from the mobile project has been that it has made staff feel safer, according to Cahalane.
“Now they are aware of what they’re going into on a visit, right up to the minute they go through the door, whereas they might not have known before.
I had a mental health practitioner say it was the first time in over 20 years she’s felt safe at work. That is an enormous thing for IT to be able to deliver,”