Going paperless — what pressure will this put on NHS IT?
Marc Stein of Dell Software Group reviews the changes that are taking place around paperless and mobile working, how the Caldicott report supports this and the measures NHS organisations need to take to keep up in the changing environment.
11 July 2013
The Caldicott 2 report, published in April 2013, gives NHS IT professionals an overview of how patient information can be shared and kept secure in a changing healthcare environment. 
Alongside wider patient data concerns, the report also offers examples, both good and bad, that cover mobile access to patient records and the potential to improve work processes.
This report comes at the same time that NHS bodies of all sizes are grappling with issues of providing access via NHS-owned mobile devices and/or individuals’ own phones or tablets. Their decisions could offer greater flexibility and productivity for clinical staff that are increasingly called to work outside the bounds of the hospital and in the community. However, it also requires a better understanding of what resources and assets are currently in place, and how these can be accessed while keeping systems secure.
Windows of opportunity
From a technology perspective, the forthcoming end of support for Windows XP in 2014 also forces NHS IT professionals to consider their options. Windows XP has been a stalwart operating system for NHS bodies across both clinical and non-clinical environments, but the fact that it will be unsupported means that migration efforts need to be prioritised.
The overall change in approach to patient records and making the move over to paperless systems is both a big opportunity for NHS IT managers to rethink the delivery of services, and a significant challenge. Going paperless provides an opportunity to reduce the amount of time required to enter data, and to keep it in uniform formats, but it also can lead to changes in procedures that make overall workflows more efficient too.
For IT professionals looking at this mix of migration, management and process update projects, change management skills will be essential. The first consideration is, therefore, how to either marry the technical projects like XP migration with the wider strategic needs of the paperless NHS, or whether these should be conducted separately so there is less risk.
Both approaches have their benefits. While XP migration is a significant change to manage, most NHS organisations have either embarked on their migrations already, or are planning to do so. For those that have already embarked on the migration journey, it does not make sense to shift resources away and risk those projects being completed unsuccessfully. It is far better to get them completed and then see what next is required.
For NHS bodies that have not begun their migration planning, looking at the bigger picture of moving over to a paperless model can provide many more opportunities to re-envision what can be delivered. At the same time, migration away from existing platforms can be factored into this overall strategy, so investment can go further and more can be achieved.
Knowing your assets
Wherever NHS organisations are within their planning and deployment schedules, the same thought is uppermost: greater insight into where and how clinical staff are using IT assets now can assist in planning for the future.
This should include looking at standard systems management requirements, like the number of software licences that are in place, how much they are used and whether users are mobile or not. Building up this picture of what resources are being used currently and when, can help with migration planning, but also can be used to determine which processes and paper-based systems are still in place.
Conducting an audit like this does not have to be hard: automated tools that harvest licence details and usage information over time are available, while IT departments should already have lists of assets that are installed in place. If these are not available, or are not up-to-date, then getting this insight now is a priority.
Once this picture of existing assets and usage is created, the IT department can work with the clinical and non-clinical teams to go through what workflows are in place at the moment and how these might be affected by migration to new systems. Decisions then can be made around which new device form factors might be brought into the clinical environment for staff to access patient records, and what changes within the back-end systems would be required in order to facilitate this access.
Security in the community
For most NHS organisations, the changing demographic of patients and requirements for care to be delivered in patients’ homes, rather than on-site, will lead to increased investment in tablet PCs or other mobile devices instead of more traditional PCs being deployed. This shift has to be coupled with an understanding of the data security and mobile device management requirements that have to be in place.
For NHS-owned devices, being able to wipe tablets or laptops remotely in the event of devices being lost or stolen is a pre-requisite if data is to be saved on those machines. However, most NHS organisations may prefer to stop applications or data from being saved locally and instead store all data centrally. Restricting user access to the application level, rather than saving data locally, helps NHS IT professionals ensure that data security is maintained.
Not only should this approach reduce the potential for security risk, it also makes it easier to support 'Bring Your Own Device' schemes: rather than having to support specific machines and worry about segregation of data between work and home environments, all work material is kept separate and stored centrally. The main requirement is therefore the control of access to applications, rather than the full security and protection of data on the local device.
Maintaining productivity in a mobile environment
Thinking ahead, the role of IT within the NHS will continue to change as staff work in more agile ways. As going paperless becomes a reality, the emphasis on IT assets being well-managed and up-to-date will be critical. After all, if mobile devices do not work or perform well, then staff will be unproductive or have the traditional fall-back of piles of paper file records.
This includes understanding how the ongoing requirements of IT and systems management will change over time. While tasks like patching, systems imaging and application deployment will not go away, they will change as the range of potential devices that have to be supported goes up.
Similarly, the increasing use of mobile devices will mean that all approaches to systems management must encompass all the different requirements that users may have, rather than dictating what can and can’t be used. In this scenario, automation of support and service tasks will be a necessary step to keep systems running and current.
After the strategic thinking that a move to paperless systems requires, NHS organisations as a whole will have to look at their approach to systems management and planning in general. It has become a truism that every business is an IT business, such is the role that IT plays within company success or failure.
In the same way, individuals across the NHS will rely on their IT systems being up-to-date, secure and to deliver the tools and information that are necessary to provide the quality of patient care that is required.
1. The Caldicott 2 Information Governance Review Report can be found at: http://caldicott2.dh.gov.uk/
Marc Stein is Executive Director of Software Sales for Dell Software Group. He leads Dell Software Group’s activities around endpoint systems management across Europe.