800 Lincolnshire SystmOne Users to Access SystmOne Remotely

North East Lincolnshire Care Trust Plus and North Lincolnshire Primary Care Trust have put in motion a four-year plan to equip more than 800 community practitioners with the technology to access electronic patient records from patients' homes, through SystmOne. In the two trusts, which between them look after more than 335,000 people, SystmOne is currently being used by community matrons, school nurses, health visitors, district nurses, auxiliary nurses, GPs, palliative care and intermediate care practitioners.

Kathy Drayton, District Nurse, can access SystmOne using a Toughbook when she's out and about.

John Mitchell is Project Manager for both the North Lincolnshire and North East Lincolnshire areas. He explains the aim of the project, "There is a serious benefit to the patients if the clinicians have access to their record in the home. This project gives them live access to a real-time clinical record from the patient's home."

North Lincolnshire PCT and North East Lincolnshire CTP are separate organisations but, as John explains, "There is only one IT Service across both PCTs so when we started looking at remote working with SystmOne, we realised we could roll it out across both areas at the same time."

The plan is to pilot remote working with Community clinicians, but to eventually extend it to include GPs. The project is being rolled out in stages, the first stage in May saw the launch of 11 units, followed a few weeks later by a further 12 units. Once the lessons had been learnt from this pilot, a much larger cohort of over 110 users went live in July.  "Then over the next three years," says John, "it will be rolled out to 325 clinicians in North Lincolnshire and 490 clinicians in North East Lincolnshire."

The team started to look at the technology available to them for remote working last September. "We established a proof of concept pilot to look at different laptop models and network providers. In the end, we went with a Panasonic Toughbook, and BT Mobile on a Vodafone network. The Toughbooks are great, they are semi-rugged and will take being dropped – we throw them across the room to demonstrate to nurses how robust they are. This choice of hardware has provided us with savings. BT put us in touch with an independent financial planner who went through the cost of ownership and return on investment models associated with various laptop models. The one we chose was a saving compared to the competitors when taking into consideration aspects of fitness for purpose and usability.  Key fitness for purpose factors include: battery life, touch screen capability, size and weight and session persistence whilst on the move.”

In the testing stages, the team tried different setups to find the one that worked best for them: "We've got significant 3G coverage but we can get 2G almost everywhere. SystmOne doesn't need 3G, 2G is ample for day-to-day use. To start with, we tried using plug-in cards to connect but that wasn't very successful. The Toughbook has an integrated aerial which vastly improves the reception, and means that users don't have to worry about plugging in a card, so that's what we use now. The connection we have here is good."

Having access to sensitive information from a mobile device means that security has to be even stricter than it is in the office or GP practice. John explains how users log on to SystmOne remotely: "To connect from a patient's home, a user has to first connect to the mobile network, then link up to the PCT network using a secure VPN (Virtual Private Network). They will then be able to access the SystmOne log-in screen and use their Smart card to proceed from there."

That  all sounds very complicated but for users, there's no need for any extra technical know-how: "All they have to do is remember their disk encryption password and login. It takes just a few double-clicks, a couple of passwords, and their Smart card PIN and they're looking at the record."

"The main driver for this project is the clinical benefit to patients," says John. "If the community practitioner has access to the clinical record, they can discuss the case with a doctor over the phone. Both clinicians have the record and all information in front of them, so they can make an immediate decision. We're expecting SystmOne remote access to greatly reduce the number of patients sent to the medical assessment unit at A&E."

While the benefit of having access to a patient record is clear, the advantages of remote access to SystmOne for community practitioners go further. "It saves the nurses time," says John, "They don't have to handwrite their notes, bring them back in and then add them to the electronic record. Also, they can see their caseload and schedule from wherever they are, they can see who's on their job list for the day and go straight to the site or the home. That saves them a visit to the office in the morning to look up their schedule for the day. We're saving time, travel and transport, and that benefits the PCTs, the nurses, and the environment too.  Furthermore, those clinicians involved in the project to date are very excited by the development and many more are keen to take delivery of their device and mobile working is something that makes a real difference to them.”

John has this advice for other PCTs investigating accessing SystmOne remotely in their area: "Ultimately, you need to do the testing early on in the project to see which network provider offers the best coverage. If you put that work in early, you're on safe ground. Then, once you're live with it, you need to make sure that the clinicians understand the difference between logging in externally at a patient's home, and internally in the office or practice. There's a slightly different way of logging in, and they need to be trained on that."

Over three years, the team anticipates that the project will provide the PCT with significant cost savings and John is satisfied that the benefits of remote working outweigh the costs involved in setting it up. "If you think that it costs £350 to admit one patient on a medical assessment unit, and that access to the patient's history in the home has the potential to avoid unnecessary admissions, that soon adds up."

TPP hopes to report on the benefits seen and lessons learned from this project later in the year.