From the consulting room goes mobile (or not)

This article first appeared on Microsoft’s NHS Resource Centre on 17 June 2008 (site now defunct; ).

Cheshire GP Neil Paul would like some IT support when he is out on home visits. Unfortunately, a good, working solution has yet to reach him. Although there are rumours that social services have one…

This month I thought I would bring up the subject of access to patient records while out on home visits. Why is this important, some readers may ask? Don’t the majority of consultations happen in the surgery? Aren’t GPs forever trying to get our patients to come down to see us?

Well, home visits tend to be to the most ill and most vulnerable. GPs visit patients who are often post operative, very elderly, infirm or dying. We also visit a lot of nursing homes, elderly people’s homes and other institutions such as bail hostels, children’s homes and homes for the long term care of individuals with chronic conditions.

Still looking for a solution

All the billions spent on NHS IT don’t appear to have produced a good, workable solution to deliver good healthcare to these most vulnerable of patients. When I am with them, there is no access to lab results, prescribing records, hospital letters, or old notes. “I am constantly reminded by reception to add notes about home visits – I’m convinced they think I don’t go.”

Most of the GPs that I know take a summary printout if we know about the visit beforehand - and nothing if we get called to an emergency or we are asked to see an extra patient while visiting someone else.

Let’s not forget the IMT Directed Enhanced Service (an element of the new General Medical Services contract that is designed to encourage the uptake of IT), good clinical practice and the lawyers would have us record full, accurate notes contemporaneously.

Yet how many of us can say that we do that for home visits? I am constantly reminded by reception to add notes about them – I’m convinced they think I don’t go.

Laptop funding

I therefore found it quite funny that having repeatedly refused – or at least having never quite agreed – to buy me a laptop for home visits, my primary care trust (PCT) was more than happy for me to have one to do my professional executive committee (PEC) work.

Although I understand it comes from a different budget, and that there are only a few of us on the PEC when there are hundreds of GPs in 53 practices across the PCT, it feels odd to the clinician in me that we are prioritising management over clinical care in this way. “At one stage, I trialled a Panasonic ToughBook – never quite sure that leafy Cheshire really needed its ruggedness.”

Cheshire’s tough (but not that tough)

To be fair, over the years, my IT department has tried various solutions to give me better IT support on home visits. At one stage, I trialled a Panasonic ToughBook – never quite sure that leafy Cheshire really needed its ruggedness.

Those of us involved in the trial used a mobile card and virtual private network (VPN) to gain access to the PCT’s network and then to practice systems. It was a 3G card that worked well when there was a signal - but it was dreadful when it dropped down to GPRS.

It was also a nightmare to go from home to home, as it was necessary to go through the whole log-in scenario every time - and trying to explain the benefits to patients got a bit tiring.

The mobile element worked particularly badly inside nursing homes and old buildings converted into elderly people’s homes.

A broadband link, with a correctly setup and secure wireless access point that GPs and others could use to access a VPN would cost relatively little - and would surely deliver big gains in patient care. Why can’t it be made part of the accreditation process for homes?

The downsides of downloads

My clinical supplier, EMIS, has never really sorted this, either. They once had a portable solution that downloaded to a laptop; but then they moved to a PDA version that just wasn’t good enough.

Now they seem to be back to a portable download to laptop solution - which is fine if you know who you are going to see but doesn’t really help in emergencies.

It could do with an over the air download facility to deliver wireless functionality without the need for a constant signal. Also, the solution doesn’t seem to work with Docman, even though they are one of EMIS’ partners.

Size matters

Size of device also remains an issue. PDAs and BlackBerries always seem too small. My laptop is quite large and would be difficult to use for visits. Recently, our associate director of primary care requested a small portable laptop for his work, similar to the machines the IT department use.

Meanwhile, I have heard rumours that there is a whole of Cheshire private wireless network for social services. I’ve never had the rumours confirmed, and indeed the whole thing may be an urban myth. But considering how everyone talks about joint working, wouldn’t it be a good thing to let us use it as a first step?

This has turned out to be rather a negative column. I am happy to hear any of your positive experiences around mobile working.

About the author: Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He has just been appointed to his primary care trust’s professional executive committee and has a lead role for IM&T and Payment by Results.

Tags: 3G, Dr Neil Paul, EMIS, From the consulting room, GP, IMT Directed Enhanced Service, mobile, PDAs, social services, VPN