My latest Digitalhealth.net column (Apr 2020) is out – click on the link to see the original replies. Full text copied below.
This week I’ve been working from home. Luckily, I was able to prepare and I was previously enabled as a home worker so I had some idea of how to go about it. On the whole it has worked well.
A quick recap for those readers that do not work in primary care. At the surgery, we now run windows 10 desktops. On these, we have installed an old version of outlook (no office 365), EMIS and Docman. We use a load of other software like AccuRx and iGPR and most of these have API links into EMIS and need client-side installation.
Ways to work from home
There are three main ways of remotely accessing or working from home.
Option one is using a VPN tool to join the NHS net. Technically you can have all the software above installed on your home machine and once connected it should work. I understand there can be lots of firewall issues depending on where your VPN connects to in the NHS so not all VPNs are the same.
Option two is to use the VPN to connect and then use remote desktop to control your own machine, which needs to be switched on and free at all times. Works for those lucky enough to have exclusive use of a machine but often the reason you are wanting to log on is you can’t get to your room so can be of limited use. Also, there is always the issue that someone watching your screen can see what you are doing.
Option three is my preferred, logging onto a virtual environment. Either through a browser or special software you use a virtual desktop which mimics a real machine. In reality is a powerful server serving multiple desktops, but it appears as if you have one to yourself. The environment is preprogramed with whatever software you need and this can be really useful as if anything crashes or if you install something when you relaunch it as it resets itself to the stable default. Of course, getting this stable state working and kept up to date can be an issue. Another advantage is the virtual system is device independent you can run on anything.
Locally we use a desktop and app virtualization product called Horizon from VMware.
Our initial problem is that until the Covid-19 crisis, GPs working from home weren’t a high priority and so the Horizon server is old and underpowered and if I’m being honest doesn’t work that well, so there has been a huge effort to build a new server that can cope with a lot more. Today I’m using it and it seems stable and faster than the old one but the browser version isn’t yet working properly so I’m using the software version on my iMac and it is fine.
Today I’m sat at my iMac, on Horizon in one window with Emis and Docman working, but alas no AccuRx. In a real window outside of Horizon, I have Outlook running and GP@home.
GP@home is a simple service from X-on that allows me to ring people through their website and the person not see my mobile phone number, they get the surgeries’ number.
I also don’t pick up the cost of the calls on my mobile which is a benefit. You enter the number to ring – it rings your phone then when you answer it rings them, then they answer. It all works on the cloud, and actually records the call. The sound quality is great and it didn’t take long to setup. I can also send a one-way SMS through it.
Working in unusual times
Of course, once a week I do a clinic at our local bail hostel (accommodation found for people charged with offences and released on bail, but who do not have a permanent address so that the police know where to find them), this week over the phone.
One chap had a rash and, as a temporary resident, had no NHS number so I couldn’t use it.
Luckily a company called Nye Health had contacted me to tell me about their web-based version of GP@home. I sent the resident a link while speaking to him on the phone, he installed it and then I hung up and clicked to video him. It worked – it was chicken pox.
Trialling new tech
While I sit here, I’m trialling all sorts of tech. Bluetooth headsets, USB headsets, a Konftel USB speaker phone. I’ve even messed around with an airpod. My daughter had two, a friend’s dog jumped up dislodged one and then ate it when it hit the floor. We were left with one, not much use to my music loving daughter but it makes a great phone. As you can see, I vary what I’m using to keep me interested.
As I have a management role, I’m also plugged into iMessage, WhatsApp, Outlook and have appeared to have used every conferencing software out there. I’ve also been playing with extending my desktop to my iPad but I’m not sure its big enough and I’m using my iPad so I’m currently thinking of switching the monitor from being a second screen on the laptop to a second for the Mac.
In some ways despite the horror of what’s happening out there it’s been a tech person’s dream. Who knows what next week will bring!