In consideration of this point, I’ve taken a look at the concept of the ‘New Normal’ in healthcare, what is it exactly and how are healthcare providers navigating towards it? With digital technology delivering huge opportunity for real transformation within health and social care, what are the areas that can and should already be harnessing this power? Within this
series, I’m looking at those areas capable of delivering tangible improvements to the quality of patient care and safety, provide efficiencies, savings and new revenues for Trusts looking to attract and retain staff and deliver a better patient experience. Beginning with the changing landscape of Multi-Disciplinary Teaming, and now moving to the humble Desktop and the importance of true clinical mobility.
Since the effective birth of micro computing with the introduction of the HP 9820 PC back in 1972, the pace of innovation and evolution since is staggering. From the Homebrewer Computer Club helping spawn the Apple II (a pivotal point in any Steve Jobs biography), to the Tandy TRS and Commodore PET completing the ‘Trinity’ in 1977, PCs were quickly being taken to the mass market in the millions.
For those old enough (I’m sure there’s a few), we look back fondly at the grand entrance of the Personal Computer into our homes. The arrival of the Atari 400/800, Sinclair Spectrum, BBC Micro, and in my own home Commodore 64 provided us all with a clunky, time-consuming but nevertheless wonderful way to mainly play games such as Jet Set Willy, Paper Boy and IK+. Reminiscing aside, the evolution of personal computing, especially as connectivity standards such as Internet, 4G, GPS and OS advancements have been established, along with hardware, application and device innovations is nothing short of colossal. Outside of consumer living, we’ve seen personal computing flood all industries as desktops, laptops, tablets and indeed smart phones open the door to a whole new world of digital possibility. In our own industry, personal computing has become so varied that it now carries it’s own name – End User Computing.
The Status Quo
If I asked you to imagine a hospital without a significant desktop or laptop estate, it would be a challenge. Although the days of green terminals are mainly gone, IP and Ethernet connected Windows based operation systems and mass-produced cloned desktops and laptops are simply the norm, and are usually the product of a disappointing experience all round. Outside of our workplace, we’re afforded ever-evolving superfast consumer experiences, whether its booking restaurants, finding locations, making purchases or checking the weather – all are at the simple tap of a tablet or smart phone. So why not in healthcare?
The computing experience within most hospital, community and care settings is still a way away from this level. A typical NHS hospital is likely to have a desktop estate running into the thousands, with varying capabilities and an expectation of running any combination of the varying applications in use. It’s relatively usual that it will take anywhere between 5 and 40 minutes to turn a desktop on and log in creating significant delays. Windows based PCs that are accessed by multiple users, all with different applications and data requirements. Degradation over time is expected, and without careful management, can occur rapidly impacting both performance and responsiveness.
Trusts will often have a portfolio of applications in the hundreds all being used in different ways, for various purposes and across multiple areas of the organisation. They are likely to have been acquired over many years, sometimes purchased by local departments or inherited through a merger etc, the result of which can be a complex and obscure application set that is challenging to identify, consolidate and manage. In the clinical setting, users have many different passwords and authentication requirements for various applications (eg Active Directory, Spine applications, PAS, EPMA and so forth). As you might imagine, these can be difficult to remember and is a far cry from the touch ID equivalent of the Apple world.
Alongside this, many Trust’s are also facing what seems to be a continuous, but slow rolling program of PC estate upgrades due to the ever-increasing demands of new operating systems or to support new applications. Many have recently transitioned from Windows XP to 7 skipping the unpopular middle form of Vista. Indeed so many Trusts struggled to upgrade from XP at the end of the normal support window that the UK Government asked Microsoft to extend support for an additional year at the costs of £5.5m, in spite of the 7-year notice period. With Windows 8 out of the way, the next Microsoft move for Trust’s will be to Windows 10. Extended support for Windows 7 will come to an end in around 3.5 years with devices due to stop being shipped shortly, meaning planning must commence now if a repeat of XP is to be avoided.
Consider a typical hospital ward. Often you’ll find a limited number of desktops, insufficient to service those who need them. Those desktops are used by a wide variety of Trust staff from nurse clerks to consultants, with each PC having a ratio of one to many. Some of those staff will be visiting several wards, needing access to multiple clinical systems as they check on patients and update their records. Slow logons and numerous passwords often with smartcards, combined with a lack of time mean that workarounds are often necessary to get the job done. It’s usual for someone to leave their session logged in, complete with smartcard, whilst records are accessed and/or updated by anyone. This not only results in a less than perfect audit trail, but also a very poor user experience. I often witness this same action in clinics and areas such as A&E, where poor experience hinders or even prevents clinicians from performing their jobs effectively. The outcome is one of frustration and a demand for more or indeed new desktops. This is a costly approach that will actually fail to solve the underlying problems long-term due to the inherent limitations of a fixed desktop that is used by many, not to mention the lack of available desk space, particularly on a ward. Similarly, for those in the community moving between locations or on call at home, the experience can be poor with many having to make lengthy trips back to the office to access systems, update their task lists or view records for instance.
This user-experience is often being delivered against a backdrop of an ICT department under cost pressures. I often see a lack of appreciation for the sheer mass, scale and diversity of requests of ICT as a result on the relentless cycle of NHS change, from business as usual tasks to the delivery of multi-million pound EPR systems. Many teams are much smaller than required to meet expectations with the current approach, delays are often inevitable and the investment in time required to deliver meaningful change can often be sacrificed at the cost of keeping the lights on.
The New Normal
Until healthcare applications are written to be independent of OS and/or built for mobile (which is beginning to happen e.g. NerveCentre, Isosec MIA and Cerner Power Chart Touch), then Trusts must provide a quick and efficient method of enabling staff to access systems. I am always conscious of making sweeping statements, as I recognise there are often exceptions. However in my mind, in a new world where digitisation of the NHS is so critical, and so too is the ability to create and access information there is no better way to transform a Trust’s staff experience of IT, than to provide them with a desktop they can access quickly, securely and in a mobile manner: A Mobile Clinical Workspace.
Think back to our previous ward scenario with multiple-user access issues, governance risk, delays and an overall poor and frustrating experience. Now imagine a
setting in which each workstation is securely accessed at the simple tap of a card (like contactless payment or an oyster card) delivering a new desktop every day. Logging on in around 20 seconds, the user is automatically authenticated, signed-in to all applications and provided with a home screen layout with all go-to apps opened and arranged as the user so wishes. When the user moves from PC to PC, ward to ward or even out into the community, so too does the desktop which is quickly retrieved with that same tap. Users experience near instant access to their desktop, exactly as it was left, along with all spine applications. Workstations are no longer constrained by individual user sessions left open for anyone to access and importantly do not degrade over time and the productivity incentives that could only be realised by adopting illegitimate workarounds quickly become a thing of the past.
Imagine a desktop that is quickly and securely accessed from home enabling users to provide specialist care when on call or simply to conduct tasks such as rota updates. This experience is not only possible, but is being delivered across many Trusts and quickly growing to be considered critical to the provision of high quality care. Based on Virtual Desktop Infrastructure (VDI) and other supporting components, this technology has been utilised for many years and deployed on mass across other industries and within pockets of the NHS. VDI provides people with access to applications and information from any device, regardless of location, and significantly reduces support and managemen through centralisation.
Realising the Possible
It is not uncommon to come across the fallacy that VDI (or indeed any technology for that manner) is too expensive; the first consideration for many is therefore the business case. How can we articulate the potential benefits realised against the total cost of ownership whilst also considering the alternatives? CFO’s will need to understand the return on the investment is greater when comparing to other potential investments for their capital. Barts Health NHS, the country’s largest NHS Trust, holds a significant deficit yet has been quick to recognise potential benefits despite budgetary pressures. This is a clear demonstration of how a well-considered and constructed business case is received. Investment at Barts incorporated the entire user demographic in addition to clinical users.
Driving change around the way people work, particularly within their own desktop, will always carry a degree of sensitivity. Understanding the value, capability and enablement that must be achieved is therefore paramount. When affecting true cultural change, it is not the choice of VDI technology alone that will deliver success. The technology must be combined with a plan for people, process, knowledge and awareness. This plan will mean the difference between a great technical solution lacking adoption, and a true programme for transformation able to deliver measurable business value and improvement.
We must then look to the support models and workflows currently in situ. The type of support required will be simplified as organisations transition away from complicated individual computing devices to relatively standardised dumb terminals. Naturally, this is suited to a centralised pool of expertise and knowledge, enabling teams to add focus to desk-side customer service. The support delivered will change from the approach of ‘how to’ as opposed to ‘it doesn’t work’.
I’m often asked my thoughts around the best approach to deploy and migrate users to this solution, and whether it’s best to transition through internal efforts or a full outsource. In my experience, most internal transitions take many months, often years. People’s ‘day jobs’ continue, as do the challenges needing to be overcome. However, a full outsource can often become disruptive to business as usual operations and inconsiderate of nuances, local knowledge and invasive to culture creating a level of resistance. It is my opinion that a hybrid of both is the most effective approach, where the interface and communications are provided by existing ICT capability with both organisations working in partnership toward a shared goal. With this approach, I have experienced projects of over 3000 users delivered fully within 9 months, resulting in accelerated speed-to-value and full realisation of the benefits outlined as part of the original investment within that time.
Achieving this capability and outcome will undoubtedly provide us with the ability to take back control and deliver massive improvements to our end-user experiences – what you might call the nirvana. Management of an entirely known EUC estate including all devices or groups, users, applications and requirements by department as well as by individual will deliver happy end-user’s, able to access their desktops quickly, securely and on the go. And with that, logon and other desktop related pains permanently removed.
Through June our dedicated Healthcare Team will be bringing IT and clinical leaders across the UK together. Join us at one of five locations to learn, share and discuss the changing face of clinical mobility. Learn more here.