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Steve Mathieson is a freelance analyst, journalist and editor, covering IT, government and healthcare, often in combination, writing for publications including The Guardian, I-D Information Daily, editing Society of IT Management's magazine.

@samathieson

How an NHS trust uses mobiles for dictation despite poor coverage

An NHS trust that provides mental health, learning disability and children’s services has introduced Windows mobile devices equipped with custom-written software that allows its staff to dictate clinical notes. The software copes with poor mobile coverage by storing recordings and sending them only when the device has good reception.

South Staffordshire and Shropshire Healthcare NHS Foundation Trust had tried standard software and digital pens before hearing about Northumberland, Tyne and Wear NHS Foundation Trust’s success using BlackBerrys for mobile voice dictation.

Peter Kendal, South Staffordshire and Shropshire’s associate director for IM&T development, said that large parts of Shropshire have no 3G coverage. Although it introduced wi-fi in its premises where possible, this would mean staff would have to return to an office after visiting patients’ homes, requiring further travel.

So it issued basic Microsoft Lumia 365 Windows smartphones to allow clinicians to update mental health records within its Servelec RiO electronic patient record software. But said Kendal their choice of hardware did not go down well: “Every clinician in the world appears to have shares in Apple, because they all want iPhones,” he said, with some writing letters complaining about having to use Windows devices.

More significantly, staff also complained about the RiO software’s module for offline use, even though this worked when a device was not connected to a mobile data network and synchronised when possible. The trust bought 500 licences but is now using just a handful.

Following disappointing trials of digital pens, the trust decided to pilot a process developed by Northumberland, Tyne and Wear which uses BlackBerry mobile phones. “They were designing the system around the processes, not the processes around the system,” Kendal said.

Kendal said that the trust received a quote of £2m for software for this process, but instead commissioned Cardiff software developer Rantmedia to build a bespoke Windows Phone app they called ‘Saygo’.  It allows community-based staff to dictate notes, which are stored on the device if there is no mobile signal then sent when it is in range. These are picked up by a transcription service, whose staff add the material to the RiO software.

On completion of transcriptions, healthcare professionals receive a text message so they can check and validate the transcriptions. As well as maintaining high-quality records, this checking has helped spot teething problems, such as with clinicians’ use of words that are not in the Microsoft Word dictionary used by the transcription service – clozapine, a psychiatric medication, was transcribed as ‘cocaine’. Other terminology issues included different staff using ‘care plan’ and ‘crisis plan’ for the same document.

The process was trialled with four primary care mental health staff and 20 people in a community mental health team. Kendal said that crisis staff in particular were grateful for the new service, which reduced the average time of getting their records into the patient record system from 48 hours to 16 minutes or less. And despite complaints about getting Windows phones rather than iPhones, “on average it made a clinician 40% more efficient in their day job,” Kendal said.

South Staffordshire and Shropshire will shortly publish a tender through a framework agreement to provide 800 users with a mobile voice dictation service across the trust’s clinical, operational and consultant staff, along with 176 users of automated voice to text transcription service.

It has a large core geography and also works extensively elsewhere. It provides mental health and learning disability services in Powys in Wales and substance abuse services in Buckinghamshire, Cambridgeshire, Hampshire, Reading and in 23 prisons across England.

The trust has a reputation for innovative work. Between 2013 and 2015 it digitised 1.6m documents covering nearly 300,000 patients, meaning it is now paperless on medical records. In November, its introduction of Naloxone prescription kits for service users suffering from drug overdoses won the patient safety category in Health Service Journal’s annual awards, and earlier this year it took over the running of eight libraries for Staffordshire County Council in association with volunteers.

Rantmedia case study: http://www.rantmedia.com/work/nhs

South Staffordshire and Shropshire medical record digitisation: http://www.sssft.nhs.uk/about/publications/press-releases/106-2015-news/1008-local-nhs-trust-goes-paper-less-to-improve-patient-care

Managing eight Staffordshire County Council libraries: https://www.theguardian.com/healthcare-network/2016/jul/13/nhs-libraries-wellbeing-health-promotion-community

 

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