Inderjit Singh, head of enterprise architecture at NHS England, is about to go on paternity leave. One of his first ports of call for help and advice about caring for newborn twins will be the NHS Health Apps library.
When he returns to work – hopefully after finding all the information he needed - he will be pressing ahead with integrating the apps library into NHS Choices and working jointly with the Health and Social Care Information Centre on publishing guidance on clinical safety reviews for healthcare apps used by healthcare providers.
His story illustrates perfectly the new world of health apps. Everyone wants them - but only if they are safe. And there are multiple aspects to what might be included in ‘safety’.
These are already being explored across the NHS. From Merseyside to Bristol to Kent, community healthcare providers are developing apps to support their mobile workforce. Meanwhile, healthcare providers are offering apps to patients and populations as a way of improving self-care.
Medway works on Advanced apps
Take Informatics Merseyside’s I’m Mobile programme, which is developing apps for clinicians treating patients.
One early project was to give the community respiratory team at Liverpool Community Health NHS Trust an app to access to the clinical information system, EMIS Web.
This allows the team to view and share aspects of the primary care record, as long as the appropriate consent and data sharing agreements are in place. New developments are coming along almost by the week as the programme develops.
Others are following suit. Over at Medway Community Healthcare, a large scale programme is underway to mobilise the workforce through apps. Already nurses and other healthcare professionals can use an app-based British National Formulary.
“Now we are looking at ways we can build and use our own apps,” says Fiona Stephens, clinical quality director. It is a clinically-led programme (like I’m Mobile) in which user needs dictate what will get developed.
But it’s also being run in collaboration with Advanced Health and Care, which provides Medway’s clinical system; which users can access via a mobile app.
One potential area of interest is training apps, for example medicines competency assessment. “With 800 staff and the need to train every three years, we think this is a potentially powerful way of delivering training,” says Stephens. “We are also looking at providing information for patients.”
The advantages of an app-based approach are obvious, she says. “It’s about giving our staff information at their fingertips that they can access quickly, making their lives easier and making them more efficient.”
Information governance is only one of the challenges
As Medway works through the implications with Advanced Health and Care, important new issues keep arising. One is information governance. As Stephens says, it is clear that staff cannot be allowed to download apps willy nilly.
Jim Chase, managing director of Advanced Health and Care, says the project is taking it into new territory.
He points out that the app that enables staff to access the Advanced Community PAS, along with its electronic patient management and electronic record system, is “a very specific mobile application and very rich clinically.”
But, he says: “Medway wants to deploy other mobile applications onto mobile devices to provide other solutions, for example digital dictation. So the question is: ‘how do these apps coexist with the overall mobile application?’
“That’s where we start having to look very carefully at all the issues around mobile applications and then mobile device management.”
Chase cites five key challenges: IG, the provenance of the app, creating new silos of information in individual apps, how data in apps is structured, and the cost of storing all this data. The last is a practical issue that is relatively easily solved; the others are more complex.
Management gets more complex
Even when it comes to mobile device management, apps generate an added layer of complexity. Take the scenario in Merseyside, where Informatics Merseyside provides a fully managed service for the mobile programme from setting up the device to training the end users.
The devices are secured by using MDM software from AirWatch. On top of this there is a need to maintain the apps. Adam Savage, sales director for Bomgar, says this is separate from MDM.
Where MDM gives the ability to deliver a policy or an upgrade to all devices remotely, there is an additional need to provide remote and ad hoc support to app users on a one to one basis. “That’s where we come in,” he says. Bomgar is providing the device support in Merseyside.
Over at Bristol Community Health, another ambitious programme is underway, supported by South West Commissioning Support. This is approaching the access challenge from another angle.
Bristol is now in the process of rolling out a Total Mobile app to more than 700 of its 1,100 staff, to give them on-the-go access to the clinical system RiO via Samsung tablets. So far, there are about 100 users and plans are underway to link up with EMIS systems, too.
The app is tailored for each user so that they can quickly access the information needed for a given job or role – they can pull up the relevant forms in an instant.
Graham Hotchen, interim director of finance, says: “It’s massively popular. Everyone we have shown it to says ‘wow, this is where it’s at – this is new’.”
Total Mobile’s chief executive Colin Reid says properly designed apps overcome the problems that many community trusts have had with trying to give staff access to systems on laptops.
These include the problems that many have encountered with connectivity, as well as the issue of trying to work through a browser designed for use on a PC on a mobile device. Apps, he points out, can be made native for any platform, improving the user experience, and then tailored for the individual user.
Bristol is one of its largest projects in the NHS (Total Mobile has a similar sized venture with Virgin Healthcare) but with his company’s reach into local government and social care, Reid says he can see the potential for new ways of joining up health and social care information through this type of app-based approach.
Clinical safety – new approaches
Beyond the questions raised about IG and device management, Singh is interested in clinical safety. For both consumer and professional facing apps, there is an obvious imperative for apps to have gone through some sort of vetting to make sure they are safe.
This is one of the things that the NHS Health Apps Library offers. “Apps can only become part of the library if they have gone through a review process that looks at the information governance, the clinical safety and the potential clinical risks,” says Singh. Once in the library, users can rate them.
The library was given a soft launch last March and has been building up slowly since; its weekly hit rate is in four figures. It contains a vast range of apps, says Singh, and the most popular is a self management tool for people with anxiety.
The next phase to incorporate the library into NHS Choices, which is due to happen soon. “That will allow a broader group of people to see the apps and link up to them,” says Singh.
He’s taking a different approach for professional-facing apps. Last year, the HSCIC and NHS England asked EHI readers to put their apps through an existing clinical safety review process designed for healthcare IT in general.
First, there is a decision around whether an app is a “medical device” and therefore required to go through safety processes at the Medicines Health Regulatory Authority. The award wining Mersey Burns app is a good example of an app that is also a device.
The NHS England/HSCIC process is designed to complement that by reviewing apps for clinical safety using safety standards ISB0129 and ISB0160 and can be applied where an app is not a device. Responsibility for ensuring healthcare IT complies with these standards rests with the organisations supplying and using them.
“It’s quite a robust process,” says Stuart Harrison, head of safety engineering at the HSCIC. “What we have been doing is to simplify the process to provide a simple checklist written in Plain English and make it very easy to use.”
Singh says this addresses a gap and now he and Harrison are working on implementation guidelines that will, they hope, be published in the next month.
Even in a world in which there is an app for everything and everyone wants an app, NHS IT needs to tread carefully and think through safety, security and support.