One of the key issues facing local health communities is how to cost-effectively provide all staff with easy access to key clinical and administrative applications at the point of care. Gloucestershire Health Community has shown how community-based staff can be provided with easy access to key systems and electronic patient records over a very ‘thin pipe’ using tablet and notebook PCs, a mobile phone and a sophisticated ‘access infrastructure’. The route taken by six NHS organisations in Gloucestershire – covering 5,000 staff and 500,000 patients – has been to build an ‘access infrastructure’ that enables all staff – both hospital and community based – to access electronic patient records and other key systems using either high speed networks or low bandwidth mobile phone connections. Two of the NHS organisations, Cotswold and Vale Primary Care Trust and Gloucestershire Partnership Mental Health Trust, were in the process of implementing a new EPR system – Clinical Manager supplied by iSOFT. “The biggest challenge was to make applications available to all staff,” said Simon Gill, EPR manager at Gloucestershire Healthcare Community. Gill explained that although iSOFT’s Clinical Manager system would typically operate over a 10Mb network, by deploying Citrix’s ‘access infrastructure’ it was possible to provide community staff with full remote access to systems using just a 9.6Kb mobile phone connection. Gloucestershire one of the sites included in the NHS Information Authority’s Electronic Record Development and Implementation Programme, which was completed in October 2002. Gill continued: “The challenge was to implement the EPR system within several trusts and the community. And because the NHS is always strapped for cash we had to keep costs under check and work out how to make use of existing infrastructure.” Working with iSOFT, Gloucestershire Health Community chose Citrix MetaFrame XP Presentation Server for its access infrastructure, enabling it to provide easier access to and management of critical systems and get the maximum benefit from its legacy systems and hardware. Some 500 NHS staff, including district and mental health nurses, have now been provided with secure roles-based access to electronic patient records. So far six community staff have been provided with mobile access to systems using either tablet or notebook PCs connected to a Bluetooth-enabled Orange mobile phone. The system uses 128 bit encryption and has been designed so no confidential patient information is held on the tablet or notebook. “Staff can now get full EPR access in about 75 seconds from switching the machine on from cold,” said Gill. He added that one of the biggest challenges had been to find tablet and notebook devices with sufficient battery life and big enough screens to display records. Only now are these becoming available. Experiences of staff using mobile access have been extremely positive. Jackie Smith, a district nurse at Cotswold and Vale Primary Care Trust, explained how the system was helping her avoid wasted visits: “As a district nurse a lot of my time is spent travelling. One of the things I can now see is whether a patient has been admitted over night.” She added that it also provided access to lab results and cut out laborious paper based systems: “It enables me to spend more time with patients.” A full roll-out of mobile access to community staff now depends on contracts being awarded by the NHS National Programme for IT for local service providers and negotiations over local development priorities. But immediate plans include making the system available to mental health nurses working out-of-hours. Gloucestershire Health Community’s 10 MetaFrame servers have also simplified the provision of other IT services to staff across the health community. Other applications now made easier to access include: GEAC SmartStream finance and procurement system, email, and Exact, a dental application used by Gloucestershire NHS Personal Dental Service. “Without Citrix, we simply couldn’t have been able to do what we have achieved,” said Gill. “All relevant employees – regardless of where they might happen to be in the county – can access their profile and get the information they require to do their jobs.” “We are delighted that the Gloucestershire Health Community has been able to achieve such an ambitious plan with the help of our software,” commented Lewis Gee, managing director of Citrix UK.
