Our GP columnist, Dr Neil Paul, reflects on his experience of working from home including his tech set-up and why he is trialling new gadgets.
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.
New horizons?
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!
24 April 2020 @ 22:07
Working from home … Makes sense, why insist NHS employees need to work on a hospital site when they do not need to, so much hypocrisy from some leaders, walk away from the hypocrisy … and lack of trust
20 April 2020 @ 13:31
Hmm… not sure about the information security around all of that..?
Nye were seeming spamming staff for business. Their emails looks like a combination between marketing and phishing. Warning colleagues off them after seeing one of their latest emails..!
What assurances mechanisms did you have in place?
16 April 2020 @ 16:15
You write in relation to option two, “Also, there is always the issue that someone watching your screen can see what you are doing”.
I use remote desktops every day and not once have I seen this. When connected to the Windows 10 PC in your surgery anyone looking at that screen would essentially see a screen that offered them the chance to log in whilst also stating that you were logged in at that time. They certainly wouldn’t see what you were doing.
20 April 2020 @ 12:19
I think it depends on which system you use. I believe that RDP is approved but things like Logmein and Teamviewer aren’t because of that issue. you can actually see the remote person move the mouse and see what they are doing.
I’ve certainly watched on numerous occasions support techs and others on my computer using remote software like this.
20 April 2020 @ 12:53
Remote sharing and remote desktop are subtly different.
The support techs will be undertaking remote sharing with whatever software is being used and that is what allows them to take control and you’re quite correct in that someone sitting at the machine being shared will see everything undertaken on that machine.
With a remote desktop scenario you’d have exclusive access.
15 April 2020 @ 14:35
Great piece, Neil.
Integrating myriad systems and technologies is never as straightforward or easy as many people might think it is.
One observation – your rightly point out the countless conferencing solutions available. They solve some of the immediate challenges we all face into. And right now, people will naturally use what they know, feel comfortable with or are directed towards.
Worth flagging – an independent UC expert consultant has just messaged out not all are similar in the way they work behind the scenes, although most would appear to deliver a similar outcome. He described this as “Zoom bombing.” (Heard some similar stories from elsewhere, and New York Dept. Of Ed has stopped that ones use by 1.1mil students and teachers.)
Once the dust has settled strategic requirements, things like use of VPNs and wider data security, would seem to be worth revisiting, based on lessons learned from the current emergency state.
20 April 2020 @ 12:22
absolutely – think NHS needs to standardise and minimise the cost once things stop being free. at the moment im using about 5 different conferencing software – today im being asked to install MSoft Teams.. which looks good. Personally I dont understand why I dont have full Office 365 with shared drives etc.. My local acute trust didn’t go with NHS mail – they went Office 365.. why cant I?