13 Jan 2015

Implementing Mobile Healthcare for Care Homes

Jonathan Papworth of Person Centred Software talks about how wireless healthcare technology is impacting care home providers.

Mobile healthcare is widely talked about at the moment, but practical implementation of this has a number of challenges that need to be overcome if it is to be successfully adopted.

Part of the mobile healthcare specification is wearable technology, with wrist watches and glasses feeding information to cloud based health infrastructure such as Apple’s HealthKit, Google Fit and Microsoft’s HealthVault. But technology in healthcare has to be appropriate to the needs if it is to be sustainable, or else is it likely to go the same way as the wearable technology of the 80’s, when the future was all about calculator watches.

Opportunity for mobile healthcare

Carers in healthcare spend their days attending to people, and then documenting these ‘care interventions’. They spend the vast majority of their working day on their feet; supporting people as they eat, wash, dress and do everything that most able bodied people would do unattended. There are some aspects that require more specialised care, such as dressing wounds, giving medication etc.

Documenting the care interventions can take up to an hour per carer per shift, and is traditionally done at the end of a shift. Carers at this time are normally in a rush to leave, and will have forgotten at least some of what happened at the beginning of their shift. One way to solve this problem is to provide carers with wireless mobile devices to enable documentation to be done whilst delivering care.

There are a number of challenges to be overcome for a mobile application to work in a healthcare environment. There are often Wi-Fi blackspots, and 3G is prohibitively expensive in large care facilities, leading to a need to provide an application that can operate off-line. This in turn leads to a need to manage data being received out of sequence to the care that was delivered, for example a planned care intervention could be flagged as missed because it is outside it’s time parameter, but documentation to show it was done on time could arrive several hours later.

Solution

The solution to out of sequence events is to build a logging system that operates on new records being inserted, and not on records being updated. For example, consider two scenario:

  1. Medication is planned for 8:00. A carer gives the medication at 8:15, but at 9:00 the system has not received this information until 9:30 and so marks the medication as missed.

  2. A cup of tea is planned for 8:00. A carer gives a cup of tea early at 7:45, but at 8:30 another carer on their device notices that tea and speaking to the person finds out they don’t need any tea so marks it as not needed. A third carer at 8:45 speaks to the person who asks if they can have a cup of tea, so gives a second cup of tea. All these interactions remain off-line until after 9:00, by which time the system marks the cup of tea as missed, and are received in reverse order.

To cater for all the scenarios requires three entities:

Mobile Healthcare Scenario 1

Scenario 1 for health carers

Mobile Healthcare Scenario 1

Scenario 2 for health carers

Key:

  1. Blue: This exists once for each planned event.

  2. Green: This is the evidence of what was given, and can exist more than once for each planned care intervention.

  3. Orange: This is the log for each result of the planned action, timed for when it occurred irrespective of when the central infrastructure received it.

Another major challenge was on a human user interface level, as more senior healthcare staff often have limited exposure to modern technology. The user experience of a mobile healthcare application has to allow for some peoples aversion to modern technology; carers often not having English as their first language; an industry that focuses on the nuances of people’s changing needs; and an environment where Wireless connectivity is inconsistent.

Steve Jobs showed the important of a well-designed user experience with the Apple iPhone and iPad, which are intuitive for non-technical users. A healthcare application needs to be intuitive to use, and rely as little as possible on written words.

Icons and pictures and graphs help provide a user interface that carers can relate to and navigate. For example, a prototype user interface was created for the information relating to each intervention that looked like this:

Mobile Healthcare use case study

Evolved through use case studies and user feedback into:

Mobile Healthcare use case study

In order to enable this change of interface, every type of care intervention had to have a representative icon created for it, as well as every combination of results for each intervention. For example, the section on food and drink includes:

Mobile Healthcare use case study

Selecting an intervention like Breakfast, Lunch or Tea gives these set of options

Mobile Healthcare use case study

Which enables a carer to document a care interaction simply by pressing icons.

Mobile Healthcare use case study

The completed care note

Benefits of mobile healthcare

A number of benefits come about as a result of carers being able to document care delivered using wireless mobile technology. Healthcare is often difficult to plan in detail because people are not consistent in their personal needs. Knowing exactly what care is delivered helps inform care administrators where carer time is being used, which in turn will allow for better planning.

Carers can use the mobile device to view personal preferences for each person, even if they have not delivered care for them in the past, and this helps care to be consistent and appropriate. Hand held devices are able to give carers important information about the care needs for each person they interact with. Everyone involved in healthcare benefits from visibility of the changing demands placed upon care staff, which helps provide an accurate cost for care.

Facilitating a high availability system capable of handling thousands of concurrent care has been achieved by leveraging Microsoft’s Azure hosting platform. Azure has some nuances to be overcome with their shared cache across multiple front end servers, and SQL backend servers need lots of memory to avoid bottlenecks. Benefits available with Azure include data centre security and instantly deployable scalability. The application is deployed on Android and IOS, with Apple’s iPod touch being the predominant device used by carers.

Deployment of a wireless mobile healthcare application has given two care providers additional benefits. The Downs in Cornwall is a small residential care home, and the owner lives two miles from the care home. Because every carer has an Apple device, when an emergency occurs in the care home, the owner is able to be contacted over FaceTime, and can assess the situation without having to visit the care home.

A larger care group, Signature Senior Lifestyle, have provided staff with a Samsung Mini G3 Android smart phone to enable them to document care they have delivered. They use the same device to operate a VOIP internal telephone system, and the internal telephone system is linked to their emergency call bell system, so carers have one device to meet all their information and communication needs.

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About the author

Jonathan Papworth started his career in the 70’s as a mainframe programmer, later becoming an independent software consultant. He has been involved at a senior level in many successful technology businesses, some of which have become listed companies. He has founded two companies focused solely on healthcare, the most recent of which is Person Centred Software Ltd.

Person Centred Software Ltd was created in 2013 with the aim of improving the quality of lives for service users or care staff through the use of technology. The objective of the business is to revolutionise social care by removing all administrative overhead from carers, and giving care planners and managers instant access to all aspects of care planning and delivery.     http://www.personcentredsoftware.com/

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