mobile working in the NHS a special report prepared by NDL - 2014

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NDL

2

introduction

It only needs a quick flick through the press to see just how important mobile technology has now become in the NHS. One example is the scramble we saw in January 2014 to apply for the first round of the Nursing Technology Fund. This tranche totalled £30 million and another £70 million will be on offer later in the year. Its aim is to fund “mobile and digital technology to allow nurses, midwives and care staff to work more flexibly and effectively, helping them do their jobs better, increase patient safety, create a better patient experience and reduce paperwork” (EHealth Insider).

This finally gives an official stamp on what the NDL Mobile Working Report has been saying since its inception five years ago - and in particular since we first looked separately at mobile working in the NHS in 2011. Over that time, our respondents have confirmed that mobile working creates benefits across a very wide spectrum: supporting initiatives to drive cost savings, to give patients more choice over where they are treated, and helping to meet concrete aims such as a paperless NHS by 2018.

Looking back at last year’s report, we concluded then that mobile working was starting to play an important role in achieving the two potentially conflicting aims of cutting costs and improving levels of care. What appears to have changed over the last year is that the benefits of mobile working now go beyond being just widely accepted: many respondents are saying that the business case is proven. As a result the numbers now undertaking Line of Business mobile projects have risen dramatically.

While mobile working matures, at the same time the devices available have multiplied and the technology supporting them has become more appropriate and far more secure: so critical in this sensitive marketplace. This also offers an opportunity to embrace workers using their own devices with all the associated cost savings, which is a key feature of this year’s report.

So there is now universal acceptance that this is an unprecedented opportunity to change the way we work: driving efficiencies and saving money, while at the same time improving patient care. Therefore this begs the question: why are there still trusts which are resisting the move into mobile working? The case has been proven; the technology is available; government has given it its stamp of approval: now it just needs the confidence and will to embrace it.

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NDL has researched mobile working in the public sector for five years now. This is the third year that NDL has carried out a survey into mobile working in the NHS specifically and the first time that this has been run as a separate report. We hope it offers valuable insights into the way mobile technology is supporting the introduction of new working practices, and in particular how it is helping to meet the twin aims of creating efficiencies and improving the quality of patient care.

We continue themes from previous years, including the benefits derived from mobile working and the barriers which are preventing its adoption. We have looked again at Bring Your Own Device and Mobile Device Management to see how these areas are developing. We have also explored device selection in more detail than in the past, to reflect the explosion in smart mobile devices now available on the market.

The survey was carried out in the late summer of 2013 by NDL’s specialist in-house team. There were respondents from 160 English acute, community and mental health trusts as well as Welsh and Scottish healthcare trusts.

In most cases, the results are expressed as percentages of the sample involved in that question. We have explored similarities with last year’s survey but, as this did not comprise the same data set, this is simply to identify trends rather than to make direct comparisons.

We would like to thank everyone who took part in this year’s survey. We believe the findings make an even more compelling argument than in previous years for the use of mobile working in the healthcare sector and also explodes some of the myths which are preventing take up.

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survey format and metrics

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NDL mobile working health survey 2014

Our first question this year reflects the fact that smartphones and tablet computers are now commonplace. The most recent statistics from Ofcom in its Communications Market Report (August 2013) show that tablet ownership has doubled to 24 per cent in the last year, while 51 per cent of us now have smartphones (this figure has doubled since 2011). Some estimates show that there are likely to be well over 10 billion devices worldwide by 2020 (Kleiner Perkins Caufield & Byers).

Our own research this year shows that the health sector is more technology-savvy than others. Eighty five per cent of our respondents have a smartphone, which would support the theory that health professionals are likely to accept mobile working more readily.

Is your personal phone a smartphone?

yes no n/a

12%

85%

3%

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This growing prevalence of smart devices for personal use coupled with increasing pressure on budgets has led to a rise across all markets in Bring Your Own Device (BYOD): enabling staff to use their own devices to access corporate information rather than those supplied by their organisation. People are already bringing their own devices into work for personal use: having a second device is cumbersome and may cause

frustrations if it is not as sophisticated as their personal device. This is undoubtedly contributing to the demand for BYOD.

The high numbers of NHS staff using smartphones would imply that demand from them would be even higher. In addition, our anecdotal evidence of a high prevalence of top-end tablets among clinicians is supported by recent reports of a scheme

implemented by Informatics Merseyside for access to a central clinical system: it was intending to supply iPads for this but most clinicians already had their own so these were used instead (EHealth Insider, Personal iPads to access EMIS records).

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bring your own device

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Do you allow access to work systems through BYOD?

yes no not sure

50% 49%

1%

So we asked respondents whether they allow staff to use their own devices to access either Personal Information Management systems such as email and calendars (PIM) and/or Line of Business systems (LOB). The results show significant growth from last year: almost half of respondents (49 per cent) now have some sort of BYOD scheme, compared to only 15 per cent last year.

But the response to the next question – whether these are official BYOD projects or simply allowing staff to carry out work-related tasks on their own devices – would indicate that this is driven by a demand from the clinicians themselves

rather than a conscious decision from above, which we believe usually starts with senior consultants and then spreads through the workforce. Nearly three quarters of these BYOD schemes (71 per cent) are unofficial, a huge rise from last year’s 26 per cent.

The growth in BYOD across all sectors is reflected in recent international research by BT and Cisco (Beyond Your Device, June 2013) which showed that 76 per cent of IT decision makers believe BYOD should be exploited to drive up efficiency and productivity. However, there are key issues to overcome, most notably increased demand for bandwidth, declining performance of

applications and slow log-ins to applications. So our results may reflect that more schemes are happening than senior IT in the health sector would really want, triggered by demand from technophile clinicians.

Is this:

just allowing sta� to carry out email or work-related tasks ontheir personal devices

an official BYODproject

29%

71%

Drilling down further into these figures, it is interesting to look at the difference in the access provided by official and ad hoc BYOD schemes. The emphasis for unofficial schemes is on enabling access to PIM applications (in total 93 per cent) – in other words, allowing staff to access their work emails etc from their own devices. Only 33

per cent enable access to LOB systems. This again supports our hypothesis that there is pressure from senior clinicians to access emails via their personal devices, and this high-level pressure may lead to schemes which are not strictly following good governance.

With official schemes, there is parity between PIM and LOB at 78 per cent for both, but almost one quarter (22 per cent) are allowing access to LOB applications only.

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The majority of all live BYOD schemes reported by respondents (53 per cent) are enabling access to PIM applications only, with 11 per cent exclusively for access to LOB applications; 35 per cent enable both, which means that in total 88 per cent are accessing PIM applications and 46 per cent LOB. In other words, people are more commonly being given access to their work emails on personal devices rather than to central clinical systems.

BYOD schemes can create significant security concerns, particularly with highly-sensitive patient information, which may explain why LOB is lagging behind PIM. We shall see later that there has been a rise in Mobile Device Management schemes and this is particularly prevalent among BYOD schemes (see page 17).

With all BYOD schemes reported, are they for:

PIM not sureLOB both

1%

11%

35%

53%

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Of official BYOD schemes reported, are they for:

just PIM just LOB both

22%

22%56%

Of unofficial BYOD schemes reported, are they for:

just PIM just LOB both

7%

26%

67%

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Are you planning to extend your current BYOD project?

yes no not sure

9%

41%50%

We then looked at any planned expansion in or entry into BYOD schemes. Forty one per cent of those who currently run BYOD schemes are likely to extend them and there will be greater emphasis on access to LOB applications: 28 per cent are going to extend LOB-only schemes and a further 47 per cent will cover LOB as well as PIM. Thirty seven per cent of those who haven’t yet allowed BYOD

state that they are planning to do so and, of these, 80 per cent will enable access to LOB, just behind PIM on 83 per cent.

Access to LOB applications represents true mobile working. And it seems that, as more schemes are introduced and confidence grows in their success, we are going to see an increase in the use of personal devices for

work-related applications rather than just providing access to the more mundane areas of calendars and emails. This will lead to a plethora of different devices and operating systems, which makes it critical that the apps used can run across all platforms.

If planning to extend BYOD, what it will be used for?

PIM LOB not sure

13%

28%

47%

both

12%

Are you planning any official BYOD projects?

yes no not sure

5%

37%58%

What will these new BYOD projects be used for?

PIM LOB not sure

13%

10%

70%

both

7%

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line of business projects

Although access to emails and calendars while out of the office saves time, the real benefits are only realised when clinicians can access LOB applications while out in the field, in particular across large community teams. This can generate significant efficiencies, as shown by the National Mobile Health Worker Project (NMHWP) whose results were published in early 2013. This looked at the benefits and efficiencies which could be achieved through community clinicians having access to relevant data at the point of contact with patients. The report concludes that “significant increases in productivity can be achieved, as demonstrated by huge increases in contact activity” as well as cost savings per clinician per year of around £20,000. Taking this further: the Royal College of Nursing (RCN) reported that 21 per cent of nursing services (in 2011) worked in community services, community psychiatry or community learning disabilities roles, which totals approximately 60,000 staff. When you also add in all AHPs (Allied Health Professionals) and calculate a saving of £20,000 each, this totals a colossal sum. Given the increasing move of services to community-based teams, these savings can only rise further.

At the same time as announcing the results of the NMHWP, the Secretary of State for Health declared his aim of a paperless NHS by 2018. Electronic access to patient records, from anywhere at any time, will be a critical part of this and therefore would support a widespread move to mobile working. So against this background, we looked at the activities targeted by trusts planning, piloting or using mobile technology.

In total, 123 trusts out of the 160 surveyed (77 per cent) have LOB mobile projects either planned, piloting or live. More than a quarter of these (27 per cent) have multiple projects, and there are 161 different projects happening among them. But it must be remembered that this is a snapshot of current mobile projects: at this level of analysis we don’t have additional details such as which devices are being or have been used, or whether they are re-developments of previously trialled or failed projects.

By far the most popular area for mobile working is community nursing, with 36 live projects, 13 at the pilot stage and 19 planned. This is a logical area for mobile working as it concerns large teams working away from base. It also reflects our evidence from working in the health sector, with projects such as for Blackpool Teaching Hospitals NHS Foundation Trust where district nurses are saving up to one hour a day by being able to view and update clinical notes while out in the community (see page 26). The NHS is committed to shifting more emphasis to care in patients’ homes, and the productivity gains achievable through mobile working have been demonstrated by the NMHWP.

Current LOB projects (number of projects)

planning

piloting

gone live

0

10

20

30

40

50

60

70

80

assessm

entsca

se

management

community

nursing

CQUIN

e-prescr

ibing

maternity

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Case management is the next most popular area. Delivering mobile access to central records is particularly important for Allied Health Professionals as decisions are increasingly devolved to them over patient care. It is also a key part of the move to a paperless NHS. Twenty three trusts have already mobilised this area, with three pilot projects. This number is likely to grow by 50 per cent, with 13 in the planning stage.

Patient assessment is the next most popular area, and once again would be part of the move to carrying out more care in patients’ homes. The health service performs a huge range of assessments across all areas, and it would seem a logical area to target for mobile access to central data. Twenty one respondents have live projects, with 10 planned and six being piloted.

Apart from those three areas, there are very few other activities currently benefiting from mobile working. One worth mentioning is for the CQUIN payment framework: a small number of trusts are using mobile devices to collect data to support the application for these funds. NDL has worked in this area with clients, most notably with Wrightington, Wigan and Leigh NHS Foundation Trust which is developing 30 mobile apps for gathering and processing information required by the Department of Health for CQUIN payments. By capturing data on tablets rather than taking notes and re-keying, this has saved 287 nursing hours a month across 40 wards. These time savings are being channelled into improving the quality of the patient experience.

Moving away from paper for prescribing has received press coverage recently but this is not reflected by our respondents, with e-prescribing via mobile devices only mentioned by a handful of trusts. It will be interesting to see if this area expands over the next 12 months.

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benefits of mobile working

We then turned to the benefits which can be achieved through mobile working. More than half of our respondents (55 per cent) currently have or have had successful projects. We asked them to identify the specific benefits that had been achieved.

The highest benefit is increased efficiency. This is cited by 93 per cent, up from 73 per cent last year: this may indicate that, as projects mature, efficiencies increase and become more measurable. This is closely followed by improved service delivery/better quality of care (at 90 per cent, up from 70 per cent). These two together were also the key findings of the NMHWP, which showed that mobile working saves significant costs while at the same time freeing up time which can be spent on patient care. In short, mobile working heralds a return on investment which is almost unprecedented – there hasn’t been such potential for savings since the advent of the PC. The challenge now is how to harness this opportunity – and how can you justify not doing so?

These benefits were also driven by the Quality, Innovation, Productivity and Prevention agenda (QIPP) which reached its conclusion early in 2013, and by the 2012 Health & Social Care Act. These jointly demanded savings of £20 billion by 2014 as well as giving patients more choice over where they could be treated, with more potential for treatment at home.

Reduced administration and paper also features highly at 88 per cent (up from 70 per cent last year), and is particularly relevant following the Secretary of State’s announcement over moving to a paperless NHS. With funds now available specifically to support this, it would seem logical that some of this will be used to increase mobile working.

These three benefits are far ahead of all others and perhaps show that this is where the focus is among trusts. Looking further down the list, reduced travel/carbon footprint is once again cited by just over half (56 per cent this year against 57 per cent last year). Our experience shows that this is a slightly misleading statistic: for example, Lancashire Care NHS Foundation Trust has said that, while it initially expected reduced travel, this didn’t materialise as clinicians are actually diverting the time saved into making more visits.

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If successful LOB implementation, what were the main benefits? (%)

increase

d

e�cie

ncy

reduced

admin & paper

impro

ved service

delivery,

better

quality of c

are

reduced tr

avel

or carb

on footp

rint

impro

ved work/

life balance

reduced desk

s

or o�ce

space

reduced head

count

0

20

40

60

80

100

However what is notable is the big increase in improved work/life balance, which is up to 55 per cent this year against 33 per cent in last year’s report. As mobile working matures, so working patterns become more established and teams start to understand how it works: they become more accustomed to spending less time in the office, while managers become more comfortable about seeing less of their team.

Just over one third also cited reduced desks or office space (down a little from last year’s 40 per cent). Our experience shows that this can take longer to achieve and it will be interesting to see if this rises next year.

We also asked if mobile working has enabled a reduction in head count, and 11 per cent report that it has. While some trusts have faced difficult decisions over redundancies against a background of squeezed budgets, natural wastage is often preferred and this takes longer for results to be shown.

Preparing and proving a business case for mobile working is critical to continuing current projects and introducing new ones. Of the 60 who responded to a question exploring this, 44 stated that their business case has now been proven by a successful active project. Some interesting comments are quoted here.

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5editionAmong these comments, the most interesting are the two which refer to reduced risk and improved safety: the NHS is rare in that it is able to build a business case based on quality rather than ROI.These benefits were based on the experiences of trusts who have had or are running successful mobile projects. We then turned to what all respondents hope to achieve from any future mobile implementations. It seems they have realistic expectations as these tend to follow the same pattern as the benefits achieved by active projects.

“one hour a day time saving for each nurse”

“two more tasks per day”

“increased efficiency and more tasks – able to improve by 25 per cent”

“certain tasks used to take half a day and now they take half an hour”

“access to clinical systems at point of care – reduced risk”

“revolutionised how we access patient notes: saving 18+ sheets of notes”

“close external sites – closed four down”

“reduced paperwork for community nursing - don’t have to have drug charts; more efficient and safer”

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Increased efficiency is once again at the top of the list of anticipated benefits and is cited by almost all respondents (97 per cent), which shows a universal acceptance that mobile working drives productivity gains. Ninety per cent expect improved service delivery and better quality of care, almost exactly the same as the real benefits derived. And once again this dovetails with the findings of the NMHWP report.

Reduced administration and paper also mirrors real benefits by being in third place (83 per cent). There is more expectation over reduced travel or carbon footprint (69 per cent) than is experienced in practice, which may support Lancashire Care NHS Foundation Trust’s discovery that travel isn’t reduced. While there are realistic hopes over improved work/life balance (58 per cent), the biggest disparity comes with reduced desks or office space: 55 per cent believe this can be achieved, against the 36 per cent which has come from active projects. This is probably explained by the fact that these savings take some time to be realised.

There is also realism over reducing head count through mobile working: 14 per cent see this as a possible benefit against the 11 per cent who have actually achieved it.

What benefits does your organisation hope to realise from mobile projects? (%)

increase

d

e�cie

ncy

reduced

admin & paper

impro

ved service

delivery,

better q

uality of c

are

reduced tr

avel

or carb

on footp

rint

impro

ved work/

life balance

reduced desk

s

or o�ce

space

reduced head

count

not sure

0

20

40

60

80

100

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Under one third of respondents (29 per cent)have experienced an unsuccessful mobile working project, down from 40 per cent last year. As mobile working matures, so there is greater knowledge of what is needed for a successful outcome. But of those who have experienced failures, the reasons make for interesting reading, highlighting that some good lessons have been learnt.

By far the biggest reason for a mobile project failing is the quality of the data network, cited by 60 per cent of respondents (up from 40 per cent last year). This disappointing finding is echoed by the NMHWP, where the most commonly recorded complaint was about connectivity: “This increases the importance of process mapping and knowing exactly what reliance there is on having a constant connection, and looking at other alternatives to work alongside the connected solution”.

The next year may see some significant changes in data network quality as 4G becomes more available, although its concentration in urban areas may not deliver much improvement for trusts which work across a wide disparate region. At the same time, the growth predicted in mobile working could exacerbate the problem as it brings increasing contention for bandwidth. This all builds a very strong case for using mobile working solutions which can

work in offline mode. It also undermines programmes purporting to enable mobile working which just provide a simple view of a desktop or remote access via a VPN and therefore need a constant connection.

Interestingly, the next most popular reason for project failure is wrong device selection, cited by 51 per cent. For mobile working to be successful, the user interface has to be easy to use, and we have heard about problematic projects as they are attempting significant data entry on smartphones. Successful projects involve users from the outset and take into account their opinions about the right device, which then encourages take up. One example of this is Northern Devon Healthcare NHS Trust, which is explored in more detail on page 26. The NMHWP also states that if you only involve clinicians when the new technology is being implemented rather than at the planningstage “this will greatly reduce the usefulness of the technology and limit the benefits which can be gained”.

The wrong device selection also impacts take up and gives another reason for staff or managers refusing to change existing working processes. This is reflected in thenext most popular reason for failure which is cultural resistance (47 per cent, almost exactly the same as last year), showing that attitudes aren’t changing. The NMHWP

reported that there is no evidence of ‘cultural resistance’ where staff “have been fully engaged in the project from the outset”. Yet only nine per cent of respondents feel that there is no demand for mobile working, which would seem to contradict high cultural resistance.

Projects are still failing because of lack of integration with existing systems (38 per cent), which is disappointing as simple methods exist to enable the front line to work seamlessly with existing back-office applications. There is little point in being able to enter and view some data while out in the field but then having to return to the office to update other key systems. NDL’s UK Local Government Integration and Efficiency Report 2013 explores this in more detail.

Cost is cited by under one third of respondents, indicating that the majority can see the financial benefit and ROI in implementing mobile working. This is down from 37 per cent last year, which also indicates an increasing understanding of the role mobile technology can play in an atmosphere of reduced funding. In other words, the majority recognise that the business case for mobile working based on ROI is proven.

Have you experienced any unsuccessful mobile working projects?

yes no not sure

67%

29%

4%

What were the reasons for unsuccessful projects? (%)

cost

lack of in

tegration

with exist

ing syste

ms

cultu

ral change or

sta� adoptio

n

secu

rity co

ncern

s

no demand/ not

a priorit

y

no reso

urces

to deliv

er it

data network

too slo

w

wrong device

s0

10

20

30

40

50

60

13

failures and barriers to mobile working

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Interestingly, security concerns have not played a major role in project failure, with only 11 per cent citing this (see page 13) – and this is down significantly from 32 per cent last year. Later in this section we see that security is being raised as a reason for not going ahead with a mobile project but in reality this fear is groundless. This may reflect a greater understanding of how sensitive patient data can be safeguarded through a variety of methods, which has persuaded West Suffolk NHS Foundation Trust to consider mobile working (see page 26). It is also encouraged by the growth in suitable Mobile Device Management technology for the health sector (see page 17).

Having explored the reasons why projects actually failed, we then asked about the barriers which exist in organisations towards mobile working in general, to see whether these correlate with the real reasons for failure. It seems that, in the main, the two are not in line.

The two biggest barriers cited are cost and cultural change/staff adoption (both at 59 per cent). These fly in the face of the findings of all previous NDL mobile reports and the NMHWP which highlight both the huge financial savings which can be achieved through mobile working (see page 10) and

also how cultural resistance can be overcome through the inclusion of clinicians in decision making. While these barriers are cited widely as reasons projects have actually failed, they do not figure as strongly (see page 13).

The next most cited barrier is security (47 per cent). Yet, as mentioned earlier on this page, security concerns had very little impact on project failure (cited by only 11 per cent). Therefore there is a perception of risk which is not borne out by experience.

Data network concerns are held by fewer respondents (41 per cent) than those who cite this as a cause of project failure (60 per cent). So perceptions are more optimistic – perhaps driven by hyped-up claims by providers - but this is still a significant barrier. It also ignores the fact that successful mobile working projects can be based on systems which enable offline working for later synchronisation.

The same percentage sees lack of integration as a barrier (41 per cent) and this is very close to the percentage for failed projects. This shows a realistic understanding of the need for integration to underpin a successful mobile working project. But this also begs the question as to how many mobile projects fail to get off the ground due to mistaken

concerns about the ease with which they can be integrated with the back office.

Selection of the wrong devices is only cited by just over a quarter (29 per cent), which shows a confidence in device selection which is not supported by the high rating for wrong device in the reason a project failed (see page 13). It may be that there is growing knowledge of devices now so this is less likely to contribute to failure in the future. It may also show that our respondents are aware that the market is changing at an incredibly fast pace, particularly with the likely impact of a variety of new mobile devices running on the recently-released and highly-secure Windows 8.1 (see page 18).

Interestingly, just over one third (34 per cent) state that lack of resources is a barrier to implementing mobile working: they simply don’t have the technical staff available to work on it. This indicates a huge pressure on IT staff numbers and a lack of foresight as the investment of staff time in developing mobile working brings immediate and significant rewards.

What are the barriers to adopting mobile workingwithin your organisation? (%)

cost

lack of in

tegration

with exist

ing syste

ms

cultu

ral change or

sta� adoptio

n

secu

rity co

ncern

s

no demand/not

a priorit

y

no reso

urces

to deliv

er it

data network

quality

wrong device

s

not sure

0

10

20

30

40

50

60

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We then turned to the approach taken by trusts to the management of mobile working. Firstly we asked whether respondents have a corporate or departmental approach to choosing and managing mobile applications for LOB. There is an overwhelming corporate approach (79 per cent), showing they recognise that this should be a strategic decision rather than carried out as tactical point solutions. Mobile technology offers the opportunity to introduce a fundamentally different way of working. It’s an agent for whole system change and as a result there should be ownership at the ‘corporate’ level – and our respondents agree.

Secondly we asked about mobile service providers. By far the most popular supplier is still Vodafone, with 50 respondents

having an exclusive corporate arrangement and a further 10 as part of a mixed supply arrangement. Everything Everywhere is next, at 35 exclusive and seven shared, with O2 lagging a little behind at 10 and seven. Apart from these three, there are no significant mobile service providers to the health sector. Twenty six respondents have no corporate arrangement.

We have already seen that signal or data network quality is the biggest reason for project failure (see page 13), and this is also cited by the Department of Health (DoH) as a key factor in successful mobile working. It stressed that signal strength tests from different providers are critical as network coverage maps may not be accurate and also stated in the final report of the NMHWP that

“it may also be necessary to consider using multiple network providers, especially across large geographical areas”. However this may prove impractical and trusts are unlikely to opt for different SIMs for different staff. But this does not get away from the issue that signal coverage is delivered on the basis of population density while health services have to be delivered in even the most sparsely-populated parts of the UK.

Do you have a corporate or departmental approach to choosing LOB mobile applications?

departmental corporate not sure

79%

11%

10%

Do you have a corporate mobile service provider? (number of respondents)

shared

exclusive

O2

Everything

Everywhere

VodafoneThree

Virgin

other

no

not sure

0

10

20

30

40

50

60

15

management of mobile working

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We then looked in more detail at the quality of mobile data networks, to see the service trusts are receiving and if there has been any improvement on last year. There seems to be a glimmer of optimism, with a doubling of those who report they receive a signal which is “always on with high-speed connectivity” (up from six to 14 per cent). However, apart from this the picture is still not good: over one fifth report “always on but with limited bandwidth” (21 per cent, just down from last year’s 24 per cent); while a massive 41 per cent still feel it is “patchy” (down from 49 per cent last year). Fifteen per cent report that it is “OK for occasional synchronisation”: this combined with those finding signal quality “patchy” totals more than half of respondents and would indicate the need for mobile implementations which enable offline working with occasional synchronising when in signal. Discouragingly, there has been a slight increase in those finding their signal “not fit for purpose” (up to five per cent from three per cent). Once again this supports the findings in the NMHWP report.

Concerns over the cost of data networking have risen, which may indicate increasing concerns over funding in general against a background of tightened budgets. Forty four per cent see this as a concern (up from 32 per cent last year), but slightly more (49 per cent) do not. This may contribute to cost being seen as a major barrier to mobile working (see page 14) but fails to acknowledge the financial benefits which can be delivered.

There have been recent reports in the press that mobile networks face a five-fold increase in the cost of renting spectrum from the Government with the warning that, if these price hikes happen, they will be passed on to customers (The Guardian et al). As a result, we may see greater concerns over costs next year.

How would you rate your mobile data network quality?

always on & high speedconnectivity

always onbut limitedbandwidth

patchy

41%

5%

15%

OK for occasional synchronisation

14%

not �t forpurpose

not sure

21%

4%

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Is data networking cost a concern?

yes no not sure

49%

44%

7%

With the growth in mobile working, the increasing impact of BYOD, and in particular the proliferation of devices (as we shall see on page 18), then the need for centralised management grows. We looked at Mobile Device Management (MDM) for the first time last year, and predicted that it would have more impact this year. Our prediction was correct: more than half of respondents (54 per cent) have MDM platforms compared to 38 per cent last year.

Drilling down further into these figures, it is very interesting to note that of those trusts with MDM, 79 per cent are planning, piloting or running LOB mobile working. This indicates the need for robust management of mobile devices to protect sensitive patient data. However only 62 per cent of those

with BYOD schemes (see page 5) also have MDM, which supports the theory that this is growing informally rather than being a deliberate organisational decision.

We then explored which MDM suppliers are having an impact in the market. The leader is Airwatch at 35 per cent, which is supported by our experience in working with the health service. MobileIron is making less of an impact at 15 per cent, but it has had some high-profile wins in the market. More interestingly, BlackBerry has a low share at seven per cent, but this may be improved after its recent announcement of a cloud-based MDM service which will cover Android and iOS as well as its own devices.

Of the 60 respondents who don’t currently have MDM, 29 are planning to implement one, while 12 of those who currently have MDM are going to extend this. So we should see growth next year but also some shake-up in the market as 34 of these are unsure about the MDM software they will select.

Do you have MDM?

yes no not sure

37%

54%

9%

Who supplies your MDM?

Airwatch MobileIron

Sophos

19%

7% 15%

BlackBerry

17%

other not sure

35%

7%

17

mobile device management

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18

device selection

The mobile market is dominated by four operating systems: Windows, BlackBerry, Android and iOS. Over the last few years, market share has changed significantly, with old-timer BlackBerry losing out, iOS becoming more accepted for business use and newcomer Android making inroads. The growth in tablets is having a significant impact on the choice of operating system and is leading to greater fragmentation in the market. So we asked respondents what they currently view as the appropriate device for mobile working in their organisation, and what they believe will be the device of choice for the future.

The results indicate that it’s now a mixed-estate world. At the moment, the most popular is the iPad, cited by 70 per cent as the best device currently – and reflected in our anecdotal evidence that these are very popular among clinicians. This is followed by the BlackBerry smartphone at 63 per cent, but the iPhone is very close behind at 54 per cent. Currently, Android devices are not making a significant impact (31 per cent for Android phones and 28 per cent for tablets), while Windows phones are only cited by 24 per cent. The relatively new Windows 8 tablet is only favoured by 20 per cent of respondents.

We should see a significant change however. Apple is set to dominate even more with both the iPad (cited by as many as 79 per cent of respondents) and the iPhone (66 per cent), but the biggest growth is going to be seen in the use of the Windows 8 tablet (up to 63 per cent) – and with the recent launch of Windows 8.1 with its robust security and an ever-growing list of attractive and competitively-priced devices, this could rise even further. Android phones and tablets will also see growth (54 per cent and 58 per cent) as confidence grows in their use as a business tool.

The big loser is likely to be BlackBerry (dropping to 43 per cent for phones and hardly registering for tablets), reflecting the torrid time it has been having recently. There have also been reports in the press of trusts playing a waiting game: for example, Southern Health NHS Foundation Trust has announced that it is going to wait until BlackBerry v10 proves itself as it is now experiencing greater demand for Android or Apple devices (Computing: No BlackBerry for Southern Health until platform proves itself).

What devices do you consider to be the best for your organisation now and in the future? (%)

now

future

Windows phone

Windows 8 ta

blet

BlackBerry

phone

BlackBerry

tablet

iPhoneiPad

0

30

60

90

120

150

Android phone

Android ta

blet

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However, it seems that the use of lighter, more portable devices is not necessarily going to happen overnight. We asked respondents whether they feel that laptops are good enough for mobile working in the field, despite being more cumbersome than tablets and phones. Almost three quarters (70 per cent) feel that they are. When we delved deeper into the reasons why, it is very much dependent on the situation. Comments included: “laptops are better when nurses need to see complicated information”; “new generation of laptops will be good enough”; “10 inch netbooks are

better than full size ones” – and once again the Windows 8 hybrid devices have a unique chance to capitalise on this.

Our experience in the local authority market would indicate however that, given the choice and given the right device, there is far greater take up of mobile working when tablets rather than laptops are supplied.

Larger tablet devices are preferred over smartphones when it comes to field working. Thirty four per cent feel they are better, with only five per cent supporting smartphones:

they are clearly not sufficient for the sort of activities which will take place. However more than half of respondents (52 per cent) feel that both are needed: this makes sense as you can’t make a phone call from a tablet. But overall this does show a clear move towards using tablets for mobile working and, as more devices come on the market, it will be interesting to see how far this has progressed in next year’s report.

Are laptops good enough for mobile working in the field?

yes no not sure

4%

26%

70%

Are smartphones or tablets best for use in the �eld?

smartphones not suretablets both

5%9%

52%

34%

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5edition

20

conclusion

The overwhelming message coming through from this year’s report is that the business case for mobile working has been proven, whether this is based on return on investment or improving the quality of care - or both. Respondents now recognise that mobile working offers an almost unprecedented opportunity to change working patterns which will drive efficiencies and improve patient care.

It also shows that the biggest barrier to taking up mobile working is not worries over security, which have been a fear in the past. It is actually concern over the quality of data networks. But this should not be a barrier: it can be overcome through the use of technology which enables offline working.It also seems that we are only at the beginning of a mobile working revolution, with plans on the horizon to extend it more widely into LOB applications across a large number of trusts. What may feature strongly in this area is the reliance on BYOD schemes: these are currently focused on PIM applications but they are likely to be extended widely into LOB.

The benefits from mobile working are particularly notable in the more routine areas of healthcare such as patient visits by large teams of community workers. The input of these professionals into the way schemes are developed is critical, particularly over choice of device and method of working. Using their knowledge and experience offers the chance to develop applications which truly reflect the way clinicians work. At the same time, the landscape for devices is changing and there is now an unprecedented opportunity to harness the power of the sophisticated devices coming on the market which run on highly-secure operating systems. In short, mobile working offers an unrivalled and exceptional opportunity to transform the way the health sector delivers services.

The technology and the devices are here; the business case has been proven. Now it just needs the will to truly embrace the unprecedented potential of mobile working in the healthcare sector.

5edition

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5edition

the awi suite

MXSXDX

All back-officeapplications

Mobilise

Desktop

IntegrateAutomate

awi is a suite of toolkits and server software that can be used either on their own or together to create a holistic environment for application automation, integration and mobilisation. The desktop platform, DX, lets you create standalone automations unique to a singular PC, saving individual workers’ time by automating repetitive tasks and reducing the transcription errors often made when re-keying from one application to another. The server-based application integration platform, SX, gives you everything you need to link all of your organisation’s back-office applications together in a ‘lights out’ environment, eliminating the need for re-keying information and allowing applications to work together as part of a fully-integrated business process. Finally MX, the corporate mobile platform, enables you to create mobile applications based on your back-office systems, extending them out into the field so that you can access and update records remotely. Each of these products can help in their own way and save an organisation huge amounts of time and effort as well as improving service delivery. When combined together they can provide even greater savings by allowing users to develop whole new business processes based on their existing applications. Typical examples of this would be invisibly linking a repetitive desktop process such as change of circumstances with multiple back-office systems, or taking information directly from the field back to several different back-office systems without any further user intervention. awi drives business flexibility and saves significant administration overheads.

The awi suite: efficiency in your hands.

“I love the fact that SX, DX and MX are so versatile and can be used for many applications. “

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5edition

SX

everything you need to integrate your back-office applications

The integration interfaces developed in SX for legacy systems can be presented to other applications in a variety of ways including industry standards such as web services, to be used on its own or as a perfect complement to middleware tools such as BizTalk, Ensemble or Rhapsody. Once developed, the integration interface is hosted by the SX server which manages the running of the individual interfaces and the transactions. The server(s) can be configured and managed remotely with fully-configurable audit and diagnostics facilities. Load balancing and failover options are also available with a comprehensive transaction queuing system to govern responses and actions to different behaviours such as a back-office system becoming temporarily unavailable. awiSX puts you in control of your business process transformation as application-to-application integration need no longer be a barrier. It also delivers significant savings over re-keying data or procuring multiple disparate APIs from different vendors. awiSX is a professional, scalable business-critical integration platform that has been proven in hundreds of implementations across the UK.

awiSX is a software development toolkit and server platform that enables customers to develop interfaces to read and write data

to back-office application(s). These can then be run and managed on the SX server as part of any systems integration or business process re-engineering project. The SX toolkit uses industry-standard, Microsoft-based languages and techniques to generate the application interface including the ability to automatically generate the necessary scripting code through the workbench, cutting the amount of time required to do interface development. This means that development is simple and there is no steep learning curve for anyone with a basic understanding of VB scripting. Alternatively, clients can simply call the necessary SX application profile elements from Visual Studio for use in a full .NET-based object-orientated solution.

Auto generate integration script in SX workbench

Scale, run & manage in integration server

Manage & audit transactions

AuinSX

SX

applicationPro�le existing

NDL

23

5edition

Real-time, two-way integrationOne application can update another in real-time, creating a joined up solution, extending the potential of existing systems and increasing the ROI on original investments. Reduces re-keying and errorsNo need for manual duplicate data entry, systems are kept up-to-date and back-office staff can be deployed more effectively. Single solutionOne product takes the place of multiple disparate APIs, saving the time and cost of acquiring multiple adaptors. Staff only need to learn one process as SX can be used in the same way for all applications. Uses existing UI business logicEasier to understand and develop the automation process.

Non-invasive processesDoes not access or change application data tables so does not compromise existing systems and therefore reduces business risk. Uses Microsoft standardsAutomatically generates and uses industry-standard code such as VB Script or VB.NET, significantly reducing the learning curve for developers. Built-in securityNo end-user intervention or accessibility required for target applications. All internal transaction traffic is encrypted with full auditing for added security along with configurable failover and load balancing. Fast return on investmentDrives immediate savings as well as future business process flexibility.

Mobile platform

Desktop automation

SXserver

e-forms

Back-o�cesystems

CRM

Web services

MXMX

DX

ASP.NET

24

5edition

awiMX is a software toolkit and corporate server platform that allows users to quickly and easily design, deploy and manage multiple bespoke mobile applications across di�erent types of

business smartphones or tablets. Using these applications, mobile workers can operate on or o�ine, taking information from back-o�ce systems with them and updating it from the �eld. Rather than selecting, and trying to support, multiple mobile solutions from di�erent vendors which work only on selective technology platforms in a prescribed manner, MX puts you in control by letting you design and run applications that work in line with the way that you do. Best of all it can integrate properly with your existing systems. With its intuitive, PowerPoint-style drag-and-drop App Studio interface, the MX toolkit is comparatively simple to use, allowing you to create your own mobile business forms but also leveraging the full resources of today’s mobile devices. The data sources for the applications can be mapped simply and graphically. Powerful VB-based scripting can also be used for more complex operations, even on non-Microsoft devices such as Android, BlackBerry and iOS. Once developed, the same application can run on di�erent makes and types of device. This means that you can develop and deploy applications to a wide range of devices without having to employ expensive specialist platform developers. In addition, your application developers can also draw on a range of templates and share application models with other users through the NDL awi User Group Forum and the NDL App Showcase. You can even migrate applications for deployment from one form factor to another at the click of a button should you choose to change device types.

Once developed, the MX App Server lets you deploy these applications quickly and simply to a multitude of smartphones and tablet devices over the air, minimising your management and administration costs. With its strong data encryption, the server provides synchronisation of data with the mobile devices and also with back-o�ce applications via web services, direct database connections or via awiSX, NDL’s universal integration adaptor. As the MX App Server also integrates with Active Directory it also provides application, user, group and device management as well as the full audit facilities you need to run a corporate mobile application environment.

Supporting all major mobile client phone and tablet form factors, with more being added all the time, the MX mobile client provides on-device security, communications and o�ine working capabilities. Importantly, the local client works the way the di�ering devices work, giving users the experience they are used to. The client also leverages the full facilities of a device, connecting to cameras, GPS or bar code readers as well as interworking with other on-device applications such as mapping and navigation, e-mail, tasks and calendars; even with other MX applications so you can build a modular suite of on-device applications.

awiMX is industry-proven, cost-e�ective and lets you take full control of your mobile future. Using MX means �eld workers are not travelling back and forth to the o�ce to perform administrative tasks and therefore spend more time doing the job that they are trained to do. All of this also drives signi�cant savings in administration, travel and even o�ce space.

Throughout the public sector awiMX increasingly features as a key driver on the cost cutting agenda and this is supported by many compelling case studies reporting countless bene�ts and an unparalleled ROI.

MX

everything you need to mobilise your business

Design mobile applications & publish to multiple

device types

Full audit and security

Manage devices, users andapplications ‘over the air’

n mobile applications & publish to multiple

25

5edition

Single solutionA single MX server supports multiple mobile applications on a wide range of devices. Licensed by server rather than device, a single server is capable of managing over 1000 mobile devices.

Multiple device typesNo need for specialist mobile developers as the same application deploys to different mobile operating systems and appears in a device’s native style. Design your own mobile applicationsMake mobile applications designed to fit your business process and as processes change, simply change your application. A simpler development alternativeVisual drag and drop PowerPoint-style form design, layout and data mapping. Industry standard Microsoft VB scripts, regardless of device operating system so only basic technical skills are needed to create feature-rich integrated applications. Offline working Synchronised MX device client works offline and synchronises just like e-mail, so that work can carry on uninterrupted when there is no signal available. TemplatesA growing range of user-created application templates available via the awi User Group Forum and the newly launched App Showcase that can be modified to suit customers’ exact needs, saving even more development time.

Integrates with the back office Wide range of options for back-office application integration, using Web Services, ODBC data sources and the NDL SX integration platform. SecureStrong data encryption for all communications (up to AES 256 Bit); user and device management and full audit controls ensure integrity. Ability to wipe MX applications and their data from devices remotely. Manageable Full central control over your mobile line of business applications. Simple management and low risk.

SXDatabaseconnect

Web services

AppStudio

AppServer

Mobileclients

Back-o�cesystems

integration platform

26

case studies

5edition

Blackpool Teaching Hospitals NHS Foundation Trust

West SuffolkNHS Foundation Trust

Blackpool Teaching Hospitals NHS Foundation Trust Community Health Services needed to reduce the amount of time wasted by clinicians through re-keying data into different systems. It identified awi from NDL as the best way of integrating disparate systems across the Trust. Once it started working with awi, it discovered a plethora of different ways to save time and money while still maintaining service standards.

West Suffolk NHS Foundation Trust faced a number of integration challenges, particularly with its iExpress Patient Administration System. It has now selected awi, NDL’s integration suite, to overcome these. The first project used awi to enable automatic updates between new outpatient check-in kiosks and iExpress. The Trust then used the toolkit to integrate its Aria chemotherapy e-prescribing system with the Somerset Cancer Register, enabling it to meet the latest stringent government requirements for data submission. West Suffolk now plans to use awi to support more integration and mobile working projects.

Northern Devon Healthcare NHS Trust

Northern Devon Healthcare NHS Trust has a long-term vision of providing care closer to patients’ homes. It was also facing a number of new challenges, including the introduction of the national Community Information Data Set (CIDS). It took this opportunity to introduce mobile working for its nurses and therapists working in the community, using awiMX, NDL’s mobile technology, running on Android tablet devices. By enabling them to enter data directly into its central patient information system, there have been significant clinical and operational benefits as well as an estimated annual saving of £750,000.

Lancashire CareNHS Foundation Trust

Lancashire Care NHS Foundation Trust wanted to improve quality and the efficiency of its community services. To do this it has introduced mobile working, using awiMX from NDL, for its district nurses and early intervention teams. As a result, clinicians can spend more time with patients, providing a higher-quality service, while central data is far more accurate and detailed, supporting the production of critical performance data. Lancashire Care is now starting to roll out the solution across all its teams of community-based staff.

To read the full case studies mentioned here and many more, go to www.ndl.co.uk/document-library/case-studies.

NDL’s classroom training is based in either the Wetherby (West Yorkshire) or the Leatherhead (Surrey) office, giving customers a choice of two venues. Over the course of a month, two SX and two MX courses are split between the two venues, allowing for flexibility over when and where a customer schedules training for its staff.

The training courses are a mixture of theoretical and practical sessions and provide a background to the use of awi, using practical examples and giving developers the chance to use the software in a test environment.

Because the courses are often made up of delegates from various public sector organisations, they provide the ability to meet with developers from similar backgrounds working on similar projects. This variety then flows into the User Group forum, where organisations can share code and ideas.

27

5edition

The NDL awi User Group was formed overeight years ago in direct response to customer demand. Sponsored by NDL but under the auspices of an independent Chairman, the Group is open to every organisation in the awi customer base.

Through well-attended meetings and anonline forum (hosted by NDL with controlled access), the group promotes best practice, shares experience and aims to freely distribute developed integration code. Mobile application development and sharing of application templates is also promoted through the forum as well as the online App Showcase.

As we progress through 2014 the User Groupcontinues to flourish. NDL routinely hosts webinars and sends out regular e-newsletters, as well as supporting User Group meetings every year.

The NDL awi User Group is co-ordinated by its Chairman, Martin Fuggles, a former localgovernment IT Manager and member ofSocitm.

Further information on the Group can beobtained by emailing:martin@martinfuggles.co.uk or bycontacting the marketing team at NDL:info@ndl.co.uk

awi user group

education

NDL

NDL Software Limited4 Deighton CloseWetherby, West Yorkshire. LS22 7GZ+44 (0) 1937 543500 info@ndl.co.uk www.ndl.co.uk

The NDL online App Showcase offers a selection of mobile

applications as multi-platform templates which can be

downloaded free of charge by all MX customers. Each NDL

template comes complete with documentation and a data set

ready to use, with the option to easily refine or redesign the

application to suit your own needs and ideas along the way.

This accelerates delivery and return on investment on those

all-important early projects as these apps can be downloaded,

tweaked to fit and deployed rather than having to start from a

blank canvas.

To see the great range of apps that are available, go to

www.ndl.co.uk/App-Showcase