Hospital mobile revolution starts with supply chain

An application which lets nurses access back end data anywhere in the hospital is a test case for .Net. Supply chain is just the beginning, say the builders

Bradford's hospitals are using mobile devices to save money and time on ordering supplies. The system allows workers to order supplies from an approved list, wherever they are in the hospital, and check the progress of those orders. But supply chain management is only the start, and the NHS is just the first customer, according to the developers.

The system, called Wander, was jointly made by KPMG Consulting and the Bradford Hospitals NHS Trust. It is now KPMG's to market and extend for other NHS trusts and the private sector. Supply chain management was the easiest and most cost-effective application to deliver, so the group started there, but it will be extended fairly quickly, said KPMG. "The health service had a need which was best satisfied with this technology," said Gary Howe, a director in KPMG's health division.

"Wander currently covers two-thirds of the supply chain function," said Ben Jones, head of development for design and engineering at KPMG. "The next step is to improve the back office integration, including patient support, and then it will be extended to cover clinical applications."

Because it uses XML, the product is extensible and its components are re-usable, said Jones. Some additional modules will be built by third parties, using public interfaces, he added.

Although Wander was originally an acronym (beginning "wireless application...") it is now a trademark. The development group are tightlipped about what it originally stood for. "It no longer reflects what the product does, so the original acronym is best left in the elephants' graveyard," said Jones.

Two departments in Bradford Hospital Trust which have particularly high levels of stock ordering -- the Ear Nose and Throat theatres and the Paediatrics Outreach service -- tested Wander, and it has now been rolled out to most other departments.

There are only about 50 mobile devices in use, but this will increase to around 80 in the first year, and there are already many more people using it, said Jones, since some people share mobile devices and others access the application from desktop systems.

"We believe there are about 100 to 250 people in the average hospital who could use this kind of technology," said Howe, and he believes there are similar environments outside the health sector.

Because the system uses a high level of intelligence in the handheld device, Pocket PC was the main contender for delivering the application. Tablet PCs were also considered, but were not mature enough, said Jones. "With Web services, the actual devices become irrelevant," said Jones. "We settled on the Pocket PC because we wanted to focus on usability." The application was developed in C# using Microsoft's Visual Studio .Net development system. The component for the Pocket PC without using Microsoft's Compact Framework, as this was only available in an early beta during development. Microsoft's SQL Server CE was a key element of the solution said Jones, allowing the team to build transactional web services for mobile use. "Web services are in their infancy," said Jones. "They are not transactional and that is an issue for central data, updated by mobile devices." The system had to keep working when the user moved outside the wireless LAN coverage or if the network was down, and synchronise when they returned to the network. "It works when the user is offline or online," said Jones. "In this case, users are online for the majority of the time, but other implementations may have more offline users." The first database on the Pocket PC was not up to the job, said Jones, but SQL Server CE, now in version 2.0 is "stable and robust enough to make sure data gets to the right point." The servers involved are running Microsoft Commerce Server, SQL Server and BizTalk. HP supplied the hardware including iPAQ Pocket PCs, and the wireless LAN comes from Cisco. The Bradford NHS Trust uses Oracle Financials for its existing stock control and supply chain applications, but none of this had to be replaced, said Jones. Instead, Web services were used to build interfaces to existing systems. This would also be the case in other trusts he said, owing the relatively undeveloped state of supply chain management in the NHS. "The vast majority of trusts have supply chain systems, but no end-to-end management capability," he said. "No single NHS trust has functionality in all the areas. Some trusts have components, depending which financials software they use, and there are some NHS-wide systems. Most trusts are missing some functionality." The NHS has the option of either investing in one ERP solution for all its trusts, or helping to develop a tailored solution which works with what is there, said Jones: "If anything gets replaced it will be something that would have needed replacing anyway." Some parts of the Trust's systems had to be replaced -- but these were proprietary terminal interfaces to ordering systems run by the stock suppliers. "These are usually antiquated, and they give the data to the supplier, rather than letting the Trust keep it and use it more effectively," said Jones. "The data is yours, not your suppliers'." For the future, KPMG has a long list of other NHS trusts to sell Wander to, and has already had interest from private sector companies. Among the extensions will be a corporate version with a mobile office environment.
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