A new project is giving London ambulance crews access to vital patient data through iPads - secured with their thumbprints.
Using biometrics and iPads is a big change from the current authentication system that is used across most of the NHS, which relies on card-based two-factor authentication.
If you've seen a doctor in the NHS recently, there's a chance you've seen the card sticking out of their PC keyboard. These cards, known as NHS Smartcards, are similar to chip and PIN bank cards and enable healthcare professionals to access clinical and personal information appropriate to their roles.
It's a single, unified system that gives more than 800,000 users secure and audited access to national and local records. In a healthcare system that's often criticised for its lack of integration, the NHS Smartcard is a system that ensures staff access the right records at the right time.
However, it's an approach that isn't without its issues, like unauthorised card-sharing – plus staff can lose cards too, which leads to further problems.
Now the London Ambulance Service is the first trust in the country to provide access to patient-care records without an NHS Smartcard.
"We don't have them – we use iPads to digitally access the core NHS systems because the iPad has enough security features that can do that. And it's been a lot of work with NHS Digital to make that a reality. But having done that, you now just use your thumbprint to unlock the iPad and access records," says Ross Fullerton, CIO at the London Ambulance Service (LAS).
Fullerton says much of the effort has been directed towards re-engineering existing processes. The NHS Smartcard is already engrained within health professionals' way of working. The team working on the iPad project has had to work out how to place the iPad at the centre of the authentication process instead.
Fullerton says making the technology work has actually been the easy part of that re-engineering process. Crucially, the biometric technology that supports authentication is a standard feature of the iPad.
As a result, Fullerton describes the technical effort around the implementation of this technology in the healthcare environment as "fairly low-level". The hard part of the re-engineering process has centred on engagement and ensuring that senior decision makers agreed with the proposal.
"We needed to make sure the relevant people were happy to say 'yes'," he says. "We've done that by working really closely with NHS Digital to tackle things like governance, to tackle all the information security barriers, and to take away the myths that suggest an iPad is not secure enough to identify."
They also spent time engaging with on-the-ground staff to ensure that using an iPad would help boost the efficiency of existing working practices.
"We wanted to explain the approach to our medical colleagues who make decisions around safeguarding of data and give them confidence that this is at least as good – if not actually quite a lot better – than an NHS Smartcard that can be left on a desk," he says.
The project was tested in a 16-week pilot with 60 medics at Camden Ambulance Station in London in spring last year. That project helped prove that iPads could be used to safely access patients' Summary Care Records (SCRs), which are electronic versions of patient information created from GP medical records.
Increased confidence around data security isn't the only benefit from the implementation of iPads. The 4G-connected devices can be taken out on the road by ambulance staff, which means healthcare professionals have secure access to potentially life-saving information in the palms of their hands. LAS has now rolled out 4,500 personal-issue iPads to frontline staff.
"You've then got access to all the patient records that we never had access to on the road, so that is transformational," says Fullerton. "Our staff absolutely love the fact that it's really easy – it's not another password and another thing to remember. It's access to the basic information they need about a patient to deliver better care on-scene."
Fullerton continues to think about how his organisation can make the most of its devices. As part of the cultural transformation process associated to the introduction of iPads, the implementation team focused on engaging the whole workforce. Fullerton wants staff to know that these devices can help them stayed connected in a variety of different ways.
"If you're in an ambulance crew, you spend your day in a vehicle, you'll know your crew mates really well, but do you feel part of the wider organisation? So at the moment, we're looking at how we can exploit things like our private Facebook groups to really engage with our workforce 24 hours a day, to get our managed frontline managers across the organisation actively using that, and to have direct contact with everyone in the organisation. So that's quite a simple thing – you've got an iPad, you give them access to Facebook, and off you go," he says.
Crucially, lessons learnt in LAS are now being spread out around the rest of the NHS. Pharmacists are testing the use of iPads to securely access the SCR. Fullerton says similar trials are about to take place in other areas, including dentistry.
Next steps for the project are to increase functionality and availability. LAS continues to onboard more staff to using their iPads to access the SCR. NHS Direct expects Windows tablets to be able to access the SCR from April 2020. Android functionality, meanwhile, will be explored in the 2020/2021 financial year.
There's another important plus-point from the project, too. Fullerton says the process re-engineering work he's undertaken on identity and authentication for this project is now being used to inform other pan-London innovations around data access, information sharing and improved patient care.
"I'm working really closely with everyone else across London," he says. "So it's really exciting because we are the focal point for a lot of the technological developments for the NHS in London."