Liverpool midwives cull paper with 3G laptops

Remote workers furnished with secure mobile hardware...

Liverpool Women's NHS Foundation Trust is freeing its community midwives from the burden of paper with new remote working tech.

The hospital is planning to give 3G-enabled laptops to 75 of its midwives who work remotely, providing services to pregnant patients in their homes in Liverpool. With the new laptops, midwives will be able to access hospital systems and input patient data when out and about.

The midwives will be furnished with Dell D430 laptops sporting a Vodafone datacard for mobile broadband access and running Nortel's Secure Portable Office (SPO) to create a secure virtual desktop environment.

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Currently, midwives use a time-consuming arrangement, taking paper notes and then bringing them back to the hospital to enter them into the relevant system. The hospital's CIO Dr Zafar Chaudry said the SPO will enable the remote workers to open a VPN connection to the hospital's MediTech software and input patient data directly wherever they are.

Chaudry said: "When they [the midwives] go out to see the patient they are actually documenting all of the activity, all of the treatments and examinations on paper. So they have to write it all up. In addition to that when you're carrying around lots of paper in your car there's a risk that it can potentially be lost."

There are also data quality issues with relying on handwritten notes, Chaudry said: "If the handwriting isn't clear it can compromise patient care."

Remote access to hospital systems also means lab results are instantly available to midwives. "This way you can see the lab results and make decisions about whether a patient needs to be admitted, or if the right treatment protocols are in place," he added.

Using the SPO system means no data is stored on the laptops, so there is no risk of patient data being compromised if the hardware is lost or stolen, according to the CIO.

The laptops have also been further locked down by the IT department to ensure nothing can be saved on them and no data can be removed. "In the interests of data security, safety and so on… we need to make sure the laptop itself isn't holding any patient data, the midwives can't really do anything with the laptop but enter the data, so we've made sure all the USB ports are locked down, we've stripped down the install of Microsoft Vista on it so it doesn't really have any real functionality to it besides logging into our hospital system," Chaudry noted.

Instead of running from a USB stick, as is typically the case with the tech, the SPO will run as an applet from an SD card embedded in the laptop - a precaution against the danger of lost USB sticks.

Chaudry said the laptops were chosen as they were lightweight and also have a fingerprint reader, adding a layer of biometric security to the process. Even after the midwife has verified his or her identity with a fingerprint and logged into the SPO with a password, they will also need to log in to MediTech - meaning there is two-factor authentication, he added.

The laptops also run Nortel's Mobile Client Accelerator (MCA) - a WAN acceleration software package - to ensure login and data entry is not too slow. The MCA also helps if the connection speed drops from 3G to GPRS, Chaudry added.

Although smart phones were not considered as an alternative hardware option - owing to the smaller screen size - Chaudry said a netbook such as the Asus Eee PC would have been a viable alternative.

He said: "We did look at smaller form units but the problem is once the screen size drops below about eight inches the MediTech interface is not like a Windowsy interface - it's more like a Dos interface - so it becomes very difficult to enter the data into it."

"Though I suppose if this project was kicking off now I'd go for the… new Acer and new Asus devices. My technicians use the new Asus Eee PCs now and that would have been even better because that's an 8.9-inch screen and they're extremely lightweight and they support 3G and they also support SD. So those would have worked," Chaudry added.

The Eee PC would also have been welcome due to its potentially lower cost.

"The whole overall solution of 75 laptops, connections etc - cost about £80k. A lot of it's hardware cost. I wish I'd had the Eee PCs earlier because I could have saved some of that because they're only about £190 these days. But that's technology isn't it. The laptops we bought last week are probably £20 cheaper this week," the CIO said.

The secure remote data entry system will be piloted for a month by eight midwives, starting in September, before being rolled out to the rest of the community midwives. Trialling the tech in this way will help with ensuring staff buy into the new process, after some initial resistance to the idea of moving away from a paper process from staff.

He said: "As with any new change you have to be measuring that change very carefully that's why we decided we'd only do eight and we've picked the eight who are more keen on technology than the rest of them. And we'll try to use them as champions to sell it to everybody else in the team."

Another aspect of the project which caused some misgivings among staff is the fact it will enable the Trust to measure the amount of activity each midwife achieves during the working day. Chaudry said, however, this is "very important to us because we now work on payment by results, so the more work we produce the better the payments will be for us".

If the SPO system proves effective for the midwives, Chaudry said the Trust may look at using the encrypted USB product for other remote access, such as to email systems. "We'll be able to use that as it runs on any standard USB pen and USB pens are cheap as chips these days," he added.