NHS pilot highlights potential for digital health initiatives but main barrier remains, says expert

Technology law specialist Matthew Godfrey-Faussett of Pinsent Masons, the law firm behind Out-Law.com, said that the 50% increase in time that community nurses in the Western Isles were able to spend with patients as a result of their use of digital pens showed the efficiencies that health care providers can hope to deliver by adopting digital health solutions. However, the expert said that there remain major barriers to realising the biggest benefits from digital health initiatives.

Earlier this year the NHS Western Isles (NHSWI) announced that it had carried out a pilot in which 10 community nurses that provide services across some parts of the Isle of Lewis used digital pens to input patients' notes in electronic systems.

The health body said that using the pens meant the nurses could input patient notes into "a secure system at the point of care (e.g. a patient’s own home), without the nurse having to travel back to their base to access the system and input notes into a computer". It said the use of the digital pens meant that community nurses were able to spend 50% more time with patients. A time and motion study conducted between May 2012 and July 2013, where the community nurses recorded the time spent on their various activities, identified the increase.

The pilot initiative proved so successful that NHSWI has now rolled out the use of digital pens permanently.

"NHSWI carried out a scoping exercise along with O2 in 2010 to capture and specify the requirements for the management of the information and workflows from community nursing," NHSWI told Out-Law.com. "The results showed that 41% of nursing activity was data entry back at base, travel time was 31% and only 28% of time was direct face to face time with patients. By July 2013, patient facing time had increased to 44%."

NHSWI said that the study allowed it to estimate that, prior to the use of digital pens, 768 days a year were being spent by community nurses working on the Isles of Lewis and Harris alone "on purely systems data entry time". It identified additional time being wasted repeating fields of data on paper forms, such as individuals' names.

"The study demonstrated a reduction in caseload and team management, administration and travel time," NHSWI said.

Although the study was only carried out with 10 community nurses, NHSWI said that since the digital pens were adopted more widely, there is anecdotal evidence of nurses across the area reporting increases in the time they are able to spend with patients.

NHSWI said that the digital pens were introduced alongside a "newly designed comprehensive patient held record".

"Nurses carry out these assessments jointly with patients and carers and inclusively plan future care," it said. "Therefore presently this equates to spending more time in patients homes as opposed to pre digital pen."  

Matthew Godfrey-Faussett of Pinsent Masons said, however, that the key to success for this type of project is "the availability of a unified care record and an ability to update appointment calendars, medical records and other systems through a single interface or portal."

"This means that the Western Isles experience, whilst delivering clear benefits, may be harder to replicate for other Health Boards or Trusts operating a more complex and diverse range of systems", he said. "The pilot scheme in the Western Isles proves the opportunity provided by the adoption of simple digital health solutions, but it does not overcome the barriers that still exist in creating a unified care record for patients across the UK."

"The long term existence of the NHS has brought huge benefits, but that history has also created a complicated range of IT systems which, after the wind down of the National Programme for IT, do not cater well for our increasingly mobile population. It means that there are challenges in ensuring that health professionals have rapid access to a complete and up-to-date medical record for a given patient, including recent or current treatment plans," he added.

"In a mobile world, we will only realise the full benefit of some of the digital health initiatives that are currently under way, if a patient's end to end health record can be accessible in real time and in a way that allows all underlying systems to be updated seamlessly. No easy task, but every step taken to achieving that goal will pay dividends," Godfrey-Faussett said.