The changing role of the mobile phone

It’s proving to be an interesting time for mobile technologies and healthcare. The health service has always had a somewhat inconsistent approach to the use of mobile technology. Whilst simple applications like fall alarms are well know and widely deployed, the acceptance of mobile phones in hospitals and healthcare has often been rejected, with many believing they are still banned. That’s in sharp contrast to almost every other workplace, where they have been accepted as an important tool.
    
It’s very difficult to uncover the rationale behind the reason for banning mobile phones within hospital environments. Most of the scientific claims regarding interference have about as much evidence behind them as the photocopied life enhancing benefits you see adorning the window of your local health food store. That argument might hold true for a few very sensitive pieces of electronics equipment, but nowadays these are designed to cope with interference from a wide range of radio sources.

MOBILE PHONE USE AT WORK
The truth may well be a social and status one. Certain groups within the profession are somewhat technophobic and distrust new technology, particularly if they perceive that others around them appear to be more comfortable with it than they are. Whatever the reason, there still is a strong culture against using mobile phones.
    
At the end of last year, Devices 4 – a non-profit group attempting to increase the use of mobile technology by doctors, nurses and other care professionals undertook a wide-ranging survey of attitudes to mobile phones.  Of those surveyed, only just over a quarter (26 per cent) reported that they were freely allowed to use their mobile devices at work.  A larger percentage of respondents (31 per cent) replied that phones were not allowed, with the remainder in a grey area where they were tolerated. For a sector where communication is vital, that’s worrying – it suggests that a more institutional misunderstanding of the benefits of mobile phones that anywhere else.

ONLINE BEHAVIOUR
The conservatism of health services had led many commentators to suggest that this would result in patients taking monitoring into their own hands. In recent years we’ve seen an increasing range of economically priced monitors available in the high street, from blood pressure meters through to personal ECGs and glucose monitors. What an individually can buy varies from country to country, but the internet has broken down most barriers, letting patients acquire whatever they feel they need.
    
On the back of this, many internet companies have been set up to allow patients to upload their medical data to their own electronic health records. The most well known of these was GoogleHealth. However, despite a massive amount of media coverage, usage has been limited, and at the end of June, Google announced that they were retiring GoogleHealth. In their words: “It failed to move adoption beyond a small population of tech savvy patients.”
    
This announcement may signal a back-track in the way that the medical profession looks at mobile technology. Some are claiming that it signals the fact that most patients are not interested in taking healthcare into their own hands, but continue to rely on the medical profession to do the job for them. Equally, the initial experiment with consumer healthcare has made them more aware of what’s available, which raises their expectations for how they expect to see health professionals use it.

SMART PHONES

It’s not as if the medical profession does not embrace mobile phone. The Devices 4 survey indicated that 81 per cent of respondents use a smartphone, of which almost half use it for accessing information on the web. That’s in line with experience elsewhere. Two recent surveys in the US, by Aptilon and Manhattan research came up with smartphone ownership amongst physicians at 84 per cent and 82 per cent respectively. In a telling statement on the brand loyalty of US doctors, 61 per cent told the Aptilon researches that they would be using an iPhone by the end of the year. So it seems an apple a day still has relevance to doctors’ mobile aspirations. Although it appears that some other factor is at play in stopping three quarters of UK doctors using their phone for work.
    
The UK does seem to be unique in the barriers it has created for using mobile phones in healthcare. Ever since Norman Lamont’s budget tax on mobile phone, which was seen to be based as much on status as anything else, the hierarchy of healthcare IT has reinforced the attitude that smarter phones are not seen as necessary tools, but as status symbols. Which is doing an immense disservice to patients, many of whom use their mobile devices in a more competent way than their doctors. It’s a complaint heard often from health workers that “they do more useful things on their phone outside office hours.”
    
However, there are many excellent examples of how mobile devices are being used. Many of them are simple and have been deployed in small scale, local implementations. The most obvious is still not done nearly enough, which is to use mobile phones for messaging.  
    
Health services seem to be one of the last to realise that all of its staff have mobile phones which can be used for messaging during working hours. It’s an area which raises the question of whether an employee should be expected to use their own phone, or have one provided by their employer for work use.              

Most other areas of industry have realised the benefit of using the single phone. Very few of us like carrying multiple phones, so it’s more efficient, which means it’s more likely to work.   But doing that means that cost and intrusion needs to be managed. People will only accept this if their phone does not get called when they’re off duty. Some hospitals have worked this out, but many are still stuck over deciding whether to provide a second phone.
    
The second simple use is text for appointment reminders. Patients use their phones every day, and text messages are very suitable for reminders, as well as providing personal information. Some STD clinics have been making good use of this. The Terrence Higgins Trust’s Young and free website is an excellent example of how to do it, particularly their ‘Hide Me’ button.

A BETTER WAY OF WORKING
That’s the very low hanging fruit, which needs only the most basic phone. Move to smartphones and limitless possibilities appear.  Portsmouth NHS trust did more than just join the dots when they worked with Blackberry to make it easier for their midwives to record data during post-natal visits. In the past they’d write their notes, which they then had to enter on the system when they got back to hospital. Their paper pads have been replaced with digital pens and electronic paper, which captures what they write and transmits it back to the system via a Bluetooth link to their mobile phones. The trust believes that the system paid for itself within the first year, as well as freeing up time equivalent to five midwives, giving them more “time to care”.  One key finding from the deployment was that engaging the midwives in the design of the system really helped to make it more engaging and more efficient. Many people in many tiers of the mobile industry forget that the end users often know more about how an application works. It’s very important to get them involved from the start.

AN END TO TRADITIONAL PROCESSES

Portsmouth isn’t the only successful example of the digital pen in healthcare.  Wolverhampton is so pleased with their trial they did with their anti-coagulation and district nursing service, that they’ve just rolled them out to 600 community care staff. They believe that as a result, information is getting back to the hospital records five days earlier.
    
These applications open up the ability to share patient records and information – particularly important for caring for patients in the community, where they are likely to come into contact with multiple carers. The major network operators – particularly O2, Vodafone and Orange have all set up health divisions that are working closely on trials in this area with a range of NHS trusts.
    
Phones don’t need to look like phones. A good example is the lone worker alarm that is being provided by Identicom. To all intents and purposes this look like a normal NHS identity badge, but the back of the badge holder contains a GPS tracking device and an embedded mobile phone. When the wearer presses a discreet button on the rear of the badge holder, it makes a phone call to a monitoring centre, who can listen to and react to the conversation taking place. If the badge is ripped off, it immediately sends an alarm, along with its location. The beauty of this design is that it is non-threatening; because it looks like a normal badge it is unlikely to cause a confrontation. It’s already widely used within the NHS – you’ve probably seen one, but not realised.
    
Nor is it just people who need to communicate. It’s often claimed that the location of up to 25 per cent of wheelchairs and 30 per cent of endoscopes are unknown. Wi-Fi tracking devices are increasingly being fitted to these for asset management, reducing the time that is wasted in tracking down a wide range of equipment that isn’t where it ought to be.
    
In our everyday life we all recognise that mobile phones have transformed the way we interact with friends and run our lives. The health services have been slow to adopt that trend, hampered by internal issues. That tide is beginning to turn. As more of those involved in running our health services become aware of what is possible, often on their own phone, the future for mobile communications is looking decidedly brighter.