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White Paper

Citrix.com

How to Empower a Paperless NHS through Clinical Mobility Tried and tested best practice strategies to deliver a mobile clinical workspace while maximising security and regulatory compliance.

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“This is not just about technology as an enabler. It’s not just about putting in faster machines. The Citrix virtual desktop has changed the way clinicians work.”Brett Walmsley | Chief Technology Officer (CTO) | Bolton NHS Foundation Trust

The NHS is gradually transforming to deliver multi-disciplinary, multi-site care in the acute setting and beyond. The drive towards integrated care models and a paperless NHS is creating opportunities to leverage mobile solutions to enhance clinician-patient interactions whilst creating organisational efficiencies.

The concept of mobility has, over the past few decades, come to the fore as being an essential part of the NHS’s digital strategy. The rise in the popularity of smartphones amongst clinicians has meant that inno-vative clinical workflows are now being seen in healthcare settings through the UK. However, mobility includes a wide array of devices and clinical settings, and healthcare organisations are now spend-ing time devising mobility strategies that are manageable, secure and optimised for clinical practice. This white paper outlines a best practice approach to making the most of clinical mobility based on the experience of Citrix as a leader in the field of mobility for healthcare.

Defining Mobility

Different clinicians will define mobility according to their individual and depart-mental needs. Within these definitions there are often personalised preferences based on smartphone and tablet choices that clinicians use as personal devices. This has created a challenge as, although clinicians are optimising their workflows, it is not always easily visible or manageable for IT administrators.

This presents a number of challenges as healthcare organisations want to provide their clinicians with a consistent clinical IT experience according to their needs, while also balancing patient information and device security. Keeping track of devices and their status, which can range from smartphones to workstations on wheels, can be a highly resource intensive process.

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These devices are increasingly the gate-ways for accessing electronic health record (EHR) systems too, which means monitor-ing and maintaining access is becoming mission critical.

The Impact of Mobility

Before discussing a best practice approach to implementing mobility it is useful to take a deeper dive into the granular benefits that mobility creates for clinicians on a daily basis. Being able to access clinical applications in a mobile environment is only the first stage of realising the benefits of a mobile clinical workspace. Whether it is a surgeon completing a night shift or a nurse visiting patients in the community a mobile workspace offers:

• Flexibility to optimise patient visits and ward rounds based on a clinician’s preferred application access workflows

• Enhanced time available to allocate to patient engagement as clinicians are not wasting time searching for available terminals to view patient information

• The ability to gather more clinical infor-mation, more quickly when managing a patient, as it is readily available through mobile application access allowing a clinician to take the most informed possible clinical decisions

• Streamlined decision making as investiga-tions and referrals may be communicated and requested through a mobile device regardless of type or location

• A more complete patient record as clini-cians can update patient records in real time using any device rather than retro-spectively after returning to a hub clinical site to access the EHR

These benefits when considered together enhance patients’ experiences of their healthcare journeys whilst also having a tangible impact on clinicians’ abilities to take streamlined, informed decisions, ultimately contributing to improved patient outcomes.

However, the rise of mobility has also creat-ed an increased number of risks that have to be mitigated. Without complete trans-parency of what devices are being used within a healthcare organisation, it means that IT administrators do not know:

• Who is accessing confidential patient information

• Whether patient information is secured within devices

• How clinicians are communicating with each other and whether they are sharing patient information that might breach information governance (IG) guidelines

• How reliant clinicians are on mobile devices and what happens when they lose mobile access

• What applications are being used and whether they are approved for clinical use

It is clear that despite the workflow ben-efits, there are significant risks that are created through an unmanaged mobile environment that can place jeopardise the privacy of both patients and healthcare organisations. Given the renewed focus on security and IG in the NHS illustrated by the most recent Caldicott and Care Quality Commission (CQC) reports, it is essential that trusts and clinical commissioning groups (CCGs) are supported to balance the clinical needs of their users with the pro-tection of patient information. Fortunately, the right balance can be achieved through a methodical best practice approach.

Optimising Mobility through Best Practice

When it comes to mobility strategies, the most popular approach is to leverage the power of ‘Bring Your Own Device’ or BYOD. BYOD means that clinicians do not need to be restricted to using devices that they are allocated by a trust but can use their own preferred devices. This is optimal as clini-cians have often been using their preferred devices for some time and are comfortable with the associated user experiences. IT and digital transformation leaders want to maximise this user experience whilst also ensuring smooth and secure workflow tran-sitions from personal to enterprise devices. Taking a methodical user centred approach to deployments is essential to doing this.

Step 1 – Understand your clinical servicesThere are significant differences between healthcare organisations based on the clinical services they offer and the com-position of their clinical user populations. For example, the delivery of mental health services contains a combination of acute secondary care services and community

outreach services. The mobile workflows for mental health are therefore highly contextually varied when compared to the emergency department setting. This affects a number of decisions, including which applications need to be accessed from a mobile device and the number of different devices needed for the optimal workflows to be created. The scale of complexity also informs the amount of support and training that needs to be provided for clinical staff to ensure user adoption is maximised and best practice is being implemented.

Step 2 – Engage your stakeholdersOnce the context of the clinical services of your organisation has been understood at a high level it is time to engage with the broad range of stakeholders required to make a BYOD strategy successful. This can be achieved in a number of ways and normally requires a combination of IT, in-formation governance, HR, digital transfor-mation and clinical leaders to be effective. By working together through a mobility steering group, this becomes an effective way of highlighting potential benefits but also concerns that can be addressed before any tangible steps are taken towards a BYOD strategy. A multi-disciplinary commit-tee should be able to propose solutions for a number of challenges ranging from the timeline for implementing a BYOD strate-gy through to the amount of support and training for all the different types of clinical end-users that will have varied amounts of digital literacy and will want minimal disruption to their clinical work when a new technology strategy is implemented. By discussing concerns and offering solutions at such an early stage, an organisation increases its chances of maximising the adoption of a BYOD strategy in a manner that will positively impact patient care.

Step 3 – Identify regulatory requirementsThere is always a balancing act to be struck between security and workflow and this will have been raised as a part of the stakeholder engagement process. Once the needs of users have been mapped, it is time to map the security and IG policy requirements for the organisation. This should be aligned with guidance issued by Dame Fiona Caldicott, the CQC, NHS Digital and the Information Governance Alliance. However, it should not be completed in

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isolation and should include an on-going consultation with your organisation’s Chief Clinical Information Officer (CCIO) and mo-bility steering group in order to make sure that user policies that are set do not hinder clinical workflows.

Step 4 – Agree your technology strategyWith a multi-disciplinary oversight team in place and agreement reached about user and security requirements, a technology strategy can be developed. This involves making decisions about the devices and applications that will underpin the mobil-ity strategy moving forward. Within the context of a BYOD approach, it may require surveying users and cataloguing the range of devices that are currently being used by clinicians both personally and within the organisation itself. Within the context of your organisation’s broader IT strategy, this step will provide transparency about how your users are likely to interact with clinical applications such as EHRs and clinical portals, and support decision making about any additional investments that need to be made in solutions that will enable the deliv-ery of a secure, mobile, clinical workspace.

Step 5 – Launch your strategyWith a strategy in place, it is critical to communicate this to your organisation as a whole, leveraging the leadership of the mobility steering group’s members to articulate the strategy and its goal. Prior to the launch of the strategy, a benchmarking exercise should be conducted so that there is a formal baseline of existing practice that illustrates the extent of any perceived workflow inefficiencies and IG risks. When this has all been completed, tools should be made available to support enrolment, self-provisioning and clear communications being made to staff about how to access support during the launch of the strategy. An ideal way to do this, to be minimally disruptive to staff, is to undertake a phased rollout starting with specific user groups or departments over time. With this, once the strategy is more embedded then measure-ments can be repeated to demonstrate the benefits that clinical users and the organi-sation have gained from the BYOD strategy compared to the initial baseline findings.

Solutions that Enhance Clinical Mobility

Citrix has been at the forefront of delivering mobility solutions for healthcare for many years. Our experience working across a range of clinical environments and applica-tions has given us the expertise to support clinicians in the NHS to optimise their clini-cal workflows as trusts become increasingly digitally mature. Features of our mobile, clinical workspace include:

Enterprise mobility management (EMM)Using Citrix XenMobile, clinical users can access a full range of clinical mobile, web, SaaS, data centre and Windows applica-tions from a unified app store regardless of their device or location. This is paired with single sign-on capabilities to ensure smooth transitions between devices without disrupting clinical workflows. Meanwhile, IT administrators have complete capabilities to provision, de-provision, monitor and manage devices in order to protect patient data whilst maintaining secure information workflows for clinicians. A host of further application and network features means that both clinicians and IT staff can be confident that, no matter the status of a device or the presence of a security threat, they are operating within a secure and trusted environment through XenMobile.

Application and Desktop VirtualisationWithin even a single organisation, clini-cians are increasingly mobile, seeing their patients across the hospital estate. It is important therefore that they can maintain the continuity of their access to applica-tions such as EHR systems, ePrescribing platforms and imaging applications as they move around the hospital. Maintaining access to a desktop session while seeing patients minimises the need to constantly reload applications and potentially lose patient information. Citrix XenDesktop and XenApp create a ‘follow-me’ desktop experience for clinicians so that they never have to break their workflow and can pick up precisely from where they left within their application work, despite moving between different devices. When combined with partner technologies that allow users to be authenticated using proximity readers

and smartcards, this creates an efficient and secure environment that is ideal for the mobile clinician.

Secure file sharing and collaborationIncreasingly complex patient populations mean that care delivery is increasingly multi-disciplinary in nature. Clinicians have to have secure, intuitive tools that allow them to share and discuss patient information in order to aid clinical decision making. Citrix ShareFile is a policy-based, fully auditable file sharing solution that allows clinicians to do precisely that, whilst also syncing files across all their devices to support their roaming capabilities. Citrix GoToMeeting and GoToWebinar are powerful high-definition conferencing platforms that can underpin multi-site, multi-disciplinary meetings so that clinicians can collaborate and share information to further support patient care planning.

Case Study – Bolton NHS Foundation Trust (BNFT)

BNFT is an integrated care organisation in the northwest of England providing community services across over 20 health centres and acute care services through the Royal Bolton Hospital. Its clinicians work in a range of environments including those in the acute setting but also in community clinics and inpatients’ homes. Brett Walms-ley, the trust’s Chief Technology Officer (CTO), wanted to support and empower his clinical staff as a through technology as part of desktop refresh.

To do this, BNFT embarked on a Digital Desktop project that centred on leveraging the capabilities of XenDesktop and XenApp to deliver a follow-me desktop experience for clinicians on every device. The overall solution involved a number of supporting pieces such as iGel thin-client terminals and Imprivata’s ‘Tap and Go’ solution. This meant that using their own user security cards, clinicians could now tap an RFID reader, rather than inputting a username and password, and have their desktop and application sessions load exactly from where they left off. A clinician can now move around the hospital or a highly mobile

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department such as Accident and Emergen-cy, and never lose access to their imaging or EHR application sessions.

The solution also meant that clinicians could access their desktops and appli-cations with the same high quality user experience whether they are in the hospital or community. This means that clinicians could now have all the necessary patient information for decision making regardless of location. When all these benefits are considered together, they contribute to more time efficient workflows for end-us-ers while enhancing clinicians’ abilities to take clinical decisions without being re-stricted by the ability to access IT systems. As Brett explains:

“This is not just about technology as an enabler. It’s not just about putting in faster machines. The Citrix virtual desktop has changed the way clinicians work.”

Conclusion

Mobility is an essential enabler when it comes to maximising the benefits of a paperless NHS that is powered by EHR sys-tems. Citrix has an established record as a clinically engaged organisation that under-stands the balance between security and usability. By following a tried and tested best practice methodology, NHS trusts can be confident that they are leveraging our solutions to enhance their ability to secure-ly support clinicians to deliver enhanced patient care in the digital age.

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About Citrix Citrix (NASDAQ:CTXS) aims to power a world where people, organizations and things are securely connected and accessible to make the extraordinary possible. Its technology makes the world’s apps and data secure and easy to access, empowering people to work anywhere and at any time. Citrix provides a complete and integrated portfolio of Workspace-as-a-Service, application delivery, virtualization, mobility, network delivery and file sharing solutions that enables IT to ensure critical systems are securely available to users via the cloud or on-premise and across any device or platform. With annual revenue in 2015 of $3.28 billion, Citrix solutions are in use by more than 400,000 organiza-tions and over 100 million users globally. Learn more at www.citrix.com.

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