While remote and wireless technologies have no specific schedule of their own, NHS Connecting for Health (NHS CFH) director of infrastructure Mark Ferrar says the mobility theme runs through the programme like words through a stick of rock.

"We are expecting greater mobility of staff and we realise we need to do more to support that mobility,'' he said. ''So all our work in developing new technologies is carried out with thought as to how applications will function in a mobile environment.

"The Common User Interface programme, for example, is looking at ways we can make the Microsoft interface work better for us and NHSmail is looking at delivering mobile email at best cost to the NHS.

"We are also running a series of NHS CFH 'lighthouse' projects to test new technologies, and are busy collating as much information as we can on non-NHS CFH projects in order to share the learning.

"And we are working closely with local service providers to find out as much as we can about their wireless activities with customers in industry to see how some of these ideas might be adapted for NHS use.

"Our job is to make sure people know what the possibilities are, and to provide support and access to training so that clinicians are comfortable with the technologies.''

Mark recognises however, that the rate of development will depend very much on individual trusts and how much money they have to spend on changing their systems.

"It's not a one-size-fits-all scenario and each trust needs to generate its own business case to improve communications and efficiency,'' he says. University College London Hospitals is dipping its toe into the water by testing the use of PCs on mobile carts or COWs (Computers On Wheels), while St Mary's Hospital, is trialling the use of Radio Frequency ID to record vital signs via a barcode on the patient's wristband.

In a matter of seconds the information is added to the patient's electronic record to keep data up to date and maximise patient safety.

The same technology could, in theory, be used to tag drugs and prescriptions to track their progress through a hospital and match them to patients.

In Cornwall and Liverpool, hospitals are piloting the use of bleeper badges which are Wi-Fi-enabled hands-free phones. They operate via voice recognition, enabling clinicians to be called and link in to the phone network wherever they are within the hospital.

"There's no doubt it's starting to happen – and some of it is pretty Star Trek," says Mark. "But it is true to say that we have fewer examples of good use of mobile technologies in the community than in acute settings, largely because primary care trusts (PCTs) have so many other competing priorities. We would like to see more projects like the one in Huddersfield coming through."

While commitment is slower in some places than others, Barbara Stuttle and Susan Osborne - the joint national clinical leads for nurses at NHS CFH – believe the need to invest in mobile technology is undeniable.

"The many benefits simply cannot be ignored," says Barbara. "It means nurses will be able to prescribe from a patient's home. They will be able to access and record up-to-date information while visiting a patient. And patients will have the novel experience of only being asked a question once!

"If you look to the future, you can see there is no way we cannot do this. It's happening globally. When you consider how many people use mobile phones and PDAs, you have to question why we are not already using this technology in the NHS."

Among the 'innumerable' benefits listed by Susan is better use of clinicians' time. "Staff can download their calendar in advance and use hand-held computers to keep in contact with their teams by e-mail rather than having to return to base to catch up," she says.

"They can also text or phone the client in advance, from wherever they are, to make sure journeys are not wasted because of Do Not Attends (DNAs) or cancellations.

"This efficient use of time releases them to undertake more direct patient care and educate and empower patients to take better control of their own health and treatment.

"Such partnership working is also enhanced by the use of easier, more legible, accurate electronic documentation which can be shared with patients and other clinicians to improve communication and patient safety."

Other benefits include tighter stock control as handsets are used to record the use of items and order their immediate replacement, enabling cost savings associated with weekly rather than daily stock collections.

And improving mobile communications between primary and secondary care also has the potential to increase the safety of home births by giving midwives instant direct access to clinicians and other support in the event of emergency.

Staff safety is an area where wireless/remote technology offers a clear advantage. "Staff can be located and contacted easily," says Susan. "There are systems in place where health visitors/community nurses/midwives can key in their location and telephone contact and indicate a time at which they should be called to check they are okay. Some technology can even track their exact whereabouts.

"Of course the issue of safety in carrying valuable handsets is not one we should ignore and it is an issue that has been raised by some community nurses. As with mobile phones, prescriptions pads and controlled drugs, this is a local responsibility.

"People have to be careful and aware of their environment and the fact that there will always be people who will want to steal equipment. It's the modern world and we can't legislate for everything, but nor can we let such fears stand in our way of harnessing technology to deliver more efficient healthcare to patients."

Remote v wireless technology – what's the difference?

Mobile working involves the use of both remote and wireless technologies – but they are not the same thing.

Stephen Humphries, technical manager for N3 – provider of the new broadband network linking all NHS organisations – explains: "Where you are wireless working, you are not physically connected.

"You could be in an office environment equipped with computers that haven't got hard wires 'plugging' them, but instead have a connection through a wireless antenna.

"In a hospital setting, you might have PDAs or computers on trolleys that can be moved from bed to bed. Both are examples of wireless working, but neither is remote. Remote technology means accessing a system from outside the traditional office (or hospital) space.

"If you are at home using your own computer hooked up to the NHS system through dial-up or home broadband, it's remote but not wireless. If, on the other hand, you are using a PDA to access the network say, from a patient's home, you are both remote and wireless."

Using personal digital assistants to improve the care of children and families in Huddersfield

A team of health, education, employment and voluntary sector professionals is piloting the use of personal digital assistants (PDAs) in improving the care of children and families in Huddersfield.

The innovative project, piloted by health visitors based at the Chestnut Children's Centre in Deighton and East Fartown, uses Palm Pilots to collate a universal needs assessment with local families when women are around 34 weeks through their pregnancy and at subsequent core contacts after the child is born.

The information they gather is then shared with the multi-agency team in real time so that they can decide who will do what and ensure those most at risk do not fall through the care safety net.

Margaret Hornsby an independent consultant who is a member of the project team, says: "It's helping us shape the children's centre agenda and the kinds of services that need to be delivered.

"We are not just using new mobile technology, we are actually harnessing its potential to help us change and improve practice."

The project is one of many examples of good practice in the use of wireless/remote technology now being collated by NHS Connecting for Health (NHS CFH), the agency charged with maximising the potential of the National Programme for IT (NPfIT).

Before visiting a woman's home, health visitors upload latest information about the family on their PDAs so that, rather than 'going in cold', they are aware of child protection issues, any history of domestic violence or substance misuse, or other causes for concern.

"This gives them a better understanding of any potential risk to their own safety and of the need to get particular information that may help avert a problem," says Margaret.

They then conduct a rigorous holistic needs assessment. This includes calculating a social capital score, which indicates how the family will cope in a crisis. For example, the assessment asks questions like 'Do you have anyone you could leave your children with in an emergency? Does your health stop you doing anything? Is there high crime in your area that makes you fearful of going out?'

If the family has a low social capital score, it indicates the need for particular attention from the team, in particular following up any non-attendance of antenatal appointments as a matter of urgency.

The handsets are 'docked' each night at the children's centre and the password protected data downloaded onto the main computer database to ensure all decision-making is based on latest facts.

If a handset is not docked and charged, it loses its memory overnight. So if a PDA were to be stolen, the information would automatically be wiped out.

Margaret said: "What's really exciting is the ability to manage our own information for improving care. Rather than waiting months for paper reports to go to the primary care trust and then back to us, the new technology allows us all to instantly record and share information in real time, when we are most able to do something about it. It is giving practitioners a tool to do their job effectively and to show what they do, how and why.

"It's early days, but indications so far are that the information recorded through 1,083 assessments is both valuable and meaningful and, after being trained to use the PDAs successfully, the health visitors are now comfortable and highly delighted with the technology."

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