1. Apps for AHPs An evaluation of Allied Health Professionals’ use of iPads for a variety of clinical specialties within NHS Fife

2. Background to project 2012/13 Scottish Government funding to support the increased use of mobile devices in community health services Several NHS Fife AHP services successful in their bid for iPads Devices were distributed across a range of AHP specialties to trial and evaluate the iPad use in a spectrum of settings. The iPads given out were a combination of 3G and wi-fi only devices Main aim of trial was to explore a range of applications and to determine whether they added value to service delivery.

3. Aims of the Project 1.To explore different ways in which mobile technology could be used in clinical settings 2.To evaluate the effectiveness of the mobile technology usage 3.To highlight patient /carer opinion of using mobile devices in their rehabilitation 4.To share experiences of iPad usage across the allied health professions

4. Preparation work Initial work with NHS Fife e-Health team to resolve security of devices & set up issues Service leads – procedures & governance issues Wifi installation in offices Airwatch teething problems Staff engagement with project and familiarisation with devices Teams involved in pilot: Learning Disability Physiotherapy RIVERS Chronic Pain Team (Physio & Pharmacy) Paediatric Occupational Therapy Occupational Therapy – Stroke Unit, QMH

5. Data capture & evaluation During April 2014 the pilot teams collated information on: 1. The type, scope and frequency of usage 2. Any difficulties encountered 3. Availability and usage comparison of 3G and wi-fi 4. The range of rehabilitation applications available 5. Any efficiencies in ways of working and cost savings Since May 2014 we have continued to capture subjective data from teams, patients and carers

6. “SAFE” Checking x-ray results while in rural clinic allowed treatment to be adapted immediately Took video footage of person eating & drinking to share with SLT colleague – allowed triage without a further visit Pharmacist scanned & emailed prescription change to GP immediately – medication error much less likely Guided access function – service users can only access the app being used

7. “SAFE” Translation app for patient with limited English ensured accuracy of information Use of Cisco Jabber being trialled by paediatric OT - Allows therapist and support workers to call each other from different locations to seek guidance

8. “EFFECTIVE” Checking emails or writing letters in car during unexpected gap in the day – less mileage & better use of time Assessment form templates can be completed immediately Taking unplanned Photographs for assessment or personalised programmes saves an extra visit Check equipment store for stock levels & order in house while measurements available

9. “EFFECTIVE” Bethany’s story “I asked my OT for advice about some small aids I wanted to buy to help me around the house. Because she had her 3G iPad with her she was able to do an internet search and talk me through my options there and then. It was great this could be done immediately and I got my equipment ordered soon after”

10. “PERSON CENTRED” Using familiar ipad games makes engagement in rehabilitation more likely & continued at home Use of 3D anatomy app to discuss with patient and carer about their health problem – increases understanding so increases likelihood of following advice Choosing own pictures for Accessible Information ensures the patient understands it fully & improves engagement

11. “PERSON CENTRED” Rachel’s story “I liked it when my physio took a video of me walking, then played it back to me. It helped me to understand what I was doing wrong and why it was making me sore. My walking is much better now that I’m aware of how to correct it”

12. “PERSON CENTRED” Use of relaxation apps during pain programme means patients can download same on their own phones & ipads later Video feedback to patients with unilateral neglect more useful than traditional use of mirrors Using video footage to give feedback on progress increases motivation – particularly good for reflecting slow progress over long periods

13. “PERSON CENTRED” James used a game to facilitate his handwriting then told us, “I am going to get my mum to download this game and play it at home with my brother”. The fact that iPads are a common feature in many households helps to integrate treatment with normal family life

14. Challenges we faced! Logging on difficulties – need to be in NHS wifi zone Inconsistent network reception in some geographical areas Difficulties of switching iPad use between multiple users Confusion between network passwords and log-ins vs device passcode Automatic deletion of iPad contents after several failed log- in attempts Short default time on screenlock – impact on patients Unable to print from ipad – rely on emailing documents Certain files wont open on ipad e.g. embedded documents Some useful features disabled by e-Health because of security concerns e.g. face time

15. Cost Savings & Efficiencies Wifi devices have no ongoing cost just initial outlay However…… lots of the examples given relied on having 3G enabled device Current 3G contracts are £4.50 pcm per device 1 business journey of 20 miles costs £11.20 1 hour of a band 6 costs approximately £15 Preventing extra home visits or using unexpected time gaps efficiently, saves money and frees up professionals time to use with another patient

16. Conclusion Data from our pilot and our experience so far, suggests iPads (or similar mobile devices) have an important role to play in improving the efficiency and cost effectiveness of working practices, increasing patient safety and enhancing the patient experience during their rehabilitation journey

17. Key Messages Ipads utilised in clinical practice can: 1.Improve service efficiency by allowing community staff to “work on the go” 2.Contribute to improved cost effectiveness by reducing business mileage 3.Add to the currently available treatment options within rehabilitation 4.Improve access to education materials for patients and carers 5.Be accepted and easily available for many patients to continue their usage beyond the end of their AHP sessions 6.Be recognised as standard clinical equipment and accepted as a part of modern day life

18. Future plans Developing postural advice for use of ipads Developing guidance on ‘screen time’ for patients Sharing information about accessories Sharing information about useful apps Further development of Jabber for communication purposes

19. Thank you for listening! Amanda Leech Physiotherapy Manager Learning Disabilities & Chronic Pain services Lynebank Hospital Dunfermline 01383 565384 amandaleech@nhs.net Questions