At an oncology conference in Geneva, Switzerland, Dr Oscar Breathnach boots up his iPad to review urgent imaging and blood results on a cancer patient. Within minutes he has logged onto Beaumont Hospital’s computer system, accessed the laboratory and radiology clinical applications, assessed the patient’s status, and issued vital treatment decisions without delay to his team 1,500 kilometres away.

This is 21st century efficiency – a mobile virtual workstation that can increase the speed and accuracy of patient diagnosis and treatment by providing flexible access to data on demand without compromising security, and that removes structural boundaries and proximity limitations so that the delivery of patient care is fully optimised, any time, anywhere and on any device. 

With instant messaging and 24/7 access to email, information and services, friends online and colleagues around the world, it’s a limitless globe we navigate from the tiny, smart devices that can be tapped, swiped and pinched to get what we want, when we want it. 

A convergence of mobile and cloud computing – the so-called “fifth wave” of technological development – is driving innovation at a spectacular speed, matched by equally significant changes in the way the world operates. You may not realise it but if you’re on Facebook, have a Gmail account or use eBay you already comfortably inhabit “the cloud”.

Almost without exception, businesses and organisations are reinventing themselves so they can plug into this rapidly emerging online ecosystem and take full advantage of the mobile-internet evolution.

The motivating force propelling us further and faster into the digital ether is, predominantly, us: the end user. Our expectations of what technology can do for us at work and play have increased exponentially over the past decade. We like computing without the tears, and technology innovators have spoiled us enough for us to take the logical leap and ask: if my desktop can fit in my pocket, why not the entire office?

Remote access at Beaumont Hospital

Dr Breathnach, a consultant medical oncologist at Beaumont Hospital in Dublin, was among a group of medical and nursing staff to call for remote mobile access to Beaumont’s clinical applications in recent years. 

Previously, the patient data and clinical applications, including PACS (Picture Archiving and Communication System) and the laboratory data processing system, resided only on computers in the hospital. If they were to be accessed, you needed to physically get to one of Beaumont’s 1,800 desktop workstations.

“All of these applications are great while you were sitting on the hospital network but as soon as you left the building, you had no access,” says Mark Graham, ICT operations manager at Beaumont Hospital.

“We were hearing from radiology consultants, oncologists, the neuro-team and others who were looking for access to imaging on PACS, or to order blood work or get test results while they were away from the hospital. Timely access to this sort of vital information is critically important when you’re making a diagnosis and deciding on treatment. The patient doesn’t want to have to wait and their doctor doesn’t want any delay either.” 

By the summer of 2012, a “proof of concept” initiative commenced at Beaumont and approximately 20 interested doctors and nurses were provided with secure access to a mobile clinical computing (MCC) system from VMware, one of the world’s fastest growing software companies that provides cloud and virtualisation software and services. 

A two-factor security authentication was implemented whereby each time a user logged in to the system it generated a unique PIN number and when entered the user was then prompted to input their name and password.

Clinical workspace on a smart device

By virtualising clinical workspaces with VMware View and hosting them on a private cloud, Beaumont’s ICT department succeeded in creating a truly “mobile” experience for the participating staff, both in the portability of their virtual desktops from one computer station to another within the hospital building and in the capacity of this virtual desktop to function securely on mobile devices, such as smartphones and tablets, inside or outside the confines of the hospital or, indeed, anywhere in the world. 

“The ability to assess images in a timely manner from any location, on a variety of platforms is invaluable,” says Dr Breathnach. “The nature of cancer therapy is that decisions regarding treatment are influenced to a significant degree by imaging and by blood results, in addition to the actual physical interaction with the patient. VMware is very simple to use, is very fast, and has been utterly reliable. It saves time as I can view the images from home, or even when in different countries.”

In recounting the instance in Geneva, he adds: “This was a patient I had seen on consult who had outstanding information; the ability to be able to check on the images, histology and lab results allowed me define the final plan, resulting in the patient proceeding with therapy in a timely manner. Otherwise the treatment might have been deferred for about five to seven days.”

Dr Breathnach also serves on various oncology committees and research groups. His virtual desktop allows him to assess images when off-site and give appropriate guidance on how to proceed to other team members. “As such, it further enhances our ability to give the highest level of care,” he says.

Mark has heard similar reports from other doctors and nurses involved in the proof of concept who are finding the mobile computing solution indispensable, including one consultant who bought iPads for each member of his team so they could all have portable access to clinical applications faster and easier, enhancing clinical productivity and giving them more time with patients.

Within a short period, the initial group of 20 staff members enlisted in the MCC pilot project expanded to 95 people. “It just grew legs,” says Mark. “It was so popular, everyone was very positive about their experience and so many people wanted to get on board that now we have a waiting list.”

The proof of concept report was recently considered by Beaumont’s IT steering committee, and approval was given to roll out the MCC system hospital-wide. Mark and his team are currently developing a strategic plan, which will then go to tender before the end of the year. Potentially, the hospital’s 3,000 staff may be plugged into the cloud early next year.

Benefits at the point of care

Ian Moore, country manager (Ireland) at VMware, sees the future of health IT as one that relies heavily on easy-to-access technology at the point of care, whether it’s updating patient charts, prescribing medicines, viewing images or collaborating with colleagues from any hospital terminal, laptop, tablet or smartphone. 

“The users always have access to hospital IT systems regardless of where they are or what device they’re on; their clinical workspace will follow them,” Ian states.

He says the virtual desktop will give users the same familiar Windows experience but the desktop is actually sitting securely in the data centre. No data resides on the device itself. 

Ian continues: “We have teamed up with one of our partners called Imprivata who specialise in proximity identification – that could be using a tap card or biometrics, such as using your finger print – to log onto the system. The caregiver will be immediately presented with their clinical desktop to resume caring for patients. They don’t need to struggle to remember passwords or login credentials. Instead, logins are fast, efficient and very secure.

“What hospitals also love about the Imprivata technology is that it records who accessed what, when, where and why. There’s a whole instant audit trail. 

“In a busy emergency department, for example, it wouldn’t be unusual for the first person in to log onto the hospital system and for other staff to use that workstation throughout the shift. Logging in and out for each user is time consuming, particularly with older PCs that take longer to boot up, and sometimes shortcuts are taken.”

Ian is currently in discussion with the Department of Health officials about installing VMware systems in public hospitals. “It’s cost-efficient, improves data management and provides massive productivity gains. This technology is huge in America, and in the UK and Northern Ireland they are jumping on board because they can see the benefits; it brings point of care to the patient or wherever it’s needed, it improves workflows and avoids delays with fast logins, and provides auditing and reporting on user activity. 

“This is not technology for technology’s sake, it’s making a real difference.”