NHS WiFi - User Stories

(Marcus Baw) #1

HI,

I’m currently involved in some work with the NHS WiFi Programme Board, developing standards for the ‘Free WiFi in every NHS Building’ part of Martha Lane Fox’s digital recommendations for the NHS. For a load more background on WiFi in the NHS, have a look here: http://www.bawlabs.co.uk/t/staff-wifi-in-the-nhs-overview/34

We’re creating some user stories that would highlight some of the improvements in care that would be enabled by having roaming WiFi, with predictable access control/web filtering policy, ubiquitously across the NHS and social care (possibly further than this because Govroam, the solution that has been suggested to be a potentially good fit, would allow all of the public sector to be included in the roaming WiFi. We already have a number of good examples of use cases and user stories.

I wondered if the openhealthhub.org members had any user stories that they’d like to contribute and discuss. In particular, given the OHH audience, are there any ‘more technical’ or ‘less obvious’ use cases that this kind of WiFi would enable?

Marcus

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#2

Hi Marcus, all,

Just to check the scope of the user stories - is this just for NHS staff,
or for patients as well?

Cheers,

Laura

. . . . . . . . . . . . . .

Dr Laura James
Technical Director
Doteveryone

Public value, startup style

doteveryone.org.uk | @doteveryoneuk https://twitter.com/doteveryoneuk

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(Marcus Baw) #3

For anyone - patients, staff, carers - anything that you think highlights needed functionality, or a benefit of WiFi, or even a risk of WiFi.

M

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(colin.brown99) #4

Nursing and Residential Care Homes?
Perhaps a “more obvious” and “less technical” use case, but couldn’t find reference in the links so far.
For clinicians and carers who are peripatetic, and residents who long to be.

Colin Brown MB MBCS FRCGP
Glasgow
Clinical Informatics Adviser
SCIMP

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(Marcus Baw) #5

@colin.brown99 there’s an excellent possibility that the standard we are likely to select (Govroam, based on Eduroam) would allow pretty much any organisation that provided care to join in. So nursing and care homes - yes definitely I hope.

##User Stories
Perhaps I should elaborate on what I mean by ‘user stories’. They are intended to give a non-technical (and usually non-clinical) audience an insight into the kinds of things you could do with (in this case) WiFi.

They can be a terse and functional ‘three-part user story’ as used in Agile development:
As a role, I want goal/desire so that benefit”:

  • As a doctor in an emergency department prescribing an uncommon drug
  • I want to mobile access to the British National Formulary in real time via the Web
  • So that I can ensure I am aware of the latest cautions and interactions

Or they can be something much more narrative, fluid and human:

“I usually keep in touch with my brother in Sweden, and our extended family, through a private group on Google Hangouts. When I’m in hospital for my platelet transfusions it’s invaluable in staving off the boredom to be able to converse with distant relatives using IM because I don’t have to share my conversation with the whole ward, or disturb other patients, as I would if I were conversing by phone”

M

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#6

Can I offer my own case story?

Elderly patient with long term conditions and frequent user of multi- site acute care hospital trust. While in theory Trust authorised clinical staff can access my GP SystmOne Patient Record, in practice there are still many IG issues to be resolved. But thanks to recent Patient Wifi installation, using my tablet I can log into my GP Patient Online to provide instant real time access to any clinician who, for very different reasons, is not able to do so [research departments, internal network infrastructure…]. This is absolutely brilliant because it easily solves the IG issues which still plague health and social care! The patient de facto gives consent and the clinician [or researcher] can access latest medication prescriptions and dispensing dates, for instance.

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(Rakeeb) #7

Between August 2015 to the beginning of last week I’ve been working at Leeds Teaching Hospitals (St James’ Hospital and Leeds General Infirmary). Open wifi was introduced around Feb of this year in these hospitals.

It’s been really awesome to have free Internet at work. Particularly because some parts of the hospitals have no phone reception whatsoever, so it’s been handy to have the ability to always be connected for doctors and patients alike.

“The Cloud” , who supply the wifi at these hospitals have some interesting data collection policies however, and this had put off some of my colleagues, including consultants to put off signing up for the service as they fear that their Internet use will be tracked, websites they’ve visited will be tracked and ultimately may be used against them at some point in their career.

From my perspective, the service has been quite erratic at times. Before I left hospital medicine last week for example the wifi had not been working for several days/a week. The email updates we received reported that this was actually due to an error at the central offices of the supplier of the Wifi service and they had been incredibly slow to react and fix the issue.

In terms of having a secure internet wifi service I can think of a ridiculous number of possibilities that I wish someone had already thought of and implemented!!

I remember when I was in trauma and orthoapaedics and we’d often take (anonymous) pictures of x-rays and injuries to send to the registrar/consultant who was off site through whatsapp. Having a secure way of sending patient sensitive data with all their details would make things like this soooo much more efficient. Even communication between primary care and secondary care with secure images would be amazing. For example if a GP could get in touch with a secondary care physician and ask if a child has Kawasaki disease with an image attached could probably reduce a lot of referrals. Also, in terms of things like safeguarding issues, both in primary care and secondary care, it would be very useful to take a picture with your phone and store it somewhere secure as evidence.

If doctors sign up for wifi, it would be really nice to not have to carry a bleep all the time, but have a system where you could be messaged and could reply instantly. It’s the worst feeling when you are dealing with an acutely unwell patient, but then keep getting bleeped to prescribe paracetamol for someone inn mild pain. Being able to quickly respond is another thing as often you can’t even find a phone!

Having access to results in the hospital would be another major boon. I can’t tell you how long people spend logging in to a results server to see the blood results of their patients. It would be incredible if you could simply see whether the bloods or other tests have been seen and could see the results immediately. It would also simply stop you from forgetting you’ve sent off these tests and realising the patients have been waiting for hours.

I’m probably dreaming a little, but I could go on and on. Mobile WiFi certainly underutilised in the NHS and could improve loads of things drastically! :innocent:

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(Paul Targett) #8

I would support all the discussion above that good wifi coverage would allow new app innovations to grow.

Service provider story:

Supporting a GP weekend working service with a mobile solution. Mobile devices had WiFi and 4G so the app could talk to the cloud service most of the time. This meant that connectivity wasn’t an issue and meant the doctors could deliver care without being concerned about having the right dongle or wifi code entered. The WiFi in this case was provided in GP Practice but was not available to patients.

If the NHS had a deal with BTOpenzone and/or Virgin then any doctor entering a patients home with this broadband provider could get connectivity immediately - this would be a good move.

Patient story:

My comment would be from a patient’s view point. Having a friend who was in hospital with a condition in a general ward. The piped in TV was a) expensive and b) of poor visual quality. This guy is use to having his broadband at home and having good 4G signal on an iPad. To go into a ward where he couldn’t get GPRS made him very bored. His wife had to take his tablet home to download stuff on iPlayer and then bring it in.

I guess the flip side is that if everyone is streaming iPlayer then the next issue is one of bandwidth?

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#9

The cynic in me makes me suspect that the performance of this won’t come close to 4G. I’d be suspicious that it would be slow, and unuseable due to filtering. My first suggestion to someone spending any amount of time in hospital would be to get as much data on 4G as possible.

Patient story:

I was a patient in a trauma ward. There was commercial wifi and television, and they were pretty expensive (also using television in a shared ward would be a little antisocial). I’m not really sure you can expect ill patients on painkillers in an environment where everyone is busy all the time to be able to buy anything, you also have to bear in mind that people are arriving at all hours.

Fortunately, I had an unlimited 4G data contract, and a smart phone.
I found access to music and audiobook very useful to

  1. Sleep in a noisy environment (people arriving at all times, someone in the ward was talking to themselves, bells ringing all the times, people asking for pain killers)
  2. Manage pain: If you’ve ever been on a trauma ward, you’ll know that many people are continually trying to ask for more painkillers while nurses are trying to limit painkiller use / not hit a limit where they aren’t allowed to give you more painkillers.

Access to email was also important to communicate with people. (E.g. sending email messages at night)

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(Marcus Baw) #10

This is all great feedback @opentom @paultargett @RakeebChowdhury @Pappageno !

Great to hear the legitimate reservations that you, as informed users, have about an NHS-provided WiFi service - that the service would be rendered useless by over-filtering, poor bandwidth, etc.

4G is great where the signal exists, but many hospital areas are either heavy old Victorian brick construction, or they’re modern PFI steel-framed buildings that behave like Faraday Cages!

Does anyone else have a perspective on WiFi from an ‘NHS Staff’ point of view?

  • overfiltering of results meaning legitimate ‘medical/work’ sites were blocked?
  • poor bandwidth?
  • captive portal / ‘landing page’ WiFi meaning constantly having to re-login when moving around the building?
  • non-access to email (blocked)?
  • difficulties getting Trust to recognise you as a ‘staff’ member? - eg when working at another hospital temporarily - in the case of medical/nursing students & PAMs - when slow HR departments prevail, etc

M

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(Aaron Donnelly) #11

Free Wifi is always a bonus. Filtering is always a nightmare.

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(Pepsie Khan) #12

I came across this topic whilst searching for an instance of staff using the nhs WiFi to hack into (if that term is applicable) a patients smartphone- as happened to me. But no one believed me.
So now,no matter how ill I get, I will never go back into hospital.
It appears that I am the only one that this has ever happened to.

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(Marcus Baw) #13

What evidence do you have? I’m open to the possibility that public WiFi networks can be used for hacking. I’m much less convinced by the suggestion it would be the staff at the hospital - even the IT teams in most hospitals lack the skills for this kind of hacking.

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(Pepsie Khan) #14

Hi,

I was in a & e at the time, they were able to see all my photos and actually deleted 1 that I had taken of one of the nurses from a long time ago (taken with her permission) it was in the early hours of the morning and fairly quiet in the sense of not so many of staff other than those on duty. They had a photo of my house on the main monitor and that’s how I realised what was happening, it was highly amusing to them to be able to get such a rise out of me, even the night porter was in on it.

One of the junior doctors was sniggering and although I was so upset at the time I recognised him on the ward I eventually ended up in. I walked up to him and asked his name and he totally ignored me, but a senior doctor turned to him and told him to give his name, he was bright red and showed his name tag and practically fainted he just said “I am just one of the junior doctors”. I got back into bed and this scene had been noticed by the staff nurse who came and asked what the reason was, I told her and although she was very genuine she said I was probably imagining it, but she would put it into the day book.

The other person I told was a junior female doctor that I knew from a previous visit. She was very sympathetic but said it was probably my imagination due to the high level of painkillers I had taken.

Also whilst still in a&e a relative with a patient in the next cubicle popped her head round the curtain having overheard what was going on and offered her name and telephone number if I needed a witness but within seconds they moved him to somewhere else and as I was unable to move from the bed and they closed the curtains, I have no idea where she went.

By the way, the photos that I saw of mine on the screen were all stored on iCloud but I had photos of my bank statements that one of them commented on, but I also had very personal photos that were taken of my sister before she died and by now I was going demented. No one was listening to any of my cries to ask them to stop, I was shaking from anger and frustration and I didn’t think about turning my phone off, but in any case I couldn’t reach it.

Eventually (I had been 6 hours outside in the ambulance and over 5 hours waiting for a bed ) and was so upset and grief stricken by what was happening I pulled on the handle of a bag that the paramedics had brought with me and found a makeup case with a (safety) razor blade in it and tried to cut my wrists, I had been alone and no one had checked up on me but I wanted to do the job properly, so I used a sheet to cover my arms in case anyone came in. It was hard work trying to cut myself deep enough and although the sheet was heavy with blood the cuts kept drying up, so I would try again higher up the vein. Eventually I must have fallen asleep or lost consciousness but a young Irish male nurse was shaking me awake to tell me a bed had come available (he noticed the blood but must have assumed the cuts were why I was in there, The sheet soaked in blood was underneath me and before I was taken I put the sheet on the bottom of the trolley where it was noticed by one of the nurses but nothing was said.

There is so much more to tell but at the end of the day, the people I tried to tell (I live alone and have no close friends or family) didn’t take it seriously and I was both physically and emotionally drained of the will or capacity to try to help myself.

When I got home I tried to contact places that may be able to help, including the police, but one computer hacker type place which was a business that dealt with corporate type businesses told me that even if I sent them the phone, yes they could prove a photo had been erased, there was no proof of who had done it, and at the end of the day by the very fact I was in a hospital and by then was using the free WiFi I had accepted the terms of the contract and it would be my word against theirs.

At first I spent hours, days, weeks trying to find someone to help but I get so agitated when it comes to mind and I know there is very little I can do about it, so apart from when I remember and in a frenzy, using every search term on every search engine, tor, onion, specialist, free and paid for, I have never found anyone else who seems to have had the problem or offer a solution. I had a four page script prepared to send to anyone who would listen, but all I was finding were impenetrable brick walls. So thank you so very much for at least replying, but I do understand everything is stacked against me getting anywhere with it. (I read books and books on hacking, I bought the WiFi adapters and gadgets to see if I could prove that it was doable, I now know it is possible but (as everyone seems to think) improbable. BUT, on oath,I was not imagining it,and they used the hospital monitor at least, which although not absolutely certain, but leads me to assume the hospital computer too and from what I have read up on it’s usually a laptop that is used to hack into accounts or is it packets? But I do know that if someone has the inclination to pull a stunt like that, why I have no idea, but there is all the info on how to do it easily accessible via the net.

Again, thankyou very much for your reply.

Jackie

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