Nottinghamshire Health Informatics Service

Working together to create ‘true mobile working’ conditions for mobile clinicians


Mobile working is the essence of being a peripatetic clinician and although there had been attempts by the Nottinghamshire Health Informatics Service (NHIS) in the past to provide ‘true mobile working’ conditions, user connectivity issues and users understanding the complexities of VPN access were still proving problematic. NHIS wanted to investigate the ongoing issues and improve working conditions for its mobile workforce.

Nottinghamshire Health Informatics Service (NHIS) supports over 18,000 users and hundreds of IT systems across Nottinghamshire, and is an excellent example of a shared ICT service that is ‘fit for purpose’, supporting the needs of all customers.

At NHIS, innovation is regarded as the key to the future of the Health Informatics role, in supporting the many challenges that NHS organisations face.


Mobile working is the essence of being a peripatetic clinician and although there had been attempts by NHIS in the past to provide ‘true mobile working’ conditions, the chosen technology solutions were deemed by the clinicians to be unreliable.

Mobile access was being thwarted by a combination of connectivity issues and the relative technical competence and confidence of the clinicians in using the devices. The log-on process was cumbersome and time consuming. Once logged-in it was difficult for staff to understand the complexities of VPN access and the connection signal status.

As a result, many clinicians still spent significant amounts of time transferring patient data from paper to the application, SystmOne. This situation was tedious for clinicians and did nothing to improve their productivity. This practice also put a strain on the work-life balance as staff travelled to and from base to input data into SystmOne.

Furthermore, IT support staff had no way of reporting upon the service delivery – how often were staff receiving a good signal and were they able to access the required applications?


NHIS engaged with ITHealth, who they had been working with extensively for over a number of years. ITHealth specialise in providing IT security and access management solutions for all types of NHS organisations with Secure-IT (a remote access solution) being ITHealth’s flagship offering. NHIS and ITHealth worked together to add to the Secure-IT offering (which NHIS were already using) so that the additional needs of NHIS could be met. They called the new clinical mobile working solution Monitor and it is being extremely well received by NHIS clinicians.

The Secure-IT solution offers strong, 2-factor authentication to enable Trust staff to securely access Trust data from wherever they are working, using NHS Smartcards, hard tokens, or mobile phone ‘soft’ tokens as their means of authentication. A typical Secure-IT solution comprises Secure-IT 2 factor authentication software combined with approved EAL4 appliances to provide firewall, VPN concentrator and intrusion detection; installation, training and on-going support are also provided from ITHealth. Secure-IT has been used by over 200 NHS Trusts and meets the rigorous standards that are set by NHS Digital.

The Secure-IT solution enables Trust staff to access their Trust and N3 applications and information, the internet and email, using a secure mobile VPN connection that safeguards confidentiality. This approach of providing access at the point of care enables ways of working that increase efficiency and can improve clinical outcomes.

Monitor was jointly developed to offer additional functionality to enable:


  • Reduced multiple log-ins
  • Intelligent network connectivity
  • Intelligent launching of the VPN and application based upon network connectivity
  • Provision of management information detailing user connections

Prior to using Monitor, clinicians had to work through 6 log-ins. With Monitor, this was reduced to 3 – improving user-friendliness and saving clinicians’ time. NHIS were also able to use their Imprivata Single Sign-On (SSO) to even further reduce the log-ins to just one. A typical SystmOne user could now authenticate by simply using their NHS Smartcard and be passed through their SafeBoot, Windows, VPN and on to their application.

During this more automated log-in process, the Monitor software is set to detect network connectivity, i.e. wired or WiFi; if these are not present Monitor will launch 3G or 4G. The user is advised of signal strength via a traffic light indicator: green for ‘go’, amber for ‘marginal’, and red for ‘there is an unacceptable level of signal present, so do not try to proceed’. Knowing whether a network connection is available saves time for the mobile clinicians, thereby adding to their productivity and user experience.

As the details of all user connections are saved by the Monitor software, management reports can be produced to identify which mobile internet service providers are enabling good service and which are not. NHIS were able to establish that by engaging with different service providers in different areas of Nottinghamshire this would provide the ideal environment for the mobile clinicians.


True mobile working has now been established for mobile clinicians working within NHIS. The ITHealth Mobile Clinical Working solution has significantly improved upon previous difficulties with coverage, log-on time, and assessment of signal strength. NHIS have been able to use this solution with existing laptops, new Panasonic Toughbooks, and tablet devices.

An inner-city trial involving Community Matrons has produced an overwhelming endorsement of the solution. Many benefits were seen to accrue from the clinicians’ better use of technology.

Key benefits:

  • Increased productivity: overall 87% of Community Matrons reported workable signal coverage in 85% of visits
  • Time efficiencies: administrative tasks are easier and faster to complete as they can be processed in real time without the risk of duplication
  • Reduced costs: accrued from greater staff productivity and a reduction in travel costs
  • Improved patient care: clinicians have access to real-time data on test results, treatment and the medical history of the patient, which may improve the quality of the service provided
  • Improved security: this solution provides a greater level of security than other services, e.g. BTN3, whilst being considerably lower in price
  • Reduced clinical risk: improved data quality and a significant reduction in the amount of duplicated data
  • Improved clinician work-life balance: increased team morale and reduced stress levels
  • Supports the ‘paperless’ drive