By Daniel Johnston MRes, RN, Sr Clinical Workflow Specialist & UK NHS Clinical Safety Officer
Why we need connected care systems
Clinicians in every section of the health sector are working as hard as they possibly can after the recent pandemic. With budgetary pressures and widespread staff shortages adding to an already challenging situation, it’s imperative to make efficient and intelligent use of technology to improve the experience of clinicians and therefore patients. As burnout continues to impact clinicians’ quality of life, there is an urgent need to stem the flow of highly qualified nurses and doctors leaving the profession. Connecting care systems through digital transformation can improve efficiency, and satisfaction, making the day-to-day experiences of clinicians easier and more fulfilling.
As the NHS transitions to a new, more collaborative way of working as part of the recently created Integrated Care Boards, healthcare organisations can take a fresh look at how healthcare workers interact with all aspects of technology. Digital solutions are rapidly evolving and becoming increasingly vital elements of clinical and administrative workflows. At this time of unprecedented challenge, efficient and effective collaboration is much easier to achieve when care systems are connected, both within and between organisations. One of the key deliverables of digital transformation, with its upgraded technology and better integrations between computer systems, is that it will make connected care systems a reality to deliver for patients and stretched workforces.
Successful digital transformation
Improving data sharing capabilities within and across health and social care organisations has long been a goal of the NHS but has not yet been fully realised. Digital transformation has the capability to fundamentally reshape the provision of health and social care to make collaboration for clinicians working across the new Integrated Care Systems (ICS) a reality. Technology has the power to deliver the increases in productivity. This is essential to meet the ever-growing demand for healthcare services, especially while keeping up with post-pandemic waiting lists.
The proliferation of cloud-based services, mobile devices, hybrid workforces, and the Internet of Medical Things (IoMT) provide many wonderful opportunities to increase productivity and improve collaboration. However, the adoption of new technology also introduces a different level of complexity and increased risk regarding workflows, security, and compliance. IT professionals must be aware of the potential pitfalls and take steps to mitigate these risks.
Involving clinicians in digital transformation processes and projects is vital. Considering the care-provider’s perspective is essential to effectively incorporate procedural and cultural changes which will lead the workforce to embrace the solutions as their own. When this happens, the creativity of the workforce is unleashed as they find new ways to use technology to its maximum capabilities – providing greater return on investment while improving the care delivery process and the patient experience.
The role of digital identity
The adoption of digital identity technology has an important part to play in connecting care systems. Digital identity provides many benefits to healthcare organisations, particularly for its ability to massively enhance the clinicians’ experience at the point of care. Simply put, digital identity enables secure, appropriate, and efficient access for the right people, to the right information, at the right time and place. This makes clinical workflows simpler, faster, and more secure within an organisation. With greater digital capabilities enabling clinicians to keep up with the evolving care-delivery model – both within and beyond traditional hospital walls – the workforce will be better equipped to keep up with growing patient demands and will feel empowered to collaborate across ICS.
‘Tap-and-Go’ single sign-on technology is here already, but that is just the beginning of the efficiency a holistic digital identity strategy can unlock.
Fast, secure, and auditable access to patient and clinical information including electronic patient records (EPRs) is central to a digital identity strategy. With access to patient data at the bedside and beyond, clinicians will be better equipped to support good care and treatment decisions improving patient outcomes, while making life easier for clinicians – in turn reducing burnout. They no longer need to log in and out of multiple systems and can readily access information on mobile devices. Instant access to patient data saves clinicians significant time per shift and removes the complexity of remembering numerous login details, like complex passwords, which require periodic change to maintain security and thus increase administration burdens and often lead to cognitive disruption, interrupting patient care.
Imprivata has seen the adoption of digital identity bring time-savings and increased efficiency across a range of organisations. The average time-savings for clinicians [i] accessing systems across UK NHS Trusts was 20 minutes per person, per shift, with some trusts seeing 40 minute savings which can be returned to patient care and improve clinician quality of life.
The importance of digital identity for clinicians
Digital identity is the control plane through which all interactions within healthcare systems can be managed, secured, and monitored. When deployed correctly it provides the optimal balance between user access, security, and compliance to make the everyday lives of clinicians easier and more productive. Recent findings from KLAS research [ii] (a part of the Arch Collaborative programme) show that, for example, the quality and functionality built into the software of an EPR is one part of driving adoption and delivering user satisfaction.
Clinicians’ day-to-day interactions with the system dictate their view as to whether the system eases and enhances their workflows and therefore overall usability. This drives acceptance, adoption, and success. Instant access to the patient information they need, at the point of care, without worrying about multiple, lengthy logins is invaluable.
As clinicians move from department to ward to clinic and beyond the institution’s walls to work from home or within other collaborative organisations, their digital identity goes with them and provides access to all the appropriate systems, in any location. When doctors assume new roles, effective management of digital identities through identity governance technology provides the ability for immediate secure, role-based access to all applications and devices that they need. This eliminates any lost time from a clinician not being on-boarded quickly enough with all the access privileges they need.
Digital identity provides instant authentication at both shared workstations and mobile devices. With mobility being an increasing priority for modern healthcare, the importance of fast, secure, and compliant access on these devices cannot be understated. A digital identity strategy also includes access to medical devices such as those used for patient observations and early warning scores, mobile medicine cabinets, clinical weighing scales, and much more.
Addressing cybersecurity risks
Healthcare is under constant attack from sophisticated cyber criminals. Connecting more systems together and opening them up to a wider range of people can expose an organisation, and indeed all organisations collaborating within an ICS, to increased cybersecurity issues if not addressed in the design and maintenance of the systems.
Cybersecurity dangers such as ransomware attacks, phishing scams and data breaches can disrupt healthcare IT systems and disturb patient care. Once inside an institution’s IT walls, cyber criminals can easily move laterally from system to system and across organisational boundaries if the principle of least privilege is not enforced. This manner of attack can seriously impact day-to-day running and tarnish a healthcare organisation’s reputation, leading to costly regulatory fines.
Research conducted by Imprivata [iii] across international healthcare markets indicated that almost a third of healthcare organisations that experienced a data breach were forced to divert patients to other healthcare facilities. A further third said that procedures and tests had been delayed resulting in poor patient outcomes and one quarter saw an increase in complications from medical procedures as a result.
A comprehensive digital identity platform reduces cyber risk by making secure workflows practically invisible for staff. The platform can be configured to control access to resources whether hosted on-site or in the cloud, via role-based access and multi-factor authentication. What’s more, digital identity forms the basis for a ‘Zero Trust’ approach to information security whereby continuous identity verification minimises the risk of a security breach.
With the tap of a single badge or smartphone, convenience of care delivery is taken to a new level. Clinicians can gain access to relevant patient data, and use the same means to enter wards, access car parks, and buy their lunch. Shared logins, sticky notes with passwords on, or smartcards left in readers for an entire shift for all to use, become an inefficient and highly insecure way of working consigned to the past.
Ensuring patient privacy
A holistic digital identity strategy enables a full audit trail and helps to ensure good data governance. Without the need for shared logins and other insecure workarounds, the healthcare organisation has a record of exactly who provided what treatment to whom, when and where. Workstation screens are never left unlocked for unauthorised eyes to view sensitive patient information, people can access only the patient records they are permitted to see for the role they are performing at that time, and there is a time and date log for every interaction with patient information.
In short, data is shared with only those that need to see it in order to do their job. GDPR requirements are met along with the NHS Data Protection Policy. As well as protecting patients’ sensitive data, strong data governance helps organisations to avoid hefty fines for non-compliance.
Digital identity benefits in real world scenarios
Digital identity and identity and access management (IAM) support a whole ecosystem of data access solutions, with single sign-on, or tap-and-go, just the starting point. Here are some real-world examples of digital identity providing the springboard for some impressive productivity gains, as well as making clinicians’ lives easier, ensuring strong cybersecurity and data governance, and improving patient care.
A recent paper published in the BMJ [iv] discussed eight different innovative use cases where the existing digital IAM solution was used to provide new ways to help manage infection control, during the COVID-19 pandemic. The wide variety of use cases included:
- Symptom-free attestation by clinicians at shift start
- Detection of clinician exposure/contract tracing
- Reporting of clinician temperature checks
- Inpatient telehealth consultations in isolation units
- Virtual visits between isolated patients and families
- Touchless single sign-on authentication
- Secure access enabled for rapid expansion of personnel working remotely
- Monitoring of temporary worker attendance
- As a result, clinical care, infection control and facility operations were improved using IAM solutions during COVID-19
- Electronic recording of patient vital signs
South Eastern Health and Social Care Trust used its IAM solution to rapidly provision staff accounts for a new mass vaccination centre that needed to be operational within five days. 500 accounts were set up in just 25 minutes with consistent access rights for all new users. User accounts were decommissioned automatically when the centre closed.
Bolton NHS Foundation Trust extended its deployment of single sign-on technology with the addition of mobile device access. Clinicians electronically record patient vital signs via shared mobile devices. This resulted in more accurate data and improved outcomes with patients receiving the correct level of attendance based on signs of deterioration.
South Tees Hospitals NHS FT went further, giving access utilising Imprivata’s Virtual Smartcard solution. This takes up significantly less resources from ICT, as well as removing issues such as sourcing physical security cards, printers, consumables, and card readers.
Understanding your organisation’s digital identity maturity
To help organisations assess and benchmark the maturity of their current strategy, Imprivata offers its free Digital Identity Maturity Assessment. This self-service, interactive tool enables clinical leadership, IT, and security teams to quickly assess the effectiveness of their digital identity programme based on current-state tools and processes. A customised report is produced that considers user outcomes, security, and compliance in alignment with the maturity model, with actionable insights to drive improvements across all areas.
To take Imprivata’s free Digital Identity Maturity Assessment and determine how your organisation can optimise its strategy for user access, security, and compliance, please visit www.imprivata.co.uk/assess.
References
[i] https://www.imprivata.co.uk/single-sign-on-sso
[ii] https://klasresearch.com/arch-collaborative
[iii] https://security.imprivata.com/a-digital-identity-crisis-ebook.html
[iv] Gellert GA, Kelly SP, Hsiao AL, et al. COVID-19 surge readiness: use cases demonstrating how hospitals leveraged digital identity access management for infection control and pandemic response. BMJ Health Care Inform 2022 https://informatics.bmj.com/content/29/1/e100680
