I have heard a lot of folks talk about the “right” device for delivering mobile healthcare information.
I am not sure there is a right device. It really depends on what you are trying to do. What are the workflows that are most problematic? So maybe the right question to start with is: “What significant blockages in workflow are you experiencing now?”
If we focus on the hospital it seems the tasks that are often the most problematic (read: long waits for services, prone to errors, issues with staff and patient satisfaction ratings) are:
- Admitting
- Discharge
- Medication administration
- End of shift handover
- Asset location
Can these areas benefit from Mobile Point of Care (MPOC) technologies? IMHO (in my humble opinion): It would seem so.
If this is true, then what might the optimal form factor be? A lot of this depends on how you envision the workflow and for this you really have to talk to the stakeholders. If technologists (the IT Dept.) try to figure this out in a vacuum you will likely get a solution only a technologist can love.
Let’s start by talking about the admitting process. If a nurse were to do the process on the floor after the patient was in an assigned room then a bedside documentation instrument like the Tablet PC (or MCA) might work well. If the tablet PC were linked to a vitals signs monitor by Bluetooth this could auto populate parts of the admission form and speed the intake process and accuracy. If this same workflow were performed in an admitting dept by a clerk then it might make sense to use a desktop (no mobility) or a laptop and have some “portability.” The tasks we are performing matter; but so does the “actor” and the “venue.”
For end of shift communications a device that sets alerts and reminders for the incoming shift might be ideal (replaces lots of sticky notes). A device that can “consume” a lab value that comes out at 8 PM STAT might be a real lifesaver. Imagine a result that is pushed to the nurse, sets off a reminder, and allows the nurse to communicate that instantly to the attending clinician so immediate decision making with all relevant UTD data takes place. Aside from improving regulatory compliance regarding timely delivery of STAT data we might see a positive change in both staff and patient satisfaction ratings. This device might be something as common as a Smart Phone or something as custom designed for nursing workflow as the Mobile Clinical Assistant (MCA) ……Note: more on the MCA in later blogs.
For medication delivery, once again, the exact workflow is important. Are you looking for mobile cabinets to contain unit doses? Do you need flat working surfaces to take notes and dispense meds from? Are you dealing with small cramped patient areas that would be difficult to get a Mobile Cart into? Are you looking to implement bar code technology that links to your eMAR (electronic Medication Administration Record)? In certain cases a COW might be ideal and in others an MCA with integrated bar code reader might be best (what about a hybrid technology that docks an MCA with a COW)?
You have to start with the problem you’re trying to solve.
- Analyze the workflow you have now (here is where you need stakeholder involvement)
- Talk about the new workflow you envision and finally
- Plan and design the steps you need to take to get from “as-is” workflow to the future “to-be” workflow
This may sound so obvious but all too often we jump to the solution and fall in love with a gadget technology. Think workflows and not technologies….that is what will get you to the right device.
I would love to hear from readers about the stories that drive their device selection process. I have seen groups talk about “device fairs.” Given the emphasis I am placing on workflow I wonder how you evaluate a device at a “fair.” What is the context? What is the workflow? How successful have these fairs been in actually predicting the devices that end users would find most useful? (And enjoy using?)
I would like to hear about device implementations that exceeded expectations. I would also like to hear about those that failed (and even failed spectacularly).
What do you attribute your successes to and what contributed to the failures?
Did you start thinking about a workflow and a certain device and then find you could actually use the device in new ways with new unexpected workflows?
It seems to me that lots of stuff has been purchased over the years, and a lot of promises made but at the end of the shift lots of the stuff goes unused.
To be sure, we need to improve our implementation processes but we have to start with the selection process.
Please share your selection stories and let’s see what the MHB community can learn from each other!
Let’s blog together.
Mark
Comments
Response to Device Nirvana: Assessing Gadgets
First and foremost, I am happy to hear that your investment in your solution is paying off. You bring up a great point in detailing a usage model that is common among clinicians who have admitting privileges at one or multiple entities and host clinic at their “home office”. Roaming between networks is a challenge, especially with WiFi to cellular IP mobility. We worked with one of the leading hospital systems in the NYC metro area to deploy a similar solution to the one that you describe. Our challenge was to ensure connectivity to enable a patient monitoring application for Critical Care Medicine across multiple networks across the city, like your solution we had to enable a custom solution to address the usage model. In the end, the project was a success for all who were involved and a positive impact to clinical workflow. Our project concluded about 3 years ago. I would be interested to see the progression that has been made by the solution providers to address this usage model.
Mobile doesn’t mean Available
A mobile device doesn’t always mean instant accessibility to patient records. Sometimes, external entities can hamper your implementation efforts. For example, I recently assisted a General and Vascular Surgery group with their implementation of an EHR system which contained a mobile application module. During the discovery phase, the vendor pitched the mobile device idea and even brought in several sample devices to choose from. All of the devices were basic PDAs based on a windows mobile OS.
During the presentation, I asked sales rep. if the application could be utilized at the hospital while the providers were conducting rounds. The answer was yes. However, I took note of the sales reps lack of detail when explaining the functionality of the mobile application. Upon due diligence, we proceeded with the testing phase and noticed a deficiency in the concept of free roaming wireless devices in a clinic setting where provider routinely venture beyond the home office network. We discovered that the application required each provider to download patient records and “log off” the vendor application prior to leaving the office for the hospital. Naturally, the providers wanted real time access, but the hospital was not whiling to allow a “third party” application admission to its network.In the end, we went with a Samsung i760 PDA/Cell Phone running windows mobile 6 with built-in WIFI and an unlimited data plan from Verizon. This enabled the providers to “stay connected” in real time while roaming beyond the home office. I must note that decision was met with resistance from the vendor because it was not a “supportable solution” given our deviation from their supported devices. However, none of their devices would allow for real time access from remote locations. A mobile solution using cellular technology has its ups and downs. So far the solution we went with is working well despite the lack of support from the vendor.