A Clinician Usability Pilot: Improving Quality of Care and Workflow Efficiencies Using Mobile Technology

Facility Profile

University of California San Francisco Medical Center, San Francisco, California

• Two campuses
• 642 beds and an average daily census of 489 patients
• 90 ambulatory practices
• 28,367 discharges in FY 2007
• Almost 700,000 visits in FY 2007

Background

The University of California San Francisco (UCSF) Medical Center was an early adopter of the electronic health record. In 2002 the medical center began implementing IDX’s Carecast®, (now GE Healthcare’s Centricity Enterprise) and found it very useful to have a single source for patient data. The obvious next step was to add a mobility component to the equation to make it easier for clinicians to access that data at the point of care. UCSF’s initial step toward mobility was to implement computers on wheels (COWs). COWs were preferable to stationary PCs.  However, UCSF soon found they came with substantial drawbacks such as expensive batteries with limited charge. Furthermore the COWs took up space in the hallways and were hazardous obstacles at the bedside in emergency situations. The COWs required a significant amount of maintenance, and, since they were shared, there was limited availability and clinicians were often frustrated with the amount of time it took to log on and off the COWs during a given shift. UCSF’s leadership realized that while COWs had helped the institution move away from a stationary system, they could not provide the level of safe, convenient, and efficient mobility UCSF needed going forward.

Improving on a Good Idea

UCSF wanted to find a long-term solution for their mobility-at-the-point-of-care needs.  As a result, the institution conducted a time-motion study to determine exactly what nurses’ workloads and needs were regarding technology and the EMR. What they found surprised them. 

“We found that nurses, on average, were logging-in to the devices approximately 45 times in an 8 to 12 hour shift. When you factor in the 30 seconds it was taking to log-in, you can see that it adds up to a significant amount of resource used just getting access to the system.”  Dr. Michael Blum, CMIO, UCSF Medical Center.

Preparing for Change: Partnering with Motion Computing

Through its affiliation with Intel, UCSF knew that the company was working with industry partners on a new generation of tablets such as the Motion Computing® C5 mobile clinical assistant, a portable device designed for clinicians in acute care environments. UCSF conducted a pilot study to identify whether the Motion C5 could improve clinical workflow, efficiency, and user satisfaction. The pilot was conducted on UCSF’s Adult Transplant Unit (solid organ), which has 30 beds, and it employed a clinician usability study methodology developed by Motion Computing. A team of leaders from various UCSF departments including nursing, operations, and IT formulated a set of hypotheses, performance improvement goals, and metrics.

Major objectives were to:

• Improve accuracy and timeliness of EMR data
• Enhance nursing productivity and workflow
• Improve nursing satisfaction
• Reduce the number of devices in hallways

One of the team’s primary workflow goals was to allow nurses to spend more time on clinical care and less time on administrative activities such as login and documentation.

Results: Greater productivity, speed and accuracy of clinical documentation

The pilot showed that nurses consistently preferred the Motion C5 mobile clinical assistant over COWs. The nurses at UCSF noted that the C5 enhanced patient interaction, better fit their work environment, offered greater portability, and was easier to move in constrained areas. They reported that the Motion C5 made it easier to enter and access data and improved the ergonomics of data entry.

The pilot’s findings include:

• 60% reduction in vital signs documentation time
• Saving 30 minutes per 8 hour shift
• 2+ hour reduction in clinical data latency (the time between capturing vital sign data and entering it into the EMR)
• 83% reduction in the number of data items that needed to be transcribed
• Reduced risk of transcription error
• Reduction in the average number of clinician logins from 42 to 12 per shift
• 20% increase in point of care charting beyond the automated vitals sign acquisition

The pilot showed that the Motion C5 successfully integrated with robust technical infrastructure and advanced healthcare applications. Furthermore the C5 provided efficiencies at the point of care, for more accurate and timely decision-making, improved clinical workflow, and clinical satisfaction.

“We had finally gotten the devices to come to the workflow. Now [clinicians] had the ability to do it digitally—they had the software that supported them…and they naturally started adopting additional documentation in the record. Documentation in the digital record went up about 25% without any teaching, without any coaching.  [Clinicians] just did more documentation right then, because it was easier to do.” Dr. Michael Blum, CMIO, UCSF Medical Center.