Interoperability, end-user input essential for mobile, point-of-care tools
By Steve Shirley, CIO and VP of IT, Parkview Medical Center
Healthcare organizations across the country are exploring data and systems interoperability initiatives. According to June 2015 survey results published by the Healthcare Financial Management Association, nearly 70% of senior financial healthcare executives rated interoperability as a top projected need for their organization over the next three years, followed closely by access to real-time data.
Interoperability discussions, however, in these organizations are too often limited to electronic health record (EHR) systems and how to effectively exchange data with unaffiliated providers. Not enough discussion concerns mobile point-of-care tools used by clinicians within the organization, especially communication tools. Our organization, Parkview Medical Center, a 350-bed nonprofit health system located in Pueblo, Colorado, recently integrated VoIP and secure text messaging functionality with clinicians’ smart, mobile point-of-care devices.
The mobile platform, by PatientSafe Solutions, is interoperable with our EHR system thanks to the bi-directional interface we worked with both vendors to develop. This interoperability allows the mobile platform to embed real-time clinical data in care-team messages to prevent miscommunication and help clinicians at the point-of-care better understand patients’ health statuses and care plans. The interoperability also allows clinicians to upload data from the bedside into the EHR, which delivers real-time information to physicians and the entire care team who can then access the information on our mobile platform or from any EHR terminal.
As a result, we have found our mobile platform helps clinicians deliver safer, more efficient care, and allows our organization to capture more data for performance and patient experience improvement.
Communications: The foundation of patient experience
I recently hosted a breakfast attended by chief information officers (CIOs) and chief nursing information officers (CNIOs) from hospitals and health systems at the Health Information and Management Systems Society (HIMSS) Conference in Chicago where we discussed these communications issues at their organizations.
The general consensus amongst the audience was that treating communications at the point-of-care as a stand-alone application continues to have systemic limitations. The most provocative discussion revolved around single-purpose applications and devices that fragment end-user experience and ultimately reduce effective communication and collaboration by creating further context silos.
I shared with attendees our experience at Parkview Medical Center. We had been using mobile point-of-care tools for BCMA, blood specimen collection and labeling since 2007, and blood transfusions since 2013. Communications options at the time were limited to pagers and VoIP phones – separate devices – and the hallway intercom. Juggling multiple devices to communicate with the care team often distracted clinicians and delayed care.
Years later, when we added EHRs to the patient rooms, they only created more distraction and pulled clinicians away from bedside, and their focus away from the patient. Although EHRs were designed to deliver more information to clinicians at the point-of-care, the improved access did not deliver the appropriate and necessary context around the patient health status or condition. And it detracted from the patient experience. When we equipped clinicians with the smart, mobile point-of-care platform, the attention was returned to the patient at the bedside.
Adding smart, mobile functionality
As the popularity of smartphones expanded, we observed clinicians were already using personal smartphones to communicate with care teams. This trend concerned the hospital’s leaders due to the potential HIPAA compliance and other protected health information security risks presented when clinicians finished their shifts and took all that data outside our doors.
With PatientSafe, we began exploring how to add secure communications functionality to clinicians’ current hospital-owned and -controlled mobile devices. Along with the communications functionality, we wanted to be able to exchange information with the EHR from the bedside so clinicians could remain patient-focused.
Early on, we involved clinicians in the technology decision. We observed their workflows, particularly examining how they communicated with care teams who might be in different locations in the medical center, including physicians who may not even be in the facility. We also listened to their concerns about replacing the multiple devices they had become accustomed to with a single smartphone-type device.
Our intent with the single-device strategy was to allow clinicians to care for patients more efficiently with fewer interruptions without reducing care quality or patient safety. For example, one of the features on the device automatically identifies and alerts clinicians when they are administering a first dose of a new medication. The alert that is delivered at the point of care prompts the clinician to explain the new medication and inquire about the patients’ questions, improving the patient experience and engagement. The alternative we wanted to avoid was to have these alerts pop-up on an EHR terminal in a hallway, away from the point of administration, which might be forgotten by the time the clinician began administering the medication.
Patient and clinician satisfaction
Since implementation of the communications functionality in 2014, internal data analysis and a survey of Parkview clinicians show that the integrated single-device strategy is enabling safer care and improving clinician and patient satisfaction.
Our analysis showed total medication errors reduced from 20% to 8%. When using the Point-of-Care Solution, clinicians achieved a 98% ID wristband and badge scan compliance rate and 100% of blood specimen collections were correctly labeled.
The smart mobile, point-of-care platform reduced our handset/pager footprint by 80%, with more than 80% of clinicians agreeing that the communications module improved their ability to convey patient information and helped them feel more connected to their care team, according to our survey. The survey results also showed that 67% of clinicians saw improvement in reduced clinical interruptions and 71% noticed an improvement in response time to STAT orders. Of phlebotomists, 75% agreed labeling errors were reduced and urgent specimen collection response time improved.
From a patient experience perspective, the communications and medication education modules seem to be delivering a significantly positive impact. Ratings on our HCAHPS scores rose from about 20% to 62% on the “Communication about Medications” question, a particularly challenging metric for us prior to deployment of the mobile education alerts. In addition, fewer overhead pages through the intercom led to an overall noise-level reduction in the patient care environment.
Mobilizing safe, efficient care
The CIOs and CNIOs left our HIMSS event unanimous that a mobile, secure clinical communications and point-of-care platform that organizations can build on is essential in the quality-based era. As new functionality becomes available and more ancillary information systems become interoperable, the mobile technology should evolve to meet those demands so clinicians can stay focused on the patient at bedside.
Based on Parkview’s experience, the EHR system and electronic medication administration record interoperability we achieved, as well as involving end-users in the planning and testing, was crucial for properly implementing and sustaining the effectiveness of our mobile platform. Although obtaining enterprise-wide clinician input and achieving interoperability will require negotiation, education and change management, it will result in safer patient care, improved efficiency and better clinical outcomes.
1. Healthcare Financial Management Association. “Value-Based Payment Readiness.” Survey. June 2015. http://www.hfma.org/value-basedpaymentreadiness/