Intuitive Information Technology

Enhancing Clinician EfficiencyM. Procuniar

November 2008

“There are two ways of being creative. One can sing and dance. Or one can create an environment in which singers and dancers can flourish.”

-Warren Bennis

Objectives• Define Intuitive Technology

• Identify 3 ways patient safety is impacted by technology

• Identify 3 ways clinician efficiency is impacted by technology

• Explain the value tablet PCs, digital pens, and surface technology can bring to caregivers in a healthcare setting

• List 3 current states of clinician efficiency and describe the related future state after application of intuitive technology

• Explain how these technologies can co-exist in today’s hybrid electronic environment

Intuitive Technology

• Intuitive: known automatically; known directly and instinctively, without being discovered or consciously perceived

• Technology: Application of tools and methods; the study, development, and application of devices, machines, and techniques for manufacturing and productive processes

• Natural, organic, second nature, requires little or no training

• Gets users involved in the process

“An intuitive technology works smoothly with the subtle twists of

reality rather than trying (and failing) to overcome them by brute force.”

-Tom Graves

Identify ways patient safety is impacted by technologyM

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Clinician Perspective

Patient Perspective

Trust Issues

Participation in shared governance and standardized practices vs. lack of ownership and lack of standardization in practices

Positive patient outcomes in post surgical measures vs. high % risk adjusted mortality rates

Patient to staff ratios

Fear or reality that improved efficiency of tasks will lead to increased patient to staff ratios

Right care at right time for non-critically ill patients vs. decreased patient satisfaction scores and research documenting increased likelihood of failure to rescue within 30 days of post-op

Perceived value

Technology extends the reach of the clinician and supports decision making vs. lacks value and introduces redundancy promoting workarounds producing a threat to patient safety

Right care at the right time vs. decrease in staff response when called per HCAHPS survey (interpersonal relationships)

Identify ways Clinician Efficiency is impacted by technology

Comparative states of Clinician Efficiency before & after introduction of New Technology

Disparate HIS Systems

EHR Adoption – Physician’s Perspective

• EHR failure rate is estimated at 50-80%– 20-30% fail within 1yr

• <8% of physicians enter orders via CPOE

• Survey of 400 physicians– Retire in their 50’s vs. adopt EHRs– 81% do not use EHRs

• Survey of 2800 physicians– Only 4% have a fully functional EHR– 13% have a “basic” EHR

EHR Adoption – Nursing’s Perspective

• Survey of 263 Nursing respondents– 39% biggest barrier is fit into workflow– 35% familiarity with technology is a problem

• Survey of Nurse Executives (KLAS)1. Need quick response times for high volume of users 2. Unreliable devices mistrust in the system 3. Missing functionality quality gaps workarounds

– Learning curve is too high– Focus is on physician-based solutions

Effective Adoption

- Usefulness +

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Values of Various TechnologiesPen & Paper

Bedside / Desktop PC

Tablet PC Digital Pen

Voice Recognition

Surface

Interface Manual inscription of marks on paper or other permanent surface

Keyboard, Mouse, Biometric

Stylus, onscreen keyboard, touch screen, camera, bar code scanner

Digital pen on special paper, dock, Bluetooth interface

Voice to recorder; software decodes speech to text, records as print or electronic record

Touch or gesture, Multi-user interface, transfers raw content into digital media

Device locations

Anywhere Anchored to bedside

Can be carried or docked; weighs 2-3 lbs

Pocket sized Voice to microphone, telephone, or headset

$15000 per unit, unlikely to have multiple units at this point on tech curve

Scalability (able to implement for the masses)

Easy –cheap, available

Moderately easy –cheap, available, take up room to retrofit older hospitals

Moderately easy –cheap, available, adoption issues

Moderately easy ––cheap, available; adopters are reluctant to adopt; “step backwards”

Easy –cheap, available

Difficult, not well developed for HC; lots of WOW but intersection of efficiency & safety improvement not clear

Tablets – An extension of the EHR

• Stand-alone Use Cases:– Great for Ambulatory Care– Great for Practitioners – Is it great for Hospital-based Clinicians?

• Considerations:– Facility must have 100% Wireless coverage– Infection Control Risk

Comparative states of Clinician Efficiency

Digital Pens

•Suburban Hospital ED

•Country Villa Health System

•Cherokee Indian Hospital Authority

•Thomas Jefferson Hospital

Comparative states of Clinician Efficiency

Voice Recognition

• Heritage Ministries Management• Advanced Healthcare

Comparative states of Clinician Efficiency

Surface Technology

•InterKnowlogy – InterMountain Health, Scripps Research Institute •Teliris – Virtual FlipChart, TouchWall, TouchTable

•Harrah’s Rio All-Suite – Personalized guest experience, information locator, interactive menu•AT&T – Device comparison, device advertising

Current states of Clinician Efficiency & related future states of migration toward Intuitive Technology

Combining Technology

• Use technology where & how it makes sense– Tablets vs. Digital Pens– Tablets & Digital Pens

• Paramedics in Ireland use digital pens in rural areas

Explain how these technologies can co-exist in today’s hybrid electronic environment

Combining Technology, Part II

• Pairing Surface Technology with Voice Recognition– “VOX” in patient rooms would allow:

• Instantaneous input/recall of any information needed• Reduction of latent charting• Elimination of designated “charters” during codes

– Surface technology in patient rooms would allow:• Display of near real-time results from medical devices• Raw content instantly turned into digital format• Collaborative interaction with the patient’s chart

Explain how these technologies can co-exist in today’s hybrid electronic environment

“We shall not cease from exploration And the end of all our exploring Will be to arrive where we started And know the place for the first time.”

-TS Elliot