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Perfecting the Mobile SolutionSession #77, February 21, 2017

Nick Patel M.D., Executive Medical Director of Informatics

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Speaker Introduction

Nick Patel M.D.

Executive Medical Director Clinical Informatics

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Perfecting the Mobile SolutionSession #77, February 21, 2017

Nick Patel M.D., Executive Medical Director of Informatics

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Conflict of Interest

Nick Patel M.D.

Has no real or apparent conflicts of interest to report.

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Conflict of Interest

Nick Patel M.D.

Salary: $0.00

Royalty: $0.00

Receipt of Intellectual Property Rights/Patent Holder: $0.00

Consulting Fees (e.g., advisory boards): HP Healthcare Advisory Board

Fees for Non-CME Services Received Directly from a Commercial Interest or their Agents (e.g.,

speakers’ bureau): $0.00

Contracted Research: None

Ownership Interest (stocks, stock options or other ownership interest excluding diversified mutual

funds): None

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Largest, most comprehensive, locally owned, not-for profit health care system in the midlands of South Carolina

• Approximately 1,500 beds across 5 hospitals

• USC School of Medicine partnership - PH-USC Medical Group

• 13,000 employees

• Approx. $180 million in charity care

• Level 1 trauma center; approximately 140,000 ER visits/year

• Full Cerner integration

Who We Are

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Agenda

The Why: Making workflows more efficient

• Improve productivity and satisfaction with downstream cost savings

• Reduce documentation time with faster billing

• Reduced technology footprint and logins

The How: Deploying mobile solutions

• Analyzing workflows to streamline work day

• Working with IT and Informatics

• Choosing the right equipment/EMR integration

• Physician and leadership buy in

The Challenges/Lessons learned: “It’s the little things.”

• Dealing with unique workflows and applications.

• One solution doesn’t fit all; cart size, screen size, MDM etc.

• Education/training for all stakeholders

• IT roadblocks

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Learning Objectives

– Present usability and mobility challenges with mobile devices in patient

care settings

– Compare provider perspectives about mobile wireless device use in

patient care

– Identify impacts of using integrated wireless computing and docking

solutions in patient care

– Assess areas for improvement in the design and adoption of integrated

wireless docking solutions

– Apply concepts and lessons learned on mobile flexibility and modularity

to deploy an all in one mobile solution

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How EHR can help Providers

Growing population

Rising costs, errors

Lower reimbursements

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“For every hour physicians provide direct clinical face time to

patients, nearly 2 additional hours is spent on EHR and desk

work within the clinic day. Outside office hours, physicians

spend another 1 to 2 hours of personal time each night doing

additional computer and other clerical work.”

Sept 6,2016

Impact on patient interactions

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Health Care and Social Assistance

Real Sector Growth (Compound Annual Growth Rate), broken into

Labor Productivity Growth and Employment Growth in various sectors

of the US Economy (1990-2010) Source: US Bureau of Labor and

Statistics

Productivity Declining

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HIT productivity paradox

Top reasons for productivity drop from adopting EHRs

1. More time documenting (85%)

2. Less time for patient care (66%)

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Cerner Advance Data

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Other Unintended Consequences

Loss of revenue

Patient dissatisfaction

Higher expense

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Adopting adapting

How ?

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18.2%

81.8%

Yes

No

Do you feel your current workflow is

efficient?

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30 to 45 minutes per 15 minute visit

PT/M

D

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Barriers to mobility

• Organizational

– Limited resources to support

– BYOD vs health system ownership

– Cost

– Wireless network support

– Pre-existing policies, procedures,

protocols for change management

• Technology

– Security concerns

– Compatibility to software solutions

– Learning curve

– Device choice (form factor)

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Device choice matters

http://www.zdnet.com/why-theres-no-good-reason-to-buy-a-chromebook-7000023009/

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Power of Mobile Tablet Computing

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How Benefits Were Realized

• Improved access to health records (54%)

• Share real time data with patients at bedside

• Faster documentation (46%)

• Provider satisfaction (71%)

• Comfortable with device (83%)

• educed time spent after work documenting (64%)

• Improved security of patient records (less printing)

• Secure network/fingerprint access/Windows Hello

• Improved patient communication (54%)

• Overall improved patient education

• Improved workflow (64% reduced login times)

• Reduction in transcription costs

• Less desktops needed

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Mobility on the rise

This infographic is from the CDW Healthcare Report (whitepaper). Source: IDC Health Insights Survey "Business Strategy: US Clinical Mobility 2011-2016".

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Lessons learned for v2.0

• Larger Screen

• Full-sized keyboard and mouse

• Extended battery life

• MDM: BYOD vs Corporate Shared devices

• Dragon Dictation

• Better support for inpatient workflow

• Improved IT/informatics onsite support management

• Be conscious of the technology learning curve

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Transcription by Service October 2015 - September 2016

Values

Row Labels Sum of lines Sum of cost per line

Emergency Medicine 8,933,155 $ 1,013,913.09

Orthopaedics 1,280,302 $ 145,314.28

Internal Medicine 1,235,257 $ 140,201.67

Surgery 772,104 $ 87,633.80

Cardiac Services 644,790 $ 73,183.67

Pediatrics 549,864 $ 62,409.56

Obstetrics/Gynecology 414,471 $ 47,042.46

Psychiatry 255,597 $ 29,010.26

Family Medicine 206,511 $ 23,439.00

Neurology 193,057 $ 21,911.97

Children's Hospital 188,559 $ 21,401.45

(blank) 170,488 $ 19,350.39

Ophthalmology 165,058 $ 18,734.08

Nephrology 152,721 $ 17,333.83

Gastroenterology 138,226 $ 15,688.65

Urology 129,362 $ 14,682.59

Pulmonary Medicine 117,300 $ 13,313.55

Oncology Services 116,812 $ 13,258.16

Nurse Practitioner 115,667 $ 13,128.20

Otolaryngology 96,418 $ 10,943.44

Key Components

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Timeline v2.0

Design/Planning for Proof of Concept Summer ‘16

IRB Approved October ‘16

Official Kickoff Mid-October’16 in Orthopedics

Rollout in ER late November ‘16

FINAL RESULTS 3rd

Quarter ‘17

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Study Design

Healthcare providers have noted interest in using mobile devices as a potential tool to realize a range of desired benefits including:

• Provider workflow efficiencies [2]

• Improved documentation [1]

• Increased patient access [3]

• Increased patient education [3]

• Lower costs of care [1]

These benefits may also extend to include:

• Improved patient outcomes [2]

• Provider satisfaction [2]

The research goal is to understand provider perceptions about integrated mobile wireless device use, usability, and utility and the impact

of using these devices in patient care. Objectives are to explore potential improvements and challenges to:

• Provider workflow

• Documentation/Communication

• Patient education

• Costs of care

• Patient health/well-being

• Patient satisfaction with providers

• Perceived data privacy and security

[1] Abbott, P. A. (2012) “The Effectiveness and Clinical Usability of a Handheld Information Appliance,” Nursing Research and Practice, Article 307258.

[2] Katz, P.S. (2012) “Mobile devices offer advantages, challenges,” ACP Internest, April.

[3] San-Niccolas, T., Schooley, B. (2014). “Design and Development of a Patient-Centered eHealth System to Improve Patient Understanding at Discharge,” Communications of the Association for Information Systems (Special Issue on Patient Centered E-Health), 34(1).

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One Device, Many Settings

Patient EngagementCart Patient BedsideDesktopExam room

Move from Location-based to user-based computing

Dock to shared peripherals via WiGig Docking for charting on EMR

Approved screen size and improved ergonomics

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Orthopedic Workflow

• High patient volume

• Focused visits

• Image heavy

• Short concise notes

• Small exam rooms

• Official radiology read required

• X-ray image printing

• Large support staff• Medical Assistant

• Scribe (in certain cases)

• Casting Techs

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Early Orthopedic Benefits

• Monitor

Able to make official orthopedic reads on plain films

Reduced printing of x-rays, and share image on cart with patient

Reduced eye fatigue from looking at tablet

Improved efficiency with tablet in dual screen mode

• Tablet Reduced logins

Directed visits from chart review on the go

Better eye to eye contact, small technology footprint

• Wigig Cube Line of site viewability wirelessly

Dragon dictation on the go

Easy to setup

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ER workflow

• High patient volume

• Limited workstations

• Seeing patients in hallway

• Complex patients

• Lots of logins & outs

• Shift work – need shared devices

• Limited dictation stations

• Infection control a challenge

• Notes completion same day

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Emergency Room Record

Month Lines Cost Vendor

Oct-16 246,804 $ 28,012.25 FutureNet

Nov-16 124,865 $ 14,172.18 FutureNet

Dec-16 23,083 $ 2,619.92 FutureNet

Dec-16 49,043 $ 5,517.34 Nuance

Jan-17 38,524 $ 4,332.29 Nuance

Total 482,319 $ 54,653.98

FY 17 – Project

91% decrease

over FY16

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Reported ER Benefits

• Monitor

Impax images on the go

Improved patient engagement with healthcare findings

Reduced eye fatigue

Improved efficiency with tablet in dual screen mode

• Tablet Flexible charting options

Easy from move room to room with or without cart

Able to take history from patient in the hallway more effortlessly

Easy to share/clean device

• Wigig Cube “Look mom no wires!!”

Dragon dictation on the go

Heart of the whole solution

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Growing Pains

• Organizational

– New IT governance between medical group and hospital still fluid

– Resources tied up in Cerner One Chart implementation

– Access control of the three wireless networks

– Software licensing : Dragon dictation

– Research IRB approval process

• Technology

– Corporate Imaging devices

– Learning curve

– Resolution calibration issues between tablet and monitor for Impax

– Dragon profile import

– DICOM monitor recalled for recalibration

– Monitors 16:9 aspect ratio, most software built on 4:3 ratio

• Environmental

– Cart too large for some rooms

– Cart wheels not able to roll over door crease

– Battery Pack increases cart footprint

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Our Next Steps

• Expand physician cohort for IRB study & Publish 3rd Quarter ‘17

• Expand to other clinical arenas such as hospitalists and cardiologists

• Further refine technology mix to enhance mobility

• Work with technology vendors to streamline solution rollout

• Streamline ongoing support and training

• Conduct assessment for clinical improvement

• Give feedback for next generation products

• Help design smaller carts

• Test solution with team based care

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Questions

• @nickpatelmd

• www.linkedin.com/in/nickpatelmd

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