Where to draw the line with mHealth
'Human-to-human communication has always been siloed on one channel'
Seven years ago, Parkview Medical Center launched a bedside medication verification program with single-use wireless devices. The program proved popular with clinicians, who could quickly and easily make sure their patients were getting the right medication at the right time.
With the foundation in place for an mHealth platform, the 350-bed acute care hospital is now adding on critical tools. Parkview officials recently added HIPAA-compliant messaging to the devices, enabling care team members to receive lab orders, reference patient information and communicate with other clinicians at a moment's notice.
Steve Shirley, the Pueblo, Colo.-based hospital's CIO, said the evolution of the mobile device from a one-use platform to a multi-functional tool was a careful process. Officials didn't want to overload the platform with too many functions, making the devices more cumbersome than useful, but they did want to give doctors and nurses what they need to improve workflows.
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"For us, patient safety was the absolute reason that we got into the (mHealth) environment," he said. "It's just so critical. One mistake can be fatal. We had to make sure that what we were giving (clinicians) improved that process."
And an important new tool in that toolbox is instant communications.
Parkview's partner in this process is PatientSafe Solutions. The San Diego-based company supplies the hospital with PatientTouch devices, which operate on Apple iOS. What began as a medication administration project now also handles specimen collection, blood product administration, care team intervention and communication, as well as integration with the lab and pharmacy departments. The latter functions are handled by PatientSafe's new Emma system, which consolidates alerts, notifications and text, image and audio communications through voice-over-IP.
"Since time immemorial, nurses and doctors have been running around with a folded-up sheet of paper in one hand, trying to find other members of the care team … and when they get a chance they have to sit down at a nurse's station somewhere and enter that information into the EMR. That's a critical gap in healthcare," said Steve Davidson, PatientSafe's chief medical information officer. "To be able to bring all that data into a single point of capture of information … and to add a communication tool so that the members of the care team can share this information – that's what (nurses and doctors) want."
Both Shirley and Davidson pointed out that mobile devices in the hospital won't solve any problems if they complicate the workflow rather than improve it. A doctor or nurse who has to stop what he or she is doing and play around with a device is going to eventually ditch the device and go back to old habits. In Parkview's case, Shirley said, officials were able to start with one-use devices; once they were comfortable with that use, more functions were added.
Communication tools were the next phase in the process, Davidson said.
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"Human-to-human communication has always been siloed on one channel, while human-to-IT communication has been siloed on another channel, forcing the clinician to pull it all together and integrate it in their head," he said. "This pulls it all together onto one (platform) that enhances the cognitive workload."
Shirley sees the communication platform as the logical next step in a mobile device. "The ability to understand who the care team is really takes us into a new workflow," he said. "It eliminates that randomness."
But they also have to be careful. "We had visions of loading all kinds of apps" on the device, he said. "We realized than that we were starting to put a lot of stuff onto one device, and had to be careful."
"The number of internal devices jumping onto wireless is just massive," Shirley added. "We have to make sure we're not doing too much."
To that end, Shirley said he talked to hundreds of clinicians about the PatientSafe platform before the hospital integrated the Emma system, and found that many were worried. They didn't want electronic medication verification taken away from them or compromised by new tools, he said.
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That's why it's important to phase in new uses on a device, he said.
"Once they could see what they can do with (the PatientTouch devices) and see that it doesn't interrupt their workflow, they were ready," he said.
This story first appeared in mHealth News here.