Mobile technology should enhance work of human providers

MODERN LIFE is a blur of motion and activity, with people constantly communicating on the run. Traditionally slow to change its ways, healthcare is far from the cutting edge of mobile technology, but it’s making strides to close the gap.

“The opportunity for mobile technology to change the way we deliver healthcare is enormous, but the current state of affairs leaves a lot to be desired,” says Joseph C. Kvedar, MD, Director of the Boston-based Center for Connected Health. The Center, a division of Partners HealthCare, seeks to apply consumer-ready technologies, such as cell phones or digital cameras, to enhance the patient-physician relationship. “On the bright side, the time to make it happen is now, for two reasons: Payment reform is taking shape, and employers are fed up. Payment reform affects physician behavior, and employers affect employee behavior. When those two forces are aligned, big things can happen.”

For healthcare executives, the key is to not get caught up in the technology itself, but to view it as a means of improving human performance in—and satisfaction with—the healthcare experience. In other words, mobile technology should enhance the work of human providers, rather than seek to replace them.

“Mobile devices that can document and view vital signs, ECG strips, pain scores, medication data, lab results and nurses assessments, can give a bigger picture of what is going on so the physician can make the right decision quickly,” says Veronica Carr, nursing information coordinator with Shands Healthcare, a not-for-profit system affiliated with the University of Florida.

Best of all, mobile technology is exactly that: mobile. Savvy healthcare veterans don’t limit its role to a healthcare facility, but extend it out into the community to ensure its impact is felt by as many people as possible.

REMIND ME AGAIN

The first hurdle to using mobile devices in a community outreach program is finding technologies that the target population has access to and is willing to use. Studies have shown that more than half of all U.S. physicians own some type of smart phone, but they aren’t common in the general population.

“While it would be great if a doctor could remotely see your blood pressure or blood glucose readings on your BlackBerry, there just aren’t enough of those devices in use yet,” Dr. Kvedar says. “That’s why we look for the ‘lowest common denominator’ technologies. We do a lot with text messaging, because almost everyone with a mobile phone can send and receive them. It reaches a broad audience but still can deliver a powerful message.”

The center has two major text-message-based initiatives underway, each of which targets a highly vulnerable population. The first sends texts to remind pregnant teens to come in for their prenatal visits, and the other sends texts to substance abusers who are enrolled in addiction programs as a reminder to come in for their visits.

But even though 70% to 80% of the people in those two groups have mobile phones with text messaging capability, getting the reminder to them is only half of the battle. The other half is getting them to act on it, and who the message comes from is almost as important as the message itself, Dr. Kvedar says.

“It makes a big difference when the reminder comes from the patient’s own healthcare provider, as opposed to a vendor or even a health plan,” he says. “If you want your acceptance rate to go up, have a doctor or nurse recommend the service directly.”

FREE FLOW OF INFORMATION

Since the earliest days of organized healthcare, the basic layout of a hospital has revolved around a central nurses’ station, which acts as a communications hub for the entire floor. In years past, nurses shuttled information from the nurses’ station to patient rooms. Today, nurses and other clinicians are just as mobile as their predecessors, but in a completely different way. They aren’t moving patients’ information; they’re moving the actual patients from one room to another, and they need access to information everywhere.

“Patients today are very mobile, even within the walls of a hospital, so the nurses and clinicians who treat them need to be able to move as well,” says Edward Cuellar, CIO of San Antonio, Texas-based Methodist Healthcare, the city’s largest care provider with eight hospitals among its two dozen facilities. “Wireless communication plays an integral role in getting information to clinicians at the right time and in the right place, helping to speed clinical decision-making and deliver exceptional patient care throughout the continuum of care.”

Cuellar should know a thing or two about mobile technology. Earlier this year, Methodist entered into an agreement with two third-party vendors to develop a converged wireless system for six hospital sites. The deployment, which will provide voice and data services across an area spanning nearly 2 million square feet, includes an integrated wireless platform that will run on more than 800 wireless phones carried by physicians, nurses, administrators and staff.

Shands also has undertaken a project to keep patient data accessible to clinicians throughout its facilities, deploying an electronic charting program for nurses via laptop computers on mobile carts. Technology that people won’t use has little value, so while it was important to get multiple opinions during the planning stages of the project, it’s equally important to select a standard quickly to facilitate consistency and increase adoption, according to Erik Stielow, Shands’ manager of technical projects.

“Getting the buy-in of the end users is essential to a successful rollout,” he says, “but it’s also important to standardize relatively soon on a vendor for your hardware. Not everyone will be happy with available options or features but in the long run, end users are most satisfied when there is a consistent device experience and a high standard of up-time.”

Having multiple vendors and multiple platforms increases the need for end user training and limits IT’s ability to respond to hardware downtime, he says.

THE HUMAN EXPERIENCE

More than any other industry, the focus must remain on the human experience, whether a provider’s or patient’s. There is no room for “technology for technology’s sake.”

“In healthcare, you are faced daily with the human element,” Stielow says. “You see the frustration and the ache in people when they are sick, and their joy and jubilation during the birth of a child or the news that they are healed. We must never forget that we are here to serve our community, and all that we do as a business must support that goal.”

And that goes for getting a technology project approved and funded, according to Cuellar. When dealing with various decision makers, check the technical jargon at the door and focus on the practical results.

“Even as a CIO, if someone comes to me and wants to talk about this great new healthcare technology, I don’t want to hear about bits and bytes,” he says. “It should start with people, and that means workflow. The focus of technology should always come back to enhancing and improving the delivery of care.”

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