Last year’s AMDIS Fall Symposium focused on the Innovation Revolution, with speakers from a variety of organizations pushing the envelope when it comes to care quality, patient engagement, information exchange and new ways of delivering care.
For example, continuous care improves patient engagement with the healthcare system and improves both clinical outcomes and efficiency, said Kamal Jethwani, MD, MPH, head of the research and program evaluation initiatives at the Center for Connected Health in Boston.
He shared an example using remote monitoring for heart failure. Patients both with and without heart failure dropped their rate of hospitalization by 50 percent. “By monitoring heart rate and blood pressure, we also see drops in falls, urinary tract infections, chronic obstructive pulmonary disease and more. We realized that when patients start monitoring themselves for anything, they make healthier choices across the board. There are very few things in medicine that can do that.” The monitoring even increased patients’ lifespan.
More personalized care is “simple and extremely difficult,” said Robert Havasy, MS, corporate team lead for product and technology development, also at the Center for Connected Health. “Almost all interventions require data but knowledge does not equal motivation.” He said ability matters more than motivation when it comes to taking action. “Behavior is the intersection of ability and motivation. If you are having trouble getting someone to do something, it’s better to make it easier for them to do it than to give them more motivation.”
To get something to stick, the technology has to disappear. “It seems simple but, in fact, is very complex. We can’t just reach patients. We have to engage them.”
New tech easing bottlenecks
Wearables and other devices are improving efficiency of care to help ease stressed emergency department (ED) resources while making an impact on physician-patient relationships, said Steve Horng, MD, MMSc, assistant director of emergency informatics at Beth Israel Deaconess Medical Center in Boston.
The number of ED visits is rising at “an exponential rate,” Horng said. And, the aging population coincides with decreasing capacity but innovative technologies can change how clinicians use their limited time.
Beth Israel’s first foray into portal computing involved workstations on wheels (WoWs). Bedside registration is one of the most impactful changes the medical center has made. Three studies showed a 15-27 minute difference in door-to-doc time, and reduced wait times meant improved patient satisfaction, he said.
They wanted to find a way to accomplish the same using a smaller device and found that “using iPads, users spent 38 minutes less time on computers and logged in an average of five fewer times,” said Horng.
In another project, the medical center disseminated iPads to select ED patients who were experiencing pain (and were not psychotic nor had previous pain medication-seeking behavior). These patients used the iPads to surf the web and download apps, and the device would periodically question the patients on their pain level and whether they needed pain medication.
The intervention did not lead to a reduction in reported pain levels, but it did offload some of the nurses’ work as patients needing medications were immediately identified by the devices.
Implementation of Google Glass in the ED has led to more efficiency by providing physician access to the tracking board, medication orders, problems lists and the integrated PACS.
CDS as GPS
Physicians can’t know everything or be expected to process countless pieces of information at the drop of a hat, said Jonathan Teich, MD, PhD, CMIO for Elsevier and an emergency room physician at Boston’s Brigham and Women’s Hospital.
“CDS is giving you the right information at the right time.” Good decision support should work the same way a global positioning system (GPS) in a car works, Teich said. The technology that goes into making GPS work is sophisticated and intricate, but the end result of all that technology is the communication of a simple piece of information—“turn right” or “turn left”—relevant to the time it’s needed.
“Something like this is implementable, easy to use, valuable and cost effective,” Teich said. “That’s why GPS is everywhere, and CDS needs to get to that point.”
Which isn’t to say that we haven’t seen evidence of good CDS. As Teich pointed out, there have been many studies showing the value of CDS,