Wearables and devices’ impact on care, patient relationships

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 - StevenHorng
Steve Horng, MD, MMSc

BOSTON—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 and instructor of medicine at Harvard Medical School, at the 2014 Fall AMDIS Symposium.

The number of ED visits are rising at “an exponential rate,” Horng said. With the baby boomer generation coming of age, “patients are getting older and sicker,” he said. This means that more patients are struggling to take medications and that it takes longer for patient-physician relationships to develop.

The aging population coincides with decreasing capacity, he said. “There is a mismatch between supply and demand,” he said. “Emergency care is at a breaking point.”

A decrease in resources and an increase in patients translates to less time available per patient, but through innovative technologies “we can change how we spend that time.” About 30 percent of physician time is spent taking care of a patient. “Seventy percent of that time could be done by someone else or in a different way.”

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 had made. Three studies showed a 15-27 minute difference in door-to-doc time, and reduced wait times meant improved patient satisfaction, he said.

But WoWs, while good for data entry, were bulky when the need for space is at a premium. As such, the medical center began using devices with smaller footprints, like iPads, and saw results. “Using iPads, users spent 38 minutes less time on computers and logged in an average of five fewer times,” said Horng.  

Also, “users liked it,” he said, noting physicians spent more time engaging with patients as well as participating in shared decision making.

The center also began using the eRAD PACS viewer, which provides secure, web-based image viewing on devices. “It’s fantastic,” he said, as it promotes shared decision making with patients and allows colleagues to engage in “real-time procedural guidance.”

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.

The implementation of Google Glass in the ED has led to patient care improvements. “It’s about how to get back to bedside. That’s what wearable devices are all about,” said Horng.

The glass, which is locked so photos and videos cannot be taken, has offered a number of benefits. “We’ve imported the tracking board onto the glass,” he said, so physicians can pinpoint where a patient is located, who is taking care of that patient and obtain information on vital signs and the chief complaint.

The physicians also can access medication orders, problem lists and integrate PACs, he said. “We’ve been surprised by the quality of the images despite the [weaker] resolution.”  The glass also can reliably predict whether a patient could have a heart event, he said. It also can risk stratify patients by risk of death and level of sickness.

Patient reaction to Google Glass usage has been pretty uneventful, he said. “We thought people would be concerned but they aren’t.” Patients in more acute settings are particularly tolerant, as they want physicians to have the best tools possible to provide better care.

Most of the problems have arisen from nurses and other staff who also want access to the tool. Patient advocates also are concerned, which is why the center disabled the video and camera features.

Horng said Google Glass also shows the promise of improving efficiency because since it is on the face, the automated time-out feature is not necessary. “It’s quite disruptive to log in over and over again,” he said. Devices can be equipped with RFID and Bluetooth capabilities to ensure inventory and help physicians quickly and efficiently locate them.

Not all information in devices needs to be disruptive, some things could be passive reminders, Horng also said. He equated it with an umbrella that lights up when it is going to rain. “We can use the same philosophy with healthcare.”

For example, with real-time monitoring, a chair could turn red if a patient is at risk of a cardiac event, or accelerometers could conduct continuous gait assessments to predict falls for elderly patients. One iPhone case that monitors arrhythmias is not only signficantly less expensive than traditional methods—but more comfortable, he added.