Is it time for surface applications at the point of care
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Presentation to be given to physicians at the 2011 Cerner Healthcare Conference in Kansas City 10 October 2011
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Is it time for surface applications at the point of care
- 1. Is it time for Surface applications at the point of care? Heartland Health and Clinic October 10, 2011 David Voran, MD
- 2. Point-Of-Care Devices and Real Time Use Leveraging technology at the point of care Expands breadth of primary care services and diagnostics Improves documentation Involves the patient, increases trust and satisfaction Big, touch sensitive screens HP 600t/9000 and HP 610t/9300 Cameras Eye-Fi SD cards USB Imaging Devices Proscope Earscope MiR Spirometer
- 3. Connect everything to the exam room computer Diagnostic Tools Other Information Tools Bodelin Proscope Dino-Lite Earscope MIR Winspiro Eye-Fi cards: Enable easyreal-timehands-off transfer of photos into EMR Looking for Electronic scales Stadiometers
- 4. POC Technology Evolution notebook > tablet > standard workstations > expanded large screen workstations > multi-touch wide-screen devices Device is as much for the patient as the provider Used as a “window to the world” Technology to do as much diagnostic screening at the point of care as possible Specialists should only get those patients who’ve been screened
- 5. Power Form Modifications for Patients (and iPads) Avoid radio buttons Difficult even with large monitors and iPads Grids are relatively easy Spacing is an issue Larger boxes enable easier patient entry
- 6. Free text for signatures or drawings MS OneNote Template Multi-step process Open up One-Note > Choose appropriate procedure page Review and have patient sign (draw) in the appropriate area Save page as PDF Import document into clinical notes like this: Older 600’s and 9000’s are too vertical Have moved to 610t and 9300 where unit slides down
- 7. Next phase Drawing/Signature Controls Make PowerForms much more useful Could be applied to PowerNotes and other interactive tools Citrix recognition of locally connected devices Many low cost devices have limited shelf life Need to be able to do this without involving back-end configurations Signature/Drawing Boxes Multi-touch version of Citrix Don’t know if it will ever be created Exam room surface applications iPads and other tablets and touch enabled devices linked into PowerChart Future Directions
- 8. Demonstration Just a small taste of what’s to come
Editor's Notes
- Interactions with patients at the point of care are going to of increasing importance as we continue the digitalization of medicine. We have found there are a number of off-the-shelf technologies that are readily available to streamline and increase the collection and incorporation of information in real-time in the exam room during an office visit.These include large format touch sensitive computers, cameras wirelessly connected with the network and a variety of devices plugged into the in-room device via USB or Blue Tooth connections.
- An ever increasing number of devices are being produced that are simple to use, plug into local PC’s and networked devices, inexpensive (an order of magnitude less expensive) than previous specialized diagnostic services.Al of these lower the cost and push formal diagnoses down into the primary care physician’s office enabling just-in-time screening, avoiding costly specialist referrals and speed up the time to treatment.
- First, we started several years ago with hand-held tablet PC’s in the hands of nurses and physicians with the notion that mobility was the most efficient and important way to go digital. It didn’t take us long to figure out that as we went to point-of-care use the computer was as much for the patient as it was for the provider. Hand-held computers were not designed for this.We installed desktop computers on small movable tables and very quickly went from standard 17” to 19” monitors, then installed 21” swivel monitors because some data looked best in landscape and other data in portrait mode (as illustrated above). Then we moved to 23” touch screen all-in-one devices to further reduce the footprint and mobility of the devices as well as begun to involve the patient interacting with the computer (consents, patient education, etc). We now think that we’ll be using 52” or larger interactive wall-mounted touch screens as the price of that technology drops to the $1-2,000 range.As an aside we think the total technology investment per ambulatory exam room suite will continue to hover around $2500. Those that aren’t investing that amount per year per room are probably on the wrong side of the “wave”.
- Our experience has revealed several shortcomings that need to be addressed in order to meet future needs:Need for a Drawing/Signature control (either built into the existing CAMM drawing tool or a separate tool that can be launched and/or incorporated into PowerForms)Improved ability for numerous off-the-shelf devices to be plugged in and communicate directly with the Citrix application servers instead of intermediary software and circuitous data paths. We see a flood of devices that’ll be very useful but probably only be “current” for 6 months or so before being replaced by another better approach or version. Right now it can take 6-12 months for one configuration to go through all of the formal change-control processes and channels and by the time the approval for the configuration is process the devices has long been thrown away.And what about a ton of smart-phone based devices coming on stream?