HEALTHCARE GROUP

ADDRESSING CLINICAL NEEDS
MOBILE COMPUTING IN THE HOSPITAL
HINZ NOVEMBER 2013

Brian Ackland
Principle S...
Clinicians Challenge
• 2011 Early Warning System
–
–
–
–
–

Alex Psirides CCDHB
Replace Paper Based System
Record Observat...
The Ward Round
Mobility Suite Access to Ward Patient List

• Select Ward
• Select Order. Bed, Name, Unit or Doctor
• Touch...
The Medical Record View

Positive Patient
Identification
With Photo ID
Alerts and Allergies
Highlighted when
Medical Recor...
2011 Viewing and Recording Observations

• System Performs Calculations and Notifications
• Touch Slider Controls used for...
2012 Collaborative Document Editing

Menu Action Configured to
use Etherpad-Lite to Record
Ward Round Notes.

Collaborativ...
2012 Social Media Approach to Progress Notes
A simple alternative to the Collaborative Document Editor

Multiple
Users Add...
The Wider Context
Not just about recording the observations or progress notes

• Viewing and Ordering Diagnostics

CSC Pro...
The Wider Context

•
•
•
•
•

Access Anywhere/Anytime
Home
Coffee Shop
Hotel Room
Mac Donald Free WiFi

CSC Proprietary an...
The Study Tour - Ottawa 2013

CSC Proprietary and Confidential

December 4,
2013

10
Ottawa Hospital
iPad Rollout and Usage
• Purchased soon after launch March 2010
• 1st use November, piloted 150 in Feb 201...
Ottawa Hospital
The Application
• Developed iPad app in house
– Platform lock-in vs. HTML5 approach

• Backend is now 70% ...
Ottawa Hospital
Challenges and the Future
• Challenges
–
–
–
–

Privacy
Infection control: glass screens are easy to clean...
The Study Tour

• Canada eHealth Conference (Ottawa May 2013)
– Mobile Devices Are they secure enough for our patient data...
Clinician Challenge
Implementation Challenges
• All Care Providers Need Access
– Change Management
– Training
– Devices/De...
Clinician Challenge
Implementation Challenges
• Engages Vendor and Clinician
– How do we get the organizations engaged?

•...
Innovation Cabrini Healthcare

CSC Proprietary and Confidential

December 4,
2013

17
“Better Care for Patients and their Families”

• Results at Cabrini
• 12,800 clinician hours annually Based on each doctor...
Clinicians' Challenge 2012 Update - Mobile Computing in the Hospital
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Clinicians' Challenge 2012 Update - Mobile Computing in the Hospital

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Principal Software Architect, CSC

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Clinicians' Challenge 2012 Update - Mobile Computing in the Hospital

  1. 1. HEALTHCARE GROUP ADDRESSING CLINICAL NEEDS MOBILE COMPUTING IN THE HOSPITAL HINZ NOVEMBER 2013 Brian Ackland Principle Software Architect
  2. 2. Clinicians Challenge • 2011 Early Warning System – – – – – Alex Psirides CCDHB Replace Paper Based System Record Observations Calculate Early Warning Score Send Notifications based on score • 2012 Enhancing Medical Record Creation for Ward Rounds – – – – – – Angus Turnbull HVDHB Using Tablet Device Allow Staff to Use their Own Device (BYOD) Incorporate viewing of laboratory and radiology results Enable Progress Note Taking during Ward Rounds Open Source Collaborative Document Editor EtherPad CSC Proprietary and Confidential December 4, 2013 2
  3. 3. The Ward Round Mobility Suite Access to Ward Patient List • Select Ward • Select Order. Bed, Name, Unit or Doctor • Touch Patient to open Medical Record View Select View Ward CSC Proprietary and Confidential December 4, 2013 3
  4. 4. The Medical Record View Positive Patient Identification With Photo ID Alerts and Allergies Highlighted when Medical Record Opened Access to components of the record can be configured based on the users security profile Tabs colors and naming can be configured to match common medical record layout CSC Proprietary and Confidential December 4, 2013 4
  5. 5. 2011 Viewing and Recording Observations • System Performs Calculations and Notifications • Touch Slider Controls used for Data Entry CSC Proprietary and Confidential December 4, 2013 5
  6. 6. 2012 Collaborative Document Editing Menu Action Configured to use Etherpad-Lite to Record Ward Round Notes. Collaborative Document. with Patient and Users Context passed to document. CSC Proprietary and Confidential December 4, 2013 6
  7. 7. 2012 Social Media Approach to Progress Notes A simple alternative to the Collaborative Document Editor Multiple Users Adding Note at same time When shown as age and date/time CSC Proprietary and Confidential December 4, 2013 7
  8. 8. The Wider Context Not just about recording the observations or progress notes • Viewing and Ordering Diagnostics CSC Proprietary and Confidential December 4, 2013 8
  9. 9. The Wider Context • • • • • Access Anywhere/Anytime Home Coffee Shop Hotel Room Mac Donald Free WiFi CSC Proprietary and Confidential December 4, 2013 9
  10. 10. The Study Tour - Ottawa 2013 CSC Proprietary and Confidential December 4, 2013 10
  11. 11. Ottawa Hospital iPad Rollout and Usage • Purchased soon after launch March 2010 • 1st use November, piloted 150 in Feb 2011 • Now 3000 over 3 medical wards – Providing them free = Popular with users! – Many staff proved to be “mobile” – Benefits of bringing imaging or visual procedural explanations to bedside • Not locked down – Benefits of YouTube tutorials etc. – Staff can install own apps – “Watch and wait” strategy • Staff often prefer to desktops – Quicker to access – Carried in satchels etc. on wards CSC Proprietary and Confidential December 4, 2013 11
  12. 12. Ottawa Hospital The Application • Developed iPad app in house – Platform lock-in vs. HTML5 approach • Backend is now 70% custom code – Vendor: “You’re on your own” – Code escrow agreement for base package – All hospitals still “siloed” like NZ • Access to patient info, labs, radiology • Concept of “circle of care” – Medical, nursing, allied health automatically linked • Can find & communicate with relevant team member • SMS and FaceTime capability – Real-time communication of changes in estimated discharge dates CSC Proprietary and Confidential December 4, 2013 12
  13. 13. Ottawa Hospital Challenges and the Future • Challenges – – – – Privacy Infection control: glass screens are easy to clean Network outages Each hospital reinventing the wheel much like NZ • Future Steps – ePrescribing – Realtime streaming of observations to EHR • Limited by device manufacturers, update cycle – Printing: AirPrint – Medication dispensing and blood labelling: ?RFID • May face challenges from busy nurses • Aim to have infusion pumps etc. recognize patient + drug – Medical notes • Still paper based, trialling dictation + voice recognition • Paperless may give great flexibility/mutability CSC Proprietary and Confidential December 4, 2013 13
  14. 14. The Study Tour • Canada eHealth Conference (Ottawa May 2013) – Mobile Devices Are they secure enough for our patient data? • Arron Hendricks University Health Network Toronto • Extensive Study of different devices iOS / Android • 15 Slides Covering the Dangers the need for MDM, remote wipe, training, dangerous applications, jail breaking, hacking. • Last Slide Alternatives – Web Based Applications – Remote Desktop CSC Proprietary and Confidential December 4, 2013 14
  15. 15. Clinician Challenge Implementation Challenges • All Care Providers Need Access – Change Management – Training – Devices/Desktop/Mobile/Bedside/COWS – The “what if” questions • Initial Target Closed Loop Areas – Defined Handover Points (Print Notes for Medical Record) – Emergency Department – Home Care Units CSC Proprietary and Confidential December 4, 2013 15
  16. 16. Clinician Challenge Implementation Challenges • Engages Vendor and Clinician – How do we get the organizations engaged? • Current Hospital Approach to ICT – Large / long procurement cycles / regional focus – Revolution rather than Evolution – Waterfall Specification/Fixed Price Quote/Delivery – How do we move to a Agile Approach? CSC Proprietary and Confidential December 4, 2013 16
  17. 17. Innovation Cabrini Healthcare CSC Proprietary and Confidential December 4, 2013 17
  18. 18. “Better Care for Patients and their Families” • Results at Cabrini • 12,800 clinician hours annually Based on each doctor saving 10 minutes per day • 792 nursing hours annually Based on only 2% of results viewed through system instead of provided over the phone • 480 bed days annually Based on only 0.2% of results viewed through system resulting in the investigation being initiated on that day instead of the next CSC Proprietary and Confidential December 4, 2013 18

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