UPMC Nursing Solutions: The SmartRoom Patient Workflow System

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The University of Pittsburgh Medical Center teamed with IBM to implement SmartRoom, a workflow optimization system that guides nursing decisions and activities through interactive, in-room solutions.

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UPMC Nursing Solutions: The SmartRoom Patient Workflow System

  1. 1. UPMC reshapes the nursing unit with SmartRoom A few years ago, the University of Pittsburgh Medical Center (UPMC) Overview and IBM decided to build on their shared vision of the future of healthcare by forming a unique and far-reaching partnership aimed at The need developing and commercializing new clinical solutions. One of UPMC sought to improve the workflow efficiency in its nursing units to enhance UPMC’s defining qualities as an organization is a pervasive entrepre- the quality of care, reduce costs/errors neurial culture driven by an intense commitment to improving patient and leverage its nursing resources more care through clinical innovation. IBM’s partnership with UPMC taps effectively. directly into this quality and demonstrates how a shared vision of The solution healthcare innovation can produce real results. Supported by its innovative partnership with IBM, UPMC developed As the current national discussion around healthcare reform has shown, SmartRoom, a workflow optimization system that leverages clinical intelli- the battle to improve healthcare delivery—to make it safer, more gence to guide nursing decisions and efficient and more cost effective—has many fronts. One of the most activities. important is the inpatient nursing unit environment within hospitals, What makes it smarter which in many ways represents the backbone—the “front line”—of the As nurses address ad hoc challenges healthcare delivery system. As the point of most intensive contact on the fly, SmartRoom’s underlying clin- between caregivers and patients, nursing units are the scene of a con- ical algorithms automatically adapt the stant choreography of activities, the majority of which are routine and prioritization of tasks, ensuring that patients get the right treatment at the predictable. Patients are monitored and tested, administered medica- right time—thus improving care and tions, and, if necessary, repositioned while in their beds to avoid reducing errors. pressure ulcers—all in strict accordance with guidelines around timing, The result frequency and dosage. That’s just a sampling. “Our aim is to provide the right care, at the right time, all the time. SmartRoom is an example of how our partnership with IBM is helping us meet that goal.” —Tami Minnier, RN, chief quality officer, UPMC
  2. 2. Mixing the routine and the unpredictable Business benefits Around this core framework of tasks, nursing staff are also required to respond to ad hoc situations that routinely pull them away from their ● Reduction in time spent completing documentation of nursing tasks more structured regimens. This may include consulting with attending physicians, handling emergency situations, answering questions from ● Expected reduction in medical errors patients’ families and above all, providing compassionate care at the ● Additional time that nurses can use to patient’s bedside. It also includes the kind of critical thinking required focus on compassionate caregiving to spot and solve problems. On top of all this, nursing units need to ● Easier allocation of work among nurs- make a seamless handoff from one shift to the next to ensure not only ing unit staff continuity of care, but also that clinical “red flags” are not missed in ● Improved patient satisfaction the transition. For nursing staff, it’s a tall order that relies heavily on memory, direct face-to-face communication and lots of walking. ● More seamless hand off of patient information between shifts Within this task mix, UPMC saw the opportunity to improve the qual- ● Improved identification and tracking ity of care and timeliness of completed tasks by structuring those parts of patient problems of the nursing unit workflow where practical and by providing nursing ● Helps to ensure timeliness of tasks staff with information support that enables them to focus less on performed, such as turning patients at risk of bed ulcers remembering their complex list of “to do’s” and—once they’re done— easily recording them as completed at the point of care. Leveraging its ● Nursing management has better data on what time requirements are own clinical expertise and IT staff, UPMC designed and implemented needed on nursing units each and a workflow module known as SmartRoom, which uses interactive, in- every hour room screens to present nurses and nursing support personnel with a prioritized sequence of tasks to be performed for a given patient (in that patient’s room), as well as a prompted suggestion on which room they need to go to next. Smarter healthcare: Leveraging intelligence to guide the nursing workflow Instrumented In-room sensing devices authenticate nursing staff and trigger the retrieval and display of relevant patient information. Interconnected SmartRoom connects UPMC’s clinical knowledge base and best practices in real time to nurses on the floor. Intelligent Algorithms developed by UPMC clinical staff control the prioritiza- tion of nursing tasks, ensuring the right treatment at the right time. 2
  3. 3. Bringing intelligence to the bedside Solution components UPMC’s SmartRoom solution is supported by real-time linkages back into key clinical systems such as pharmacy and lab services. At any Software ● IBM WebSphere® Message Broker given time, the underlying workflow module compiles a list of required ● IBM WebSphere Application Server tasks from various backend systems, using algorithms derived from UPMC nursing staff activities that indicate the order in which tasks Servers should be done. To control access to this information, SmartRoom ● IBM BladeCenter® HS21 employs indoor positioning technology from IBM Business Partner, Services Sonitor Technologies, which uses in-room ultrasound sensing devices ● IBM Global Business Services® to identify the nurse—or any other hospital staff member—entering ● IBM Global Technology Services the room. Once authenticated, the nurse calls up the task list on the IBM Business Partner display screen within the room. Upon performing the task, the nurse ● Sonitor Technologies can easily confirm on the touch screen that it was completed, and this triggers the automatic updating of the appropriate electronic records. Additional clinical information can be pulled up in the room with the patient’s permission. “SmartRoom improves the quality of care by Importantly, UPMC designers realized that the true test of providing information SmartRoom’s effectiveness is its ability to adapt to the decidedly non- linear nature of the average nurse’s task sequence. Interruptions in the directly to the bedside— core workflow can range from brief (getting a blanket for a patient or where it’s needed most— new physician orders) to prolonged (an extended discussion with a patient’s family). In either case, time lapses and priorities change. The not to a computer in the intelligence of the UPMC solution is seen in its ability to dynamically hallway or to a worksta- adapt the task list based on the comparative time sensitivity of the tion at the nursing different tasks on the list. This means, for instance, that a task initially placed fourth on the priority list could be escalated to the number one desk.” priority, if not performed within a specific timeframe. This rules- and intelligence-based adaptability ensures that UPMC patients receive the —David Sharbaugh, senior director of UPMC’s Center for Quality Improvement and Innovation 3
  4. 4. right treatment at the right time. While technology enables this intelli- gence in the form of algorithms, the logic that guides it comes directly from the clinical knowledge of UPMC nurses and physicians. Rather than trying to industrialize nursing or deploy a new gadget, this tech- nology is making routine tasks easier and allowing nurses more time to do what they are trained for—critical thinking and spending time with patients at the bedside. UPMC’s SmartRoom solution is a textbook example of the technology and strategic benefits of its partnership with IBM. After developing its own prototype of the solution using home-grown technology, UPMC worked with IBM to create more open interfaces with backend sys- tems. Using IBM WebSphere® Message Broker to create an enterprise service bus between the solution and its clinical systems, UPMC was able to redesign the solution using a service-oriented architecture (SOA) with open interfaces. In addition to making it easier to deploy the SmartRoom solution more broadly within UPMC, this SOA-centric approach also facilitates UPMC and IBM’s joint strategy of offering innovative clinical solutions like SmartRoom to other healthcare providers as commercial offerings. Moreover, UPMC can deploy such solutions on its existing virtualized infrastructure (powered by IBM hardware and software), which help guarantee the high levels of availability that all clinical applications require. Improving patient care is the fundamental driver behind all of UPMC’s clinical innovations, and represents the primary benefit of the SmartRoom initiative, explains David Sharbaugh, senior director of UPMC’s Center for Quality Improvement and Innovation. “SmartRoom improves the quality of care by providing information 4
  5. 5. directly to the bedside—where it’s needed most—not to a computer in the hallway or to a workstation at the nursing desk,” says Sharbaugh. “The less nurses have to focus on mundane, predictable tasks, the more they can focus on the human, compassionate side of patient care.” The same dynamic holds true for the time spent documenting completed tasks. By sharply reducing this part of the nursing workload—the reduction was 57 percent in the initial 22-bed evaluation unit— SmartRoom enables nursing staff to spend more time at the bedside and less walking to and from a computer terminal. Finally, SmartRoom is also expected to improve patient safety by providing nursing staff with bedside access to detailed, up-to-the-minute information on not only prescriptions and doses, but also allergies and risk factors such as patient falls—all of which give caregivers the tools they need to make the right clinical decisions. Changing the patient experience UPMC also designed the SmartRoom solution to alleviate the disori- entation that hospital stays can induce in patients. The ability to send and receive emails, for example, provides patients with a crucial link to friends and family. More powerful is the way SmartRoom removes the “mystery” element of hospital stays by letting patients know who just entered the room, what tests or procedures they have scheduled that day and what they can expect to experience. These are just some of the ways UPMC expects greater control to translate into higher patient satisfaction. Chief quality officer Tami Minnier, RN sees the SmartRoom project as embodying the vision that guides UPMC’s innovation efforts. “Our aim is to provide the right care, at the right time, all the time,” says Minnier. “SmartRoom is an example of how our partnership with IBM is helping us meet that goal.” 5
  6. 6. For more information To learn more about how IBM can help you transform your business, please contact your IBM sales representative or IBM Business Partner. Visit us at: ibm.com/smarterplanet/healthcare © Copyright IBM Corporation 2010 IBM Corporation 1 New Orchard Road Armonk, NY 10504 U.S.A. Produced in the United States of America July 2010 All Rights Reserved IBM, the IBM logo, ibm.com, Let’s Build A Smarter Planet, Smarter Planet, the planet icons, BladeCenter, Global Business Services and WebSphere are trademarks of International Business Machines Corporation, registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. A current list of IBM trademarks is available on the web at ibm.com/legal/copytrade.shtml This case study illustrates how one IBM customer uses IBM products. There is no guarantee of comparable results. References in this publication to IBM products or services do not imply that IBM intends to make them available in all countries in which IBM operates. Please Recycle ODC03175-USEN-00

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