1Please excuse me. Someone else needs my attention.
Confidential & Proprietary. All rights reserved to Rover Technologies,...
Innovation at the Point-of-Care:
Rethinking the Doctor-Patient
Encounter
Oct 1, 2013
William Bria, MD
President, AMDIS
Gre...
Toll, E The Cost of Technology JAMA 307:2497 (2012)
3
The Patient Experience
is always tied to the
User Experience
PX UX
Meaningful Use
vs.
Meaningful Provider-patient Interact...
5
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
5
6
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
6
7
Patient vs. iPatient
Abraham Verghese, MD
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
7
Rounds vs. iRounds
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
8
Work Habits of the 21st-Century Intern
Block L et al. J Gen Intern Med 2013 Aug
Documentation
= 40%
(Same as in
1989)
Dire...
Asynchronous Communication
10
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
11
Clinical Implications of Empathy
and Interpersonal Communication
•Improved Patient Satisfaction
Physician empathy and list...
“The VA’s Center for Innovation (VACI) identifies, tests, and evaluates innovative
solutions to help VA better serve Veter...
2012 VHA Innovation Project #5021
• The project was conceived by Dr. Jorge Ferrer who
enlisted Rover Technologies to build...
Rover’s Innovation
• Objective: Fundamentally Improve the User
Experience (UX) and Patient Experience (PX) at
the Point of...
First Principles
• What is the primary clinical purpose of
the EHR?
– “Tell the Patients Story”
• What is the purpose of c...
Solution #1: The Story
• Encounter preparation is essential
• When a provider walks into the exam
room, he should look lik...
The quality of the story is the single most
important determinant of the quality of
clinical decision making.
Confidential...
SUBJECTIVE: The patient is a 66-year-old female who
presents to the clinic today for a five-month recheck on her
type II d...
20
This is
a story!
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC 20
Storytelling Technology: Automated
Document Assembly
• Turn structured data into unstructured data
• Scenario-specific con...
Stories
• What is the best time to read the
story?
• Who provides the content; i.e., who
fills in the knowledge gaps?
• Wh...
Solution #2: An “Ad Hoc UX”
• Dynamically generated at the point of service
• Unique – intended for a single use (disposab...
• Encompasses a variety of input modalities:
• Ink is recognized; i.e. converted to
actionable information (e.g., ASCI tex...
Scratch notes
Drawings and signatures
Check boxes
Streaming Dictation
Workstation control
Workflow control
Long handwritte...
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
26
X X
X
X
X
X
X
During
sleep
X
X
W
W
W
WR R
R
R D
D
Confidential & Proprietary. All rights reserved to Rover Technologies, L...
Workstation Integration
X
Confidential & Proprietary. All rights reserved to Rover Technologies, LLC.
28
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Shorr and bria innovation at the point-of-care rethinking the doctor-patient encounter

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Shorr and bria innovation at the point-of-care rethinking the doctor-patient encounter

  1. 1. 1Please excuse me. Someone else needs my attention. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 1
  2. 2. Innovation at the Point-of-Care: Rethinking the Doctor-Patient Encounter Oct 1, 2013 William Bria, MD President, AMDIS Greg Shorr, MD CMIO, Rover Technologies
  3. 3. Toll, E The Cost of Technology JAMA 307:2497 (2012) 3
  4. 4. The Patient Experience is always tied to the User Experience PX UX Meaningful Use vs. Meaningful Provider-patient Interaction Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 4
  5. 5. 5 Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 5
  6. 6. 6 Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 6
  7. 7. 7 Patient vs. iPatient Abraham Verghese, MD Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 7
  8. 8. Rounds vs. iRounds Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 8
  9. 9. Work Habits of the 21st-Century Intern Block L et al. J Gen Intern Med 2013 Aug Documentation = 40% (Same as in 1989) Direct Patient Care = 40% (20% in 1989) 9
  10. 10. Asynchronous Communication 10
  11. 11. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 11
  12. 12. Clinical Implications of Empathy and Interpersonal Communication •Improved Patient Satisfaction Physician empathy and listening: associations with patient satisfaction and autonomy Pollak, KI et al J Am Board Fam Med. 2011 Nov-Dec;24(6):665-72. •Improved Compliance The Effects of Physician Empathy on Patient Satisfaction and Compliance Sung, SK et al Eval Health Prof September 2004 27: 237-251 •Improved Outcomes The relationship between physician empathy and disease complications Del Canale, S et al. Acad Med 2012 Sep;87(9):1243-9. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 12
  13. 13. “The VA’s Center for Innovation (VACI) identifies, tests, and evaluates innovative solutions to help VA better serve Veterans. We develop programs that nurture innovation and create an environment where informed risk taking and progressive thinking are rewarded.” Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 13 VA Innovation project: #5201 “Technology-Enhanced Digital Documentation” Re-imagine the way clinical information is managed at the point of service
  14. 14. 2012 VHA Innovation Project #5021 • The project was conceived by Dr. Jorge Ferrer who enlisted Rover Technologies to build and test the solution • Voted #20 out of 3,841 VAi2 submissions in 2012 • The project was reviewed and signed off by the VA leadership including Drs. Petzel and Cullen • Development will be completed in the VA Sandbox under the supervision of the VA’s Technical Director/Sr. Technologist, Bill Cerniuk. • Deliverables will be tested in VA Usability Labs 14Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 14
  15. 15. Rover’s Innovation • Objective: Fundamentally Improve the User Experience (UX) and Patient Experience (PX) at the Point of Care • Strategy: Employ disruptive technology to overcome the intransigence of the UX found on the current generation of clinical workstations • Primary Tactic: Take a form-based approach to digital documentation that emphasizes the fundamentals of reading and writing Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 15
  16. 16. First Principles • What is the primary clinical purpose of the EHR? – “Tell the Patients Story” • What is the purpose of clinical documentation? – “Fill in knowledge gaps” Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 16
  17. 17. Solution #1: The Story • Encounter preparation is essential • When a provider walks into the exam room, he should look like a genius – Know the patient as a person – Know the relevant clinical history • The only way to accomplish this is for the provider to review the patient’s “story” before the encounter Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 17
  18. 18. The quality of the story is the single most important determinant of the quality of clinical decision making. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 18
  19. 19. SUBJECTIVE: The patient is a 66-year-old female who presents to the clinic today for a five-month recheck on her type II diabetes mellitus, as well as hypertension. While here she had a couple of other issues as well. She stated that she has been having some right shoulder pain. She denies any injury but certain range of motion does cause it to hurt. No weakness, numbness or tingling. As far as her diabetes she states that she only checks her blood sugars in the morning and those have all been ranging less than 100. She has not been checking any two hours after meals. Her blood pressures when she does check them have been running normal as well but she does not have any record of these present with her. No other issues or concerns. Upon review of her chart it did show that she had a benign breast biopsy done back on 06/11/04 and was told to have a repeat mammogram in six months but she has never had that done so she is needing to have this done as well. ALLERGIES: None. MEDICATIONS: She is on Hyzaar 50/12.5 one-half p.o. daily, coated aspirin daily, lovastatin 40 mg one-half tab p.o. daily, multivitamin daily, metformin 500 mg one tab p.o. b.i.d.; however, she has been skipping her second dose during the day. SOCIAL HISTORY: She is a nonsmoker. REVIEW OF SYSTEMS: As noted above. OBJECTIVE: Vital Signs: Temperature: 98.2. Pulse: 64. Respirations: 16. Blood pressure: 110/56. Weight: 169. General: Alert and oriented x 3. No acute distress noted. Neck: No lymphadenopathy, thyromegaly, JVD or bruits. Lungs: Clear to auscultation. Heart: Regular rate and rhythm without murmur or gallops present. Breasts: Exam performed with a female nurse present. The breasts do have some scars present underneath them bilaterally from prior breast reduction surgery. There is no axillary adenopathy or tenderness. Breasts appear to be symmetric. There was no nipple discharge or retraction. Upon palpation there were no palpable lumps or bumps and no palpable discharge. Musculoskeletal: She did have full range of motion of her shoulders. She did have tenderness upon palpation over the right bicipital tendon. There is no swelling, crepitus or discoloration noted. MEDICAL DECISION MAKING: Most recent hemoglobin A1c was 5.6% back in October 2004. Most recent lipid checks were obtained back in July 2004. We have not had this checked since that time. ASSESSMENT: 1. Type II diabetes mellitus. 2. Hypertension. 3. Right shoulder pain. 4. Hyperlipidemia. PLAN: 1. She is going to go to lab to obtain a hemoglobin A1c, BMP, lipids, CPK, liver enzymes and quantitative microalbumin. 2. We are going to set her up for a diagnostic bilateral mammogram due to a history of abnormal mammogram in the past which subsequently showed a benign breast cyst. 3. I told her for her shoulder to take ibuprofen 600 mg three times daily with her meals for a minimum of the next one week. 4. She is going to follow up in the clinic in three months for a complete comprehensive examination. If any questions, concerns or problems arise between now and then she should let us know. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC 19
  20. 20. 20 This is a story! Confidential & Proprietary. All rights reserved to Rover Technologies, LLC 20
  21. 21. Storytelling Technology: Automated Document Assembly • Turn structured data into unstructured data • Scenario-specific content dynamically generated at the time of service • Transform a “note-oriented” EHR into a “story-oriented” EHR • Reduces the intrusive, time-consuming burden of navigation and thereby facilitates meaninful provider patient interaction Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 21
  22. 22. Stories • What is the best time to read the story? • Who provides the content; i.e., who fills in the knowledge gaps? • Who writes the story? • Who is the recipient of the story? Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 22
  23. 23. Solution #2: An “Ad Hoc UX” • Dynamically generated at the point of service • Unique – intended for a single use (disposable) • Comfortable – Adequate amount of real estate – Essential information on the surface At the point of service, the focus should be on 1. Interpersonal communication 2. Observation 3. Filling in scenario-specific knowledge gaps – not formal documentation Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 23
  24. 24. • Encompasses a variety of input modalities: • Ink is recognized; i.e. converted to actionable information (e.g., ASCI text) • This technology is uniquely suited for point of care documentation. Enabling Technology: Digital “Ink” Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 24 – Digital pen and paper – Regular pen and paper – Tablet PC and Stylus – Streaming voice recording – Gestures (e.g., LEAP and Kinnect
  25. 25. Scratch notes Drawings and signatures Check boxes Streaming Dictation Workstation control Workflow control Long handwritten notes Digital Writing at the Point of Care Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 25 Standard pen Digital pen Stylus Voice recorder
  26. 26. Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 26
  27. 27. X X X X X X X During sleep X X W W W WR R R R D D Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 27
  28. 28. Workstation Integration X Confidential & Proprietary. All rights reserved to Rover Technologies, LLC. 28
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