Magazine Article | January 28, 2014

Mobile Computing Improves End-Of-Life Care

By Ken Congdon, editor-in-chief, Health IT Outcomes
Follow Me On Twitter @KenOnHIT

Cornerstone Hospice has leveraged laptops, mobile carts, and iPads to connect terminally ill patients to loved ones, facilitate communication, and improve the overall quality of its patients’ final days.

There’s a common perception that the elderly are, at best, less than savvy when it comes to technology and, at worst, technology averse. As a result, investing in patient-facing computer technology probably isn’t a top priority for most nursing homes and hospice care providers. But maybe it should be. Cornerstone Hospice and Palliative Care, for example, has come to realize just how instrumental mobile computing can be for providing a richer end-of-life experience for its patients. Over the past 10 years, the provider has experimented with a variety of patient-centered mobile computing applications throughout its four hospice houses in Central Florida. The results have been nothing short of inspiring.

Laptops And Carts Open Doors For Communication, Entertainment
Cornerstone’s mobile computing journey began in the early 2000s when one of its patients asked if he could have access to a laptop so that he could log onto AOL (via a dial-up connection) to email loved ones. Cornerstone had never received a request like this (a request that was granted) and it prompted the provider to start asking other patients in its care if they would be interested in using mobile computers (for email, surfing the Internet, watching DVD movies, etc.) while at the hospice. Surprisingly, several patients desired access to mobile computers.

“Much of our patient population is made up of elderly folks who aren’t native Floridians,” says Derenda “D.J.” Hamilton, Cornerstone’s director of IT. “Many are originally from up north and relocated to Florida to retire. In many instances, these folks have families in other states that can’t easily come to the hospice to visit in person. Email has become a primary means for our seniors to keep in touch with loved ones, and mobile computers allow them to use email from their beds if they are immobile.”

To satisfy patient demand, Cornerstone began investing in what it called “PCOWs” (personal computers on wheels) in 2004. These PCOWs consisted of a rugged portable PC from Stealth Computer affixed to a battery-powered mobile cart. Cornerstone had seven PCOWs that it circulated throughout its hospice houses, and the units quickly made a huge impact with patients.

“One of our patients used a PCOW to email his sisters, who he had not spoken to in years because they lived in a variety of locations across the country,” says Hamilton. “He was not computer-savvy, but we quickly set him up with an email account and showed him how to enter his sisters’ email addresses and compose and send a message. It was heartwarming to see how this technology reunited these siblings and enhanced this patient’s final days.”

Hamilton also recalls how the PCOWs helped one avid baseball fan get more enjoyment out of her last days of life. “Being admitted to a hospice can be a disheartening experience, but one particular patient was especially devastated because we didn’t carry the television programming necessary to allow her to watch broadcasts of her favorite professional baseball team from up north. We got approval from corporate to subscribe to the MLB Network, which gave her the ability to watch all of her team’s games on a PCOW. For every game, she and her family would dress up in that team’s colors and watch every inning. She wasn’t very mobile, but whenever her team would hit a home run, she would always muster the strength to give a thumbs-up. Bonding around baseball really helped hold her family together during her final days.”

“We hope to include iPops in our home hospice services in the near future, and we didn’t want our patients to need to have in-home Wi-Fi to be able to use the iPop.”
Director Of IT, D.J. Hamilton

The PCOWs improved the patient experience at Cornerstone immeasurably, but these devices also had their limitations. For instance, given their size, the PCOWs were obtrusive in the patient rooms. When not in use, the nurses would place them in a closet for storage. When these units were out of sight, they often became out of mind for the clinical staff. According to Hamilton, nurses are focused on treating symptoms and providing care. It often slipped their mind to offer a patient a PCOW that was stored in a closet in the nurses’ station. The search was on to find a more portable mobile computing option that could become a fixture in each patient room.

iPads Take Mobility Benefits To The Next Level
When Apple iPads were introduced in 2010, Cornerstone believed the devices had the promise to become the unobtrusive mobile computing platform they were looking for. However, security concerns kept the provider from investing in iPads initially.

“Given the portability of the iPad, we were worried about theft,” says Hamilton. “What if a patient’s family member decided to take one as a parting gift? However, we soon became aware of a company called Displays2Go that offered iPad stands with locks on the back. These ergonomic stands secured an iPad to the foundation, making the iPads almost impossible to steal.”

With an initial $10,000 grant, Cornerstone Hospice invested in its first 10 iPads and Displays2Go stands in early 2013. The hospice has since received the funding to place units in each of the 46 patient rooms throughout its hospice houses. Cornerstone calls each iPad/stand combo an “iPop,” and these devices replaced the seven PCOWs previously in use at Cornerstone.

With a much smaller footprint than a PCOW, the iPops are a permanent fixture in each patient room at Cornerstone. These devices aren’t stored in closets and forgotten about by clinicians the way the PCOWs often were. Moreover, Cornerstone’s clinical staff has also taken more of an interest in the iPops because of the familiarity they have with iPads.

Each iPop runs off both Wi-Fi and a data plan from Sprint. The data plan allows each iPop to be moved to different locations (even different hospice houses) without changing settings. Furthermore, it allows the iPads to easily transition to home hospice applications. “We hope to include iPops in our home hospice services in the near future, and we didn’t want our patients to need to have in-home Wi-Fi to be able to use the iPop,” adds Hamilton.

iPops provide another advantage over PCOWs because they can be “wiped clean.” The apps, data, and memory from previous users can be easily erased and each device restored to a like-new condition before an other patient uses the iPop.

While the iPops definitely provide functional advantages over the PCOWs, the biggest benefits are the new mobile possibilities the devices are providing Cornerstone’s patients. In addition to email, the iPops provide the ability for patients to FaceTime loved ones who can’t visit the hospice in person. They also give patients access to a variety of entertainment options, including a movie library, Pandora, and gaming apps.

Perhaps the most compelling innovation to come out of Cornerstone’s iPop implementation is the development of communication boards for patients who are unable to verbally communicate. One of Cornerstone’s patients was unable to speak or write, which made it difficult for the patient to communicate basic needs. By downloading an app called My TalkTools from iTunes, the hospice was able to develop a customized communication board for the patient that allowed him to finally interact with caregivers and family members. Simply by touching images on the iPad’s touch screen interface, a patient can relay essential requests such as, “I need a bath”; “I want to sit up”; or “I’m thirsty.” The My TalkTools app was so transformative in the care of this one patient that Cornerstone decided it would designate one iPop in each hospice house as a communication board unit for future patients who may suffer from communication limitations.

Cornerstone continues to seek out new ways to leverage its iPops to improve care and enhance the patient experience. It is currently working with Apple to integrate wireless scales, stethoscopes, and other monitoring devices with the iPops. Wireless printers are also being considered to allow patients to print out digital photographs or family members to print airline boarding passes from the iPops. To Cornerstone, the possibilities of mobile technology to improve its patients’ last days seem almost endless.

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