Applying Technology To Support Coordinated Care

Technology is the driving force in healthcare today, and many organizations are struggling to implement it and are unknowingly making already broken processes worse. These failed attempts are costing the industry money and frustrating clinicians. This frustration is ultimately being passed on to the very people who need it the least – the patients. In this Q&A, Denise Hammel, RN-BC, MSN, CLSSBB, CPHIMS, CMQ/OE, Director of Clinical Solutions for Futura Mobility and Daria Cuda, MBA, Marketing Coordinator for Futura Mobility discuss how to better implement and utilize technology to bring about true mobility, impact clinical work, and make the patient’s experience less stressful.

Q: What problems do you see impeding the success of healthcare organizations?
Hammel: When Futura Mobility consults with hospitals, we often find that many healthcare providers aren’t aware of how broken their current processes are. They have layered workaround upon workaround on top of broken processes and when they implement technology, it doesn’t fix anything. We also see a lot of role ambiguity in conjunction with technology implementations. There are a few essential steps every provider must follow when conducting a technology analysis: 1) You must ensure your existing workflows are nailed down before implementing any technology;   2) You must fully understand the unique roles of each player involved in a process and how these players interact with one another; and 3) You must consider both 1 & 2 in tandem when applying new technology and designing new processes. These steps aren’t optional. Technology implementations when they try to compensate for broken processes. These problems can be avoided if providers followed the steps outlined above before implementing technology.

It’s important to note how much the inefficient use of technology can cost a healthcare provider in the long run.  A variety of factors are driving IT adoption in the healthcare space (i.e. Meaningful Use, HITECH, payer reimbursement models, etc.). However, you can’t rush into a technology implementation. You need to leverage technology appropriately, within a sound process structure, to bridge gaps in coordinated care. It’s time for the healthcare industry to start thinking “outside the box” in how it uses technology to span the care continuum.

Q: In what interesting ways have you seen technology applied to cater to that care continuum loop?
Hammel: One interesting trend is the emergence of patient portals. There are many variations of this concept, but the net result everybody is driving toward is the same — patient engagement. How do you engage the patients so they can interact with providers in an automated way? From scheduling appointments to requesting refills to dialoging about their condition — we are seeing patient portals begin to take shape, and they are being deployed. We are also seeing “extenders” of these patient portals— whether it is using smartphones and iPads to communicate with patients or the use of full-fledged telemedicine solutions so physicians can conduct real-time virtual consultations with patients. Another emerging technology is business clinical analytics. Health providers have been adopting and putting data into EMRs, but how are we extracting this data and using it to drive decisions? We are now starting to see providers use the electronic data they are collecting in different and meaningful ways.  

Cuda: Futura is working on an exciting project with a large hospital that wants to enhance their patient engagement using technology and we are working to safely and securely install iPads at each patient bed. The iPads will be used as a form of entertainment and will provide easy access to information to educate the patient. Denise mentioned telemedicine where doctors and patients can communicate across distance in real-time. A great example is at Abington Health, who provides on-call neurologists for 24/7 coverage of stroke patients at neighboring hospitals. We helped them extend their reach and capabilities by implementing telemedicine. Area hospitals are able to maintain their patient relationships and offer a continuum of care. Futura is also growing our efforts in mHealth and mobile applications for the remote management of chronic diseases using smart phones, tablets and laptops.

Q: Why won’t status quo applications of technology work in the new healthcare environment that we are entering?
Hammel: Historically, technology applications — be they inpatient- /acute-care, or ambulatory-care-focused — have been too centered on one particular delivery of care. What healthcare reform and other initiatives are teaching us is that we’ve got to apply technology along the care continuum. What is happening in that space outside the hospital setting, outside of the physician’s office or ambulatory care clinic? How are we capturing that information? We need all these previously siloed stakeholders and information systems not only to communicate with one another, but work in harmony with one another. We are starting to see this concept take hold with the emergence of extender technologies (e.g. smartphones, iPads, telehealth, etc.) and HIE that augment core HIS platforms and promote interoperability.

Q: Given that coordinated care will fundamentally change the way providers are reimbursed, what new factors should providers consider when making a technology purchase?
Hammel: Providers should determine how the device or application they are evaluating communicates or integrates with other applications. For example, when creating a CCD (Continuity of Care Document), how do we get the document to other providers?  Similarly, how do those providers get their summary and care information to the originator? How do we exchange not only summary information but discreet data points that are really important in terms of the continuum of care such as medications, allergies, and other things taking place outside of the current point of care?

Q: What is Futura doing the help providers manage this transition?
Cuda: Our experienced consultants work with healthcare providers to look at their current mobility demand and develop a strategy to both identify the future requirement and build an infrastructure that will support it. We identify the unique challenges each facility faces and help them develop a technology roadmap that covers implementation and support processes to meet long-term goals.

From a technology standpoint, Futura offers a variety of solutions — from scanners, mobile carts and printers to wireless infrastructure engineering, mobile device management and telemedicine. We work with many different vendors and manufacturers to recommend the products that best meet our client needs. Furthermore, Futura provides the dedicated technical support that ensures the systems we implement work well with the infrastructure that is already in place. If tweaks or enhancements need to be made to their infrastructure — for example, if they need more wireless access points to optimize the effectiveness of the technology in use —we can suggest and make those improvements along the way. In the end, healthcare providers have a partner supporting their devices who provides clear management and consistent maintenance.

Q: What do clinicians want to see when it comes to technology?
Hammel:  I’ve been doing this for more than a decade and I still see systems and applications being implemented that don’t take clinician workflow into consideration. They don’t consider basic human factors when engineering technology solutions. There are so many fundamental principles that can be simplified to make the life of a clinician easier. We learned that clinicians need information about a patient at the point of care and that’s what we drive towards. Having the technical capabilities isn’t good enough. Data needs to be synthesized and delivered back to clinicians in a timely manner. If it isn’t, we will never truly realize the value technology can bring to the healthcare industry.

Cuda: Doctors and nurses need to be able to do their work without feeling like they have to get an IT degree. This includes capturing patient data at the point of care and ensuring quick and easy access to that data while remaining compliant with industry. Technology must be easy to use, easy to support, lightweight, ergonomic and fast.

Q: What technological applications or solutions do you feel are going to have the most impact on the healthcare industry in the next two to five years, and what needs to change within the industry to help facilitate adoption of these technologies?
Hammel: Mobile solutions, BI and analytics dashboards, and telemedicine will make a significant impact in the industry over the next few years. However, in order to maximize their impact, providers need to get our arms around the legalities, regulations, and standards necessary to leverage these tools safely and securely. For example, what are the constraints and privacy issues when using a smartphone or tablet to access patient information via the cloud? Privacy is a huge concern for both providers and patients. There is a ton of dialogue occurring in the industry around appropriateness of use. Health providers and technology vendors need to be aware of this, and incorporate this thinking into their technology deployments.