Ankur Seth

Mobile Strategy for BIDMC

June 4, 2010

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Agenda

1. Scope and Recommendation

2. Methodology

3. Proposed solutions –Lab and Medication workflow

4. Risk and Mitigation Plan

5. How other players are preparing for future?

6. Long term strategy and implementation

7. Assumptions and Risk

8. Recommendation

Scope

• Immediate solutions for using mobile devices in scenarios—

-- Medication Management-- Lab sample collection workflow

• Long term strategy for mobile devices usage in BIDMC

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Immediate Recommendation

Correct Patient Identification requires Front end Labeling at patient bedside

Every bedside Bar code scanners with display

ICU/ED Label printer on bedside

Wards Use a cart with shelves – Bluetooth enabled Label printer for each phlebotomist and nurse

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Long Term Recommendation

• Become vendor/ device agnostic, support applications, let user decide what form factor they need accessibility

• Set up an Innovation mobility lab – due diligence on new technologies/offerings usable in our workflow and support accordingly

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Methodology

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Requirements Gathering

at BIDMC

Identified Best Practices

Mapped user pain

points with present

technologies

Research on

present technologies

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Pain points

• Nurses move back and forth, use shared printers• Work load can be overwhelming, human error

possible • Too many different devices used in care settings

Nurses

• There should be quality check near the bedside• Turn around time is the key in ED

Physicians

• Right sample/drug, right patient at the right time• If Lab does not receive correct labels, rework

causes delays and can lead to errors• Standardized processes should be followed

everywhere

Lab and Admin

Best Practices from other settingsHealth

Systems Best Practices Future

Mayo ClinicPhlebotomist drags a CoW with all the devices , views EMR and scans, prints from its CoW

Standardization access to EMR , and printing strategy in mobile environment

HCA

Mediation workflow is automated, Lab sample is not. Carts have scanners and boxes filled with drugs for patients

iPod has opened doors for many others to follow and invent. Future can be Healthcare iTunes/ Podcast

Johns Hopkins Hospital

Unit level planning in different workflows. Barcode scanner in every bed . Specimen collection by rugged handheld and mobile wireless printer

The ideal device might not be invented yet, but we need to be prepared for it

M.D. Anderson Center

Mandatory training sessions before circulating any device. Major usage in BlackBerry and Motion C5 Exploring new device usage

TenetBed side administration of medication-right drug to right patient Exploring new device usage

Partners (B&H , MGH)

Owns applications, does not configure devices, Bar Code technology reduces errors*

Intuitive applications will force users to use devices which can ease their workflow

VA Clinicians decide if this device is good for themProvide secure access to information

Kaiser Permanente

Mobility Innovation Lab. Use Bar code extensively

Mobility can be used for accessing health info anytime, ability to self manage health.

Mount SinaiSuccessful enterprise wide deployment of iPhone using relevant apps

Ubiquitous accessibility of information

8* Ref – Publication on Effect on Bar code technology on safety by B&W –New England JoM ‘10

Gaps with Present Technologies

• No one device fit in all solution—viewer, printer, scanner

• Usability and Form factor are key decision criterion

• Products cannot be customized based on user preferences

• Ability to work with CPOE and eMAR in future needs to be tested

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Proposed solutions—Lab Workflow & Medication Management

Bar Code Scanners Label Printers

ED* on bed side (50) on bed side (50)

ICU* on bed side (77) on bed side (77)

Wards on bed side (544)keep on a mailing/shopping cart with other devices(12+60)

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* Maximum error prone places—Ref Clinical Pathology Quality Report Q4-09

Process Improvement required

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• ED – Label printed at triage and carried all the way

• ICU – Centralized printer location, not easily accessible

• Wards – Carry multiple devices

• Ambulatory– Batch printing of labels

• ED - Need bed side printing

• ICU - Keep printer in central location, access to nearby rooms

• Wards – Provide carts with racks/drawers to organize equipments

• Ambulatory –Batch labeling should not be allowed.

Pros and Cons of Recommendation

Pros Cons

Scanners used in both Lab and Medication Workflow

A large inventory to manage

Support bed side administration Enterprise wide deployment

ED and ICU have greatest potential for error - give them scanner and label printer at point of care

Workflow change required

Scanner can be integrated in eMAR and LIS to tell if right amount of drug given, right sample

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Risks and Mitigation

Risks

• Bar code scanner get stolen.

• Batteries run dead

• Process Adherence

Mitigation

• Use existing active RFID inventory tracking to avoid theft

• Make processes mandatory to maintain the integrity of the system

• Mandatory training to nurses and phlebotomists using these devices

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The Future

• Consumer products are gaining popularity

• Apple ahead of the race / Other players are coming with their offerings

• Native applications, App store and ease of use strengthening them

• Information, accessibility to data is within the reach of healthcare professionals

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Thinking Long term—Problem of plenty

Companies New Innovation

Dell Dell-Tablet; Applications Run in virtual environment Microsoft Windows Phone 7, Augmented Reality

HPPalm; HP Labs –Paper computing, Smart dust for infection control

AppleNative App creating difference, usability gives apple an advantage

RIM Ability to talk with peripherals, privacy complianceVecna Using robots for providing care

GoogleGoogle health as a back end database accessible from any device

Perfect Serve Intelligent message routing systemPatient Keeper Application :: Intuitive Report viewing toolVoalte Application :: Communication inside hospital

DocBookApplication::Primary Doc to Expert doc connection application

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What Key Opinion Leaders say?

• Google, Sr. Prod Manager- ’Consumer centric Health management might be the calling‘

• mHealth, VP- ’Mobile devices and applications will be used as

resources in Disease Management ‘

• Microsoft, Director -’Phones can be used as a window to a different world in future’

• HP, BDM – ’If you don’t take user feedback, you’ll end up making mistakes. Knowing your user is the key’

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What other hospitals say?

• John Hopkins ,CIO – The ideal device might not be invented yet, but we need to be prepared for it

• Partners Healthcare ,CTO –There’s a class of notifications, views and transactions that healthcare consumers expect to access on the go

• VA, Director, Emerging Health Technology – Mobility needs to support the concept of Care anywhere and everywhere

• Kaiser, Head Clinical Innovations– Devices might be hyped, but mobility is an operating reality, it is hear to stay.

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Our Long Term Strategies

• Mobile devices can change their nature/form in future

Strategy • Work on accessibility, don’t

lock a device• Be vendor/device agnostic• Let consumer own the

device • Goal—Improve user

workflows

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Proposed implementation

Set up an Innovation mobility lab –

• Collaborate with vendors(Apple, HP, Google etc) and research labs (MIT Media, IBM IRL)

• Perform due diligence of new technologies/offerings

• Usability analysis in our workflow and support accordingly

• Users bring their device, we provide accessibility to system

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Criterion for selection• Data Security

• Infection Prone

• Inter-operatibility

• Form Factor

• Connectivity

• Support

The final push by the user

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Assumption and Risks

Assumptions

• Medical Safety will be improved by using technology

• Devices will continue to evolve

• Apple will not be the only player in the market

Risk

• Data Security

• Infection propagation

• FDA compliance

• Technology adding to process overheads

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Conclusion

• How mobile devices can be used in clinical settings?

• I have workflow related problems

Can mobile devices/application solve them?

If they can help me on my pain points, definitely they can be used

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Recommendation

Frontend labeling

Every bedside Bar code scanners

ICU/ED Label Printer on bedside

Wards Use a cart with shelves -- Label Printer for each phlebotomist and nurses

• Become vendor/ device agnostic, support applications,

• Let user decide what form factor they need accessibility

• Set up an Innovation mobility lab

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Acknowledgements

• Amy Goldman• Brigitte Bowen• Gina McCormack • Henry Fieldman• Holly Dowling • Jan Olson• Jane Foley• Joe Cross

• John Powers• Julius Yang• Kim Sulmonte• Larry Markson• Larry Nathanson• Pat Folcarelli• Rebecca Hildebrand• Tricia Bourie

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John Halamka

Thank You

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