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Bridging EHRs, Clinicians and Patients

mHealth Creates Ample Opportunities

By Joe Condurso
March 30, 2015

Healthcare’s fixation on electronic health records (EHRs) and Meaningful Use has resulted in the creation of large, expensive data repositories for hospitals. Although organizations’ billing accuracy has improved, EHRs have greatly increased hospitals’ costs without delivering the expected care-quality return-on-investment (ROI).

This is because many EHRs are not designed to support clinicians’ high-frequency, short-duration tasks and decision making at the bedside. Many of these systems are viewed as complicated, monolithic systems, and they do not offer efficient communication tools to facilitate collaboration across the trans-disciplinary care team, who are usually dispersed in different locations throughout the facility or the surrounding community.

Consequently, hospital clinicians, who are responsible for executing the physician order created in the EHR, adapt their processes to stay efficient. They carry patient information around on handwritten paper notes or communicate through personal mobile devices, which 67 percent of clinicians use on-duty despite hospital restrictions and risks to patient safety and data.

Hospitals could take advantage of clinicians’ natural inclination to use mobile technology. A hospital-owned smart mobile EHR overlay solution could harness EHR data and deliver contextual clinical data and communication tools that are synchronous with the clinicians’ workflow, improving both efficiency and patient-centered connected care. By bridging the gap from the EHR to where patient care is actually delivered, hospitals can return the focus to the bedside and the “moment of truth” between the clinician and the patient.

The Post-EHR Era Requires New Tools
As Meaningful Use incentive dollars are fading, we are entering the “post-EHR” era where organizations need to determine how they will continue financially supporting these massive data repositories implemented during the Meaningful Use program. In this era, EHRs will continue to be solely an operating expense unless hospitals can find ways to leverage the stored data to help frontline clinicians deliver higher quality care that results in lower overall costs.

The natural efficiency of a mobile, single-device strategy has prompted many hospitals to create BYOD data and security policies for physicians. The policies, however, typically forbid employed staff from using personal smartphones to protect the hospital from a data breach resulting in a costly HIPAA violation penalty.

While this precaution is understandable, it does not address the cognitive workload challenge clinicians face trying to deliver safe, effective patient care with multiple competing communication tools, such as VoIP phones, pagers and instant messaging through the EHR, which is a time-consuming extra step for the clinician. Even with all these devices and tools, clinicians must still manually piece together contextual clinical information about their assigned patients from multiple sources. Post-it Note and handwritten note usage as a memory aid is still common because most hospitals lack an effective method for consolidating and delivering that information at the bedside or sharing data across the care team in a secure manner.

mHealth Promotes Best Practices
Instead of requiring clinicians to use multiple devices, hospitals could offer clinicians a single hospital-owned device installed with smart mobile clinical applications synchronized with the hospital’s core information systems. It also provides a connection network to the rest of their care team. These tools could include voice and text message communications functionality, barcode scanner for medication administration and phlebotomy, and, most importantly, access to EHR data and decision-support tools so the data presented has context.

Informed by this contextual data within the workflow, frontline clinicians who are downstream of the physician order would be better prepared on rounds, more likely to follow best practices and less likely to deliver unnecessary or erroneous care.

For example, administering insulin to a diabetic patient can be streamlined and made safer with clinicians connected through smart mobile technology. The mHealth-driven process would start with a CNA capturing vital signs and food intake at the bedside, instead of at a computer. That information would be instantly available to the care team through the mobile platform as well as the core hospital systems.

Before arriving in the room to administer the insulin, a clinician could send a pre-configured, secure text message using the mobile applications to another clinician requesting a witness, eliminating a potential delay. Then, at the bedside, the mobile platform would present the patient’s vital signs, glucose levels and food intake, collected earlier by the CNA, as well as decision-support tools.

Also in this scenario, the clinician would be able to more easily observe the five rights of medication administration, in addition to other safety checks. The clinician could leverage the mobile device’s scanner integrated with the clinical application to identify the patient, clinicians and medication, as well as directly input the amount and location of the injection. Clinicians would not need to remember or handwrite the information for the next time they happen to be at an EHR workstation.

Furthermore, as hospital-owned technology, the mobile applications and devices could be standardized, which streamlines administration, security and maintenance. When operated only on the hospital’s servers, this mobile technology would eliminate the risk of data loss or HIPAA violations because even if a device is lost or stolen, it would not contain any patient information.

Value-Based Payment Requires Process Change
Reducing unnecessary care variation and following best practices, even in a simple process such as administering insulin, are essential for healthcare organizations in the post-EHR era where payers will increasingly compensate for value and not just services.

This is evidenced by the Department of Health and Human Services’ recent announcement that by 2016 the agency wants at least 50 percent of its payments to be based on alternative, value-based compensation models. In addition, a 2014 survey of commercial payers shows 80 percent of these companies say value-based contracts are “very important” to their strategic objectives.

Value-based contracts also pose financial risks for organizations in terms of error prevention. For example, in December 2014, Medicare reported that 724 hospitals will have Medicare payments reduced by one percent for being among the 25 percent of hospitals with the highest rates of hospital-acquired conditions (HACs). These conditions include pressure ulcers, iatrogenic pneumothorax, central venous catheter-related bloodstream infections, as well as postoperative hip fractures, sepsis and wound dehiscence, among others.

mHealth, unlike EHRs, offers the unique ability to help administer workflows to prevent these HACs, while also improving care quality metrics required under value-based payment contracts. Smart mobile clinical applications accessible at the point-of-care can eliminate the inefficiencies and safety risks associated with communication failures, workflow interruptions and lack of information access.

The Patient-Centered Mobile Future
Mobile technology will only become more integrated with healthcare as hospitals continue to guard against unnecessary readmissions and seniors demand to “age in place” at their homes or independent living arrangements. Technology to monitor seniors and patients through wearable biosensor devices and other in-home equipment that can automatically transmit data to cloud-based servers will facilitate this evolution.

EHRs, on the other hand, will essentially evolve into a personal health network accessible on mobile technology that is patient-owned, patient-sponsored and becomes a real-time on-demand vehicle for therapy management. Clinicians and providers, encountered remotely over the Internet and in-person, will become advisors or coaches rather than the current batch-processing model that is essentially a direct descendant of the industrial age.

Hospitals can get a head start on this approaching mobile-driven reality now by equipping clinicians with smart mobile applications that guide and support their proven workflow. The mobile technology would allow them to deliver safe, high-quality patient-centered connected care that is rewarded under value-based payment models and promotes improved clinical outcomes.

Joe Condurso is president and CEO of PatientSafe Solutions.



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