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Empowering Clinicians with Clinical Mobility: Experiences from the Bedside

New York Presbyterian is one of the largest, most comprehensive health systems in the nation, with more than 2,600 beds across six campuses.  NewYork-Presbyterian Hospital ranks #1 in New York and is consistently among the top hospitals in the nation, according to U.S. News & World Reports. Each year, nearly 29,000 NewYork-Presbyterian professionals deliver exceptional care to more than 2 million patients (1).

One of the key aspects of our enabling informatics vision has always been “No Physical or Application Tool Belts” for our clinicians – simplifying their interactions at the point-of-care, improving quality of care, and addressing unintended consequences of EHR adoption. Over the years, we have worked collaboratively with our vendors to create new and improved use cases for mobility.

We began our clinical mobility platform journey in 2012, when we expanded our core mobile medication administration product into a unified solution that encompasses specimen collection, infant care, blood administration, and nursing assessments. It was a 5-year journey to iterate on the right form factor, right integration, right infrastructure setting, and right use cases. We are now embarking on a journey to expand on the same foundation to enable care team communications via a single unified platform.

Currently, over 6,000 clinicians are part of this clinical mobility network providing positive patient identification, care team collaboration, and documentation workflows for medication administration, specimen collection, mother-baby/mother’s milk matching, and nursing care plan execution at the point of care.  We have administered over 22.6 million medications and collected over 4 million specimens using the same clinical mobility solution.  With this volume of coverage, we are significantly reducing preventable medication errors, improving specimen collection efficiency. Our specimen collection processes has seen significant improvement across overall turn-around times, immediate notifications to Phlebotomist for stat collections, reduction of missed draws, and 20%+ reduction in duplicative test orders.

Functionality that has been enabled on our smart mobile devices includes:

-Bi-directional medication orders/eMAR integration with EHR vendor
-Bi-directional dose integration with EHR vendor
-Bi-directional documentation of care interventions such as Pain Assessment/Reassessment and Falls Risk with integration with EHR vendor
-Lab orders and collect to/from Lab System
-Secured texting
-Telephony integration
-Care team and directory integration

On the care team communications front, the clinical mobility platform we invested in have already been processing one-way messaging and notifications to frontline clinicians.  In the second phase of enhancing our care team communications, we are evaluating the most reliable path to expand on the same platform with additional Clinical Communications functionalities. This upgrade will enable clinicians to engage in voice (VoIP) and secure text message communications  (individual and group) by leveraging patient and clinical context from the EHR.  Since implementation of our clinical mobility platform, over 45 million notifications/messages have been transmitted on our platform.

NYP has the world’s first enterprise-grade, clinically integrated, and mission-critical clinical mobility solution deployed on iOS devices. It is used across the entire clinical user population.  With close to 2,000 devices deployed, the smartphone-enabled mobility environment allows for continuous improvement in eliminating harm, reducing waste, and improving productivity.  The added benefit of exchanging real-time messages with contextual clinical data from the EHR and specific clinical events help our clinicians work more effectively and efficiently together. By enabling clinicians to remain at the bedside through true mobility, more accurate and real time data can be captured to drive enterprise-wide clinical performance improvement.

In the future, our plans include adding additional analytics functionality, enhanced blood product verification, integration with our bed management and patient flow systems as well as further expansion of point-of-care documentations that can reliably help us execute nursing-sensitive quality bundles.  The development of our clinical mobility environment has been the result of collaborative efforts between NYP stakeholders and our industry partners – a truly interdisciplinary group of technical, infrastructure, informatics, and clinical came together over the course of our iteration to make this a reality.

When we step back and evaluate the progress we’ve made, given advances in technology and evolution in our strategic thinking when it comes to clinical mobility,  one William Gibson quote comes to mind “The future is already here, it’s just not very evenly distributed. “

About the Contributor

Rosemary Ventura, MA, RN-BC, is Director of Nursing Informatics at  NewYork-Presbyterian

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