mHealth: What happened in IS?
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Looking to leaders in other fields is vital because “the thing that makes healthcare work, so far, is that the caregivers are so dedicated that they make the processes work,” Potter said. “But as the Baby Boomers come toward us—and even now—the healthcare system is getting stressed to the point where it won’t hold anymore. Mistakes are going to be made,” he warned.
In the non-information services space, healthcare has quite advanced technologies, Potter observed. For example, TOH has a cyber knife (radiation treatment for oncology) that can noninvasively kill a single cell in a brain tumor without even having to shave the patient’s head. The hospital also is installing a DaVinci robot. “The technologies are quite amazing in that space. So I got to wonder, what happened in IS? We still have old green-screen systems and not very sophisticated integration.”
Healthcare has created its own technology culture, according to Potter. For example, although TOH has an EHR, “we have nearly 4,000 residents and students carrying paper around. How does that happen?” Potter wanted to find out, so he surveyed physicians, asking them how much of what they needed to have was available in the hospital’s EHR. Across specialties, he got an almost consistent answer of one-third, or 30 percent, he said.
“So I challenged my team to get that as close to 100 percent as possible in the first year. We used strategies such as document scanning, front-end voice recognition. We developed templates that [can] discretely distribute data in our EHR,” said Potter. When he surveyed the same physicians the following year, all but two reported that 100 percent of what they needed was electronically available, he said.
A few days after receiving the good news, Potter observed a physician sitting at a nursing workstation on a clinical unit, with six to eight residents. The physician pulled up the roster of patients, then printed it and the residents built files and created folders, including printouts of lab results and other information. “The residents built all these files, and they went off with the paper. What happened?” he said.
“They went to a conference room and planned the care for each of the patients for the day because having one leg in the electronic world and one leg in the paper world, that’s the only way they could do it,” he explained.
“At that point I realized we’re not finished yet.”
TOH was rolling out computerized provider order entry; Potter was concerned that when a physician at a bedside needed to change a medication order, he or she would write it down on a piece of paper if no effective electronic tools were in place.
At about that time, Apple had begun promoting the iPad as a mobile platform, and Potter obtained four, giving two to physicians and two to his technology team to see if TOH could implement an iPad-based platform. The answer was yes: Today 2,000 TOH physicians use iPads and are unwilling to give them up, he said.
“I think generally in healthcare, we’ve forced people to break their processes to get to the data. So as we put PCs [and] other solutions in, they weren’t practical for people to use. We have a whole museum of tablet PCs and PDAs and other things that didn’t work for various reasons,” Potter said.
“We should be able to provide information on whichever device is most convenient to the workflow,” he said. Currently, TOH has more than 2,000 iPad and iPhones in clinical use. “I’m not saying iPads are the best: I don’t really care. … The iPad has served us well in what we want to do,” he added.
“Mobility is game-changing: I’m observing it,” Potter concluded. “By the end of the summer we’ll have close to 5K mobile devices. … The feedback I’m getting is that this is the right direction to take.”