Mobile Techologies in LTC: Tips for Maximizing Value

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In an article today “Quality Care at Hand” McKnight’s highlighted the increasing importance of mobile technologies to maximize efficiency, improve care coordination, and most importantly – drive early interventions that prevent readmissions. Highlights:

“It isn't good enough to just collect data. Providers must now also interact with the data by gaining immediate access to a resident's care plan, care requirements, most recent vitals, safety precautions, and so on, while communicating with colleagues to facilitate quick decision-making and collaboration,” said Teresa Chase, president and CEO of American HealthTech. “Mobile devices make all of this possible and can also provide the best opportunities for early detection, intervention and the avoidance of hospital readmissions.”

Link to the full article:

http://www.mcknights.com/quality-care-at-hand/article/220757/

In Long-term care, we first started seeing PDAs (Personal Digital Assistants) well over 10 years ago, as care teams saw opportunities to have increased information and documentation closer to the patient.  As medical records have increased in richness and reach, demand for larger screens is no surprise and tablet/pad style devices are of increasing interest.  The upside: bigger screen, more information, more proactive care, more service closer to the resident.  Mobile devices (e.g., tablets) are gaining traction in the industry for a variety of reasons:

• Pricing is improving.
• There are multi-use capabilities – phone, email, digital signatures – to enhance the management of medical records.  They also do a great job of presenting nice large images.
• SNFs are increasingly looking more acute-care like.

Workflow and role is a big decision point for device selection. What is the staff member trying to accomplish and which device makes the most sense? For example, it is a management type person who is reviewing information or is it a high transaction role that is collecting a lot of data – device selection makes a big difference in these scenarios. Appropriate device selection is critical for efficiency. Can it be used for multiple functions and/or multiple roles? We know dollars are tight so it’s imperative providers get the most for their money.  From the inception of EHR at American HealthTech, we have supported many types of devices over the years – to keep up with the growing business requirements of providers.  It’s all about choice, flexibility, and focusing on maximizing patient experience.  We don’t recommend one over the other; but do educate clients about the tradeoffs.

While there is promise and excitement with mobile devices (increasingly tables)…there are a number of considerations in clinical applications: 

• Theft.  The biggest challenge, hands down, is the prevalence of devices walking out the door.  They have street value.
• Damage.  With desktops, the biggest Like anything you carry around, it will get dropped – on the floor, in water, etc.  You’ll need to budget for breakage. There are accessories that can help like comfortable hand straps for tablets.
• HIPAA.  Make sure your software properly manages PHI on devices to avoid issues with HIPAA should devices disappear. Provision must be made for devices to be “wiped clean” of data if lost or stolen, to prevent having to deal with a breach that if large, could significantly damage your reputation.  Screens that log-out automatically after they’re idle are esseintal, so that passers-by don’t inadvertently see patient data they’re not authorized to see.
• Charging.  Battery life has been improving over the past few years.  You’ll have to ensure that devices can last an entire shift, and you’ll also need space to charge them.  Also, performance of batteries degrades over time; so while at in the beginning they may last a full shift, over the months they may not.  It’s good to plan or extra devices or batteries during shifts and at shift change time.
• Productivity.  Care must be taken about rules and guidelines for acceptable, work-related use.
• Resident interaction.  Mobile workers with mobile devices have a can boost documentation quality by bringing interaction closer to the resident.  Faster, more efficient capture of data means that more staff have access and a more complete EMR.  ADL capture as well as resident interviews required with MDS 3.0 are great examples.  Best practices include not putting the device between the caregiver and the resident while the caregiver is interacting with the device.  The idea is to sit next to the resident where they can see the screen.  Residents love seeing what’s in their EMR and be engaged in the process.  When staff explain what they’re doing and why – the resident will get better, higher quality care if the information is collected completely, efficiently and quickly – so that other disciplines can see the information and adjust the care accordingly. It’s worth looking at workflow, in order to take make sure your expectations are met for service, dignity, privacy. It’s a cultural and staff training opportunity.
• Family responsiveness.  Family members really like technology. They are accustomed to it in hospitals and it says that their mom is in a facility that is using up-to-date technology combined with high quality care. It also makes it more efficient for the facility to get information for the family if there is a question or concern.  
• Ergonomics.  While some devices can fit in a pocket, many mobile devices are larger and must be carried. There are accessories and hand straps, leather cases to help.  Your Occupational Therapists may have some great tips for reducing joint fatigue and other ergonomic best practices.
• Sanitation.  You should check with the manufacturer regarding acceptable cleaning products (wipes and the like) that are safe for the materials of which the device is constructed.  Policies and procedures related to the frequency of cleaning are also a consideration.  There are protections for mobile devices as well.  With eMAR device on a med cart, for example, you can get a sealed keyboards made specifically for the healthcare environment. We are seeing more of those in the market.
• Applications & operating systems.  Windows is still the industry norm for 99.9% of businesses.  Soon, Microsoft  will be releasing  a tablet PC unique version along with a desktop version with the release of Windows 8. Windows based tablets offer a much greater degree of control, security  and familiarity when implemented into an existing Windows-based infrastructure. Android and Apple, while options you can consider, may require additional software to secure and manage them. It’s good to know your costs upfront, as some devices have unique operating systems, and must be managed – including provisioning of users, software licenses, security controls, and more.  
• Wireless.  You’ll need a high-powered network anywhere caregivers will have devices.  In the fast-paced world of healthcare with constant staffing shortages, efficiency is a top priority.  You cannot afford productivity losses related to caregivers walking around trying to find a signal.  They need information on demand constantly.  Also, devices with lower-powered wireless radios may require special management of a wireless network.  The system you design – from devices to the networks that manage them – must be done in concert in order to maximize performance of your care teams.  Wireless networks are a big win for your facilities – not only for caregivers, but also as an expected service for visitors and residents (with proper separation of traffic, of course).
• IT Staffing.  You’ll likely need higher level of management from the IT staff and/or additional resources to provision and mange a universe of devices.  You’ll need more planning, policies, and control.  The future of wired healthcare is here, and we’ll need new talent to help support it!