Interoperability

Several years ago, leaders at a large healthcare system put together a strategic plan that included among its goals to make clinical workflows more mobile and create “smarter” rooms using wireless medical devices. New technologies were purchased based on feedback from stakeholders, and everyone was properly trained on the new tools. Then it was time to go live in three hospitals. “The ultimate hiccup was with reliability of the wireless network,” recalled Kelly Aldrich, who had a key role in that major rollout and is now the chief clinical transformation officer for the non-profit Center for Medical Interoperability. “You can make multi-million-dollar investments, but if you don’t have the reliability of your infrastructure, you’re going to have very frustrated clinicians who do not adopt the technology and will not advance how it could actually work for them.” Healthcare organizations in recent years have been caught off guard by a mushrooming number of mobile devices that continually outpace existing networks’ capacities. Some groups have modernized their wireless infrastructure to securely accommodate the swell of mobile usage. Others haven’t kept pace or aren’t sure where to start. One thing all organizations do know: Failure to build and maintain a secure, reliable and scalable wireless infrastructure threatens to put their clinicians at a disadvantage, and could even compromise patient care if today’s mobile clinical communications tools can’t work as intended because of technical and telephony issues beyond users’ control. “The innovations in technology that are enabling greater use of portable devices, and the clinical communications apps on them, means you must have the infrastructure in place, and often it isn’t there yet,” said Joyce Sensmeier, RN, vice president of informatics for HIMSS. “It has to be a really secure, medical-grade wireless to support this level of access to the information.” A matter of trust Aldrich believes that wireless networks deserve the same attention as other ubiquitous utilities, such as those providing power, climate control and traditional telephony throughout a facility. After all, physicians and nurses shouldn’t miss critical alerts or alarms sent to their mobile phone because they are in a wireless “dead zone.” It’s one reason many doctors still rely on pagers that work regardless of their location. “This is a huge problem around people adopting future wireless technologies,” Aldrich said. Adding more access points is only a temporary fix but may also cause other unintended consequences. Instead, Aldrich advocates that healthcare organizations consider developing a future-ready Trusted Wireless Health plan for both wired and wireless systems that leads to reliable, secure wireless service from any location within a medical facility. Under such a plan, devices are selected based on select data, power and roaming criteria, and they operate within a virtual local area network for greater privacy and security protections. Buildings are architected to place more access points where wireless traffic is denser, while leaving no space uncovered. Patient and guest Wi-Fi-enabled portable devices automatically are routed to another access area to provide network teams greater mobile device management, particularly to prevent BYOD bandwidth and security issues. Interoperability important Alongside a proliferation of Wi-Fi-enabled medical devices and smartphones have come a growing constellation of mobile communications applications. Inconsistent access and voice quality due to unreliable wireless networks frustrate clinicians and fragment their workflows. This is exacerbated when they must use multiple form factors to access a multitude of mobile apps or can’t talk because of poor voice quality. The situation is causing more organizations to consider consolidating devices and apps into a unified solution that integrates more functionality, like telemetry and electronic medical records access. “You need interoperability among these systems for better decision support all along the path of caregiving – from gathering a patient’s history and then moving into medication documentation to the next day’s discharge planning,” Sensmeier said. “That needs to be all cohesively connected so you have all the information you need at your fingertips.” Sensmeier recommends all healthcare organizations, regardless of the maturity of their mobile strategy, to assess what is actually happening within their facilities based on network trends and feedback from those in the field. This is an interdepartmental issue, so it’s important to partner tightly with networking, telephone, clinical informatics and any other stakeholders to avoid any degradations in service. Working together these teams can build a future-proof, trusted wireless infrastructure to keep mobile clinical communications devices – and the users behind them -- working as intended. “This not only makes you more successful in your implementation and adoption and utilization rates,” Aldrich said, “it also makes the products you invest in become useful, instead of useless, tools.”

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Computers and workstations on wheels (WoWs) were designed to help clinicians spend less time working from nursing-station desktops and more time at the point of care. The reality, however, is that the ideal has yet to be fully realized. All too often care team workflows remain fragmented because of the need to access patient data and clinical information from multiple disparate systems. This fragmentation not only breaks down the fundamental human flow of care, but it also leaves patients with the perception the clinician is more focused on the technology than on them. “There are solutions that help facilitate dialog between clinicians or patients. However, there are multiple factors that contribute to that success,” said Nancy Beale, MSN, RN-BC, vice president of clinical systems and integration at NYU Langone Health Systems. Some of those factors relate to the complexity of software in use, Beale continued. “If they have to navigate through multiple systems for a single workflow, like an office visit or rounding on a patient, how integrated is the data between systems? Also, what are the form factors they’re using to access those systems? Is their hardware placed in a position to facilitate communication between a patient and physician?” Some electronic medical records systems still require access through a WoW or desktop, but in recent years more healthcare organizations have been migrating to tablets and smartphones, which appeal to clinicians’ inherently mobile workstyles. In turn, vendors now provide more mobile apps that integrate with the EHR and other clinical communications systems, such as patient monitoring devices, alerts and nurse call. The goal is to consolidate myriad hard and soft functionalities on one device, so caregivers can return to a natural workflow. However, some organizations’ mobile rollouts have been bumpy, and adoption rates are below expectations. This is especially true when clinicians are not included in IT discussions that impact them, or they aren’t adequately trained on the chosen solution. Additionally, deploying mobile technologies that still rely on disparate systems can slow the time spent documenting or retrieving relevant patient data because the clinician must open and close multiple apps that aren’t unified into one communications platform. Lighter options that carry more data heft One reason clinicians have been quick to latch on to mobile technologies stems from how they use them in their personal lives. But consumer-grade systems and devices aren’t typically designed for healthcare environments. Everything from hardware and accessories that hold up to infection control protocols to HIPAA-compliant messaging and devices must be considered.  “Being able to use the phone to be fully functional for a workflow without having to add cumbersome pieces that make it heavier and less user friendly is essential to success and adoption,” Beale said. That includes deploying mobile solutions that can take in verbal information as well as map to discrete data within an EHR instead of always requiring the clinician to be the heavy-lifter; that is, forcing the user to manually add or extract data from disparate systems instead of using an integrated solution that includes voice-enabled dictation. It’s important for healthcare IT teams to deploy and continually manage applications within a mobile device for greater usability and security. As such, a best practice is to ensure data is never stored on the device to prevent potential patient privacy violations. It’s also important to perform usability testing with clinical end users and partner tightly with all stakeholders. Keep it simple; keep it ‘app’ropriate Simplicity and thoughtful integration are important. It makes little sense to encourage clinicians to swap their so-called fat tool belts for slimmer tablets and phones requiring just as many apps. “In the long term, you want clinicians not to have to navigate between multiple systems,” Beale said. Reducing the number and size of form factors and unifying myriad applications often yields more efficient communications, collaboration and coordinated care. Providers spend less time adding or extracting data from EHRs and more time talking with patients and families. When well implemented, this more unified mobile clinical-communication approach repairs previously fragmented clinical workflows – and makes for a better patient experience.