CHIME is chiming in on the value of mHealth.
The College of Health Information Management Executives unveiled a case study this week that examines how a California-based home care and hospice agency is seeing benefits by using tablets.
The process wasn't easy, though. The 11-page case study points out that the organization spent a decade working with laptops and smartphones – and experiencing problems with each – before moving on to tablets. It's indicative of an mHealth movement that is moving by fits and starts toward acceptance.
Sutter Care at Home, an affiliate of Sacramento-based Sutter Health with more than 1,300 caregivers in 23 counties throughout northern California, transitioned to tablets running on the Android system in 2012. According to Jennifer Brecher, Sutter Care at Home's project manager, the tablets offer caregivers instant access to important information from the system's Epic electronic medical record, as well as real-time communication with fellow caregivers for care coordination.
“Tablets have sped up the flow of the process,” she said in the case study. “In the past, if one of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the electronic information about the Monday visit available. This is better from a productivity standpoint and better for the patient.”
Phil Chuang, Sutter's chief strategy officer and former director of information services, said the group had tried for about a decade to bring mobile computing into the home care process. They started with laptops, then tried smartphones, but each had limitations that affected how the caregivers did their jobs in sometimes-remote parts of the state.
They then switched to 7-inch tablets equipped with 4G mobile broadband access, and have seen noticeable results.
With the tablets, Brecher said, caregivers can now finish documentation on a visit in 24 hours, rather than the three days it took before tablets were introduced. They can also enter photos into the medical record, consult with specialists and order medical supplies (the agency reports a 20 percent per-visit decrease in supply costs in the first year that tablets were used).
“If we want to achieve better outcomes for care, we need to be sure that we are staying on top of best clinical care practices,” he said in the case study. “It’s unfair to expect a field nurse to keep up on what is best practice in all areas. This system helps drive best practice; a wound care nurse manager determines what supplies should be on the formulary and keeps it updated as improved supplies become available on the market.”
Chuang said the agency spends 18 hours training a new nurse to use the tablet, a process that includes classroom time and encouragement to take the tablet home and practice with it. The program also requires a lot of work from the IT department, which has to keep track of a thousand devices spread out all over northern California. Sutter officials said they purchase tablets commonly available to consumers, the only requirement being that they run on Android.
Among the advantages, Chuang said in the case study: IT can manage the devices from afar.
“Mobile device management is a way to bring consistency to the devices out there,” he said. “The system allows us to know where a device is, to wipe a device, to push out new policies. Our level of control is far more powerful than anything we had with laptops. We know the status of every device, without any user intervention.
“There are always issues with security compliance with any device,” he added in the case study. “If someone loses a laptop, how do you know if it was encrypted? The last time it was on the network is the last time we can tell. When our security office wants to know whether a device was encrypted, we can tell them exactly when, and we can issue a wipe command and erase the device immediately. We have a level of security that we never had with laptops.”
Sutter officials say the tablets will improve care coordination and documentation for homecare nurses, who face unique challenges in their mobile environments. They can improve their documentation, communicate and consult with other caregivers and share data and resources with their patients. Chuang expects the project will be even more meaningful as accountable care measures take root, putting more emphasis on care coordination, prevention of hospital readmissions and data transparency.
“That’s the power from a patient care perspective, that we can communicate with you and the patient wherever you are,” he said. “That’s what the mobile technology gets us.”
Written By:Eric Wicklund - Editor, mHealthNews
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