Presented by Brian Ackland Principal Software Architect, CSC

1. HEALTHCARE GROUP
ADDRESSING CLINICAL NEEDS
MOBILE COMPUTING IN THE HOSPITAL
HINZ NOVEMBER 2013
Brian Ackland
Principle Software Architect

2. Clinicians Challenge
• 2011 Early Warning System
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Alex Psirides CCDHB
Replace Paper Based System
Record Observations
Calculate Early Warning Score
Send Notifications based on score
• 2012 Enhancing Medical Record Creation for Ward Rounds
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Angus Turnbull HVDHB
Using Tablet Device
Allow Staff to Use their Own Device (BYOD)
Incorporate viewing of laboratory and radiology results
Enable Progress Note Taking during Ward Rounds
Open Source Collaborative Document Editor EtherPad
CSC Proprietary and Confidential
December 4,
2013
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3. The Ward Round
Mobility Suite Access to Ward Patient List
• Select Ward
• Select Order. Bed, Name, Unit or Doctor
• Touch Patient to open Medical Record View
Select View
Ward
CSC Proprietary and Confidential
December 4,
2013
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4. The Medical Record View
Positive Patient
Identification
With Photo ID
Alerts and Allergies
Highlighted when
Medical Record
Opened
Access to
components of the
record can be
configured based on
the users security
profile
Tabs colors and
naming can be
configured to match
common medical
record layout
CSC Proprietary and Confidential
December 4,
2013
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5. 2011 Viewing and Recording Observations
• System Performs Calculations and Notifications
• Touch Slider Controls used for Data Entry
CSC Proprietary and Confidential
December 4,
2013
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6. 2012 Collaborative Document Editing
Menu Action Configured to
use Etherpad-Lite to Record
Ward Round Notes.
Collaborative
Document.
with Patient and Users
Context passed to
document.
CSC Proprietary and Confidential
December 4,
2013
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7. 2012 Social Media Approach to Progress Notes
A simple alternative to the Collaborative Document Editor
Multiple
Users Adding
Note at same time
When shown
as age and
date/time
CSC Proprietary and Confidential
December 4,
2013
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8. The Wider Context
Not just about recording the observations or progress notes
• Viewing and Ordering Diagnostics
CSC Proprietary and Confidential
December 4,
2013
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9. The Wider Context
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Access Anywhere/Anytime
Home
Coffee Shop
Hotel Room
Mac Donald Free WiFi
CSC Proprietary and Confidential
December 4,
2013
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10. The Study Tour - Ottawa 2013
CSC Proprietary and Confidential
December 4,
2013
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11. Ottawa Hospital
iPad Rollout and Usage
• Purchased soon after launch March 2010
• 1st use November, piloted 150 in Feb 2011
• Now 3000 over 3 medical wards
– Providing them free = Popular with users!
– Many staff proved to be “mobile”
– Benefits of bringing imaging or visual
procedural explanations to bedside
• Not locked down
– Benefits of YouTube tutorials etc.
– Staff can install own apps
– “Watch and wait” strategy
• Staff often prefer to desktops
– Quicker to access
– Carried in satchels etc. on wards
CSC Proprietary and Confidential
December 4,
2013
11

12. Ottawa Hospital
The Application
• Developed iPad app in house
– Platform lock-in vs. HTML5 approach
• Backend is now 70% custom code
– Vendor: “You’re on your own”
– Code escrow agreement for base package
– All hospitals still “siloed” like NZ
• Access to patient info, labs, radiology
• Concept of “circle of care”
– Medical, nursing, allied health automatically linked
• Can find & communicate with relevant team member
• SMS and FaceTime capability
– Real-time communication of changes in estimated discharge dates
CSC Proprietary and Confidential
December 4,
2013
12

13. Ottawa Hospital
Challenges and the Future
• Challenges
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Privacy
Infection control: glass screens are easy to clean
Network outages
Each hospital reinventing the wheel much like NZ
• Future Steps
– ePrescribing
– Realtime streaming of observations to EHR
• Limited by device manufacturers, update cycle
– Printing: AirPrint
– Medication dispensing and blood labelling: ?RFID
• May face challenges from busy nurses
• Aim to have infusion pumps etc. recognize patient + drug
– Medical notes
• Still paper based, trialling dictation + voice recognition
• Paperless may give great flexibility/mutability
CSC Proprietary and Confidential
December 4,
2013
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14. The Study Tour
• Canada eHealth Conference (Ottawa May 2013)
– Mobile Devices Are they secure enough for our patient data?
• Arron Hendricks University Health Network Toronto
• Extensive Study of different devices iOS / Android
• 15 Slides Covering the Dangers the need for MDM, remote wipe, training,
dangerous applications, jail breaking, hacking.
• Last Slide Alternatives
– Web Based Applications
– Remote Desktop
CSC Proprietary and Confidential
December 4,
2013
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15. Clinician Challenge
Implementation Challenges
• All Care Providers Need Access
– Change Management
– Training
– Devices/Desktop/Mobile/Bedside/COWS
– The “what if” questions
• Initial Target Closed Loop Areas
– Defined Handover Points (Print Notes for Medical Record)
– Emergency Department
– Home Care Units
CSC Proprietary and Confidential
December 4,
2013
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16. Clinician Challenge
Implementation Challenges
• Engages Vendor and Clinician
– How do we get the organizations engaged?
• Current Hospital Approach to ICT
– Large / long procurement cycles / regional focus
– Revolution rather than Evolution
– Waterfall Specification/Fixed Price Quote/Delivery
– How do we move to a Agile Approach?
CSC Proprietary and Confidential
December 4,
2013
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17. Innovation Cabrini Healthcare
CSC Proprietary and Confidential
December 4,
2013
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18. “Better Care for Patients and their Families”
• Results at Cabrini
• 12,800 clinician hours annually Based on each doctor saving 10
minutes per day
• 792 nursing hours annually Based on only 2% of results viewed
through system instead of provided over the phone
• 480 bed days annually Based on only 0.2% of results viewed through
system resulting in the investigation being initiated on that day instead
of the next
CSC Proprietary and Confidential
December 4,
2013
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