Transcript Bar Code Scanners Label Printers ED

Ankur Seth
Mobile Strategy for BIDMC
June 4, 2010
Agenda
1. Scope and Recommendation
2. Methodology
3. Proposed solutions –Lab and Medication workflow
4. Risk and Mitigation Plan
5. How other players are preparing for future?
6. Long term strategy and implementation
7. Assumptions and Risk
8. Recommendation
2
Scope
• Immediate solutions for using mobile devices in
scenarios—
-- Medication Management
-- Lab sample collection workflow
• Long term strategy for mobile devices usage in
BIDMC
3
Immediate Recommendation
Correct Patient Identification requires Front end
Labeling at patient bedside
Every bedside  Bar code scanners with display
ICU/ED Label printer on bedside
Wards Use a cart with shelves – Bluetooth enabled
Label printer for each phlebotomist and nurse
4
Long Term Recommendation
• Become vendor/ device agnostic, support
applications, let user decide what form factor they
need accessibility
• Set up an Innovation mobility lab – due diligence on
new technologies/offerings usable in our workflow and
support accordingly
5
Methodology
Requirements Gathering
at BIDMC
Mapped user pain
Identified Best Practices
points with present
technologies
Research on
present technologies
6
Pain points
Nurses
• Nurses move back and forth, use shared printers
• Work load can be overwhelming, human error
possible
• Too many different devices used in care settings
Lab and Admin
• Right sample/drug, right patient at the right time
• If Lab does not receive correct labels, rework
causes delays and can lead to errors
• Standardized processes should be followed
everywhere
Physicians
• There should be quality check near the bedside
• Turn around time is the key in ED
7
Best Practices from other settings
Health Systems
Mayo Clinic
Best Practices
Future
Phlebotomist drags a CoW with all the devices , views Standardization access to EMR , and
EMR and scans, prints from its CoW
printing strategy in mobile environment
Partners (B&H ,
MGH)
Mediation workflow is automated, Lab sample is not. iPod has opened doors for many others
Carts have scanners and boxes filled with drugs for
to follow and invent. Future can be
patients
Healthcare iTunes/ Podcast
Unit level planning in different workflows. Barcode
scanner in every bed . Specimen collection by rugged The ideal device might not be invented
handheld and mobile wireless printer
yet, but we need to be prepared for it
Mandatory training sessions before circulating any
device. Major usage in BlackBerry and Motion C5
Exploring new device usage
Bed side administration of medication-right drug to right
patient
Exploring new device usage
Intuitive applications will force users to
Owns applications, does not configure devices, Bar
use devices which can ease their
Code technology reduces errors*
workflow
VA
Clinicians decide if this device is good for them
HCA
Johns Hopkins
Hospital
M.D. Anderson
Center
Tenet
Kaiser Permanente Mobility Innovation Lab. Use Bar code extensively
Successful enterprise wide deployment of iPhone using
Provide secure access to information
Mobility can be used for accessing
health info anytime, ability to self
manage health.
* Ref – Publication on Effect on Bar code technology on safety by B&W –New England JoM ‘10
8
Gaps with Present Technologies
• No one device fit in all solution—viewer, printer, scanner
• Usability and Form factor are key decision criterion
• Products cannot be customized based on user preferences
• Ability to work with CPOE and eMAR in future needs to be
tested
9
Proposed solutions—Lab Workflow
& Medication Management
Bar Code Scanners Label Printers
ED*
on bed side (50)
on bed side (50)
ICU*
on bed side (77)
Wards
on bed side (544)
on bed side (77)
keep on a mailing/shopping cart with
other devices(12+60)
* Maximum error prone places—Ref Clinical Pathology Quality Report Q4-09
10
Process Improvement required
• ED – Label printed at triage and
• ED - Need bed side printing
carried all the way
• ICU – Centralized printer
location, not easily accessible
• Wards – Carry multiple devices
• Ambulatory– Batch printing of
labels
• ICU - Keep printer in central location,
access to nearby rooms
• Wards – Provide carts with
racks/drawers to organize equipments
• Ambulatory –Batch labeling should
not be allowed.
12
Pros and Cons of Recommendation
Pros
Cons
Scanners used in both Lab and A large inventory to manage
Medication Workflow
Support bed side administration Enterprise wide deployment
ED and ICU have greatest
potential for error - give them
scanner and label printer at
point of care
Workflow change required
Scanner can be integrated in
eMAR and LIS to tell if right
amount of drug given, right
sample
13
Risks and Mitigation
Risks
• Bar code scanner get
stolen.
• Batteries run dead
• Process Adherence
Mitigation
• Use existing active RFID
inventory tracking to avoid
theft
• Make processes mandatory
to maintain the integrity of
the system
• Mandatory training to
nurses and phlebotomists
using these devices
14
The Future
• Consumer products are gaining popularity
• Apple ahead of the race / Other players are coming
with their offerings
• Native applications, App store and ease of use
strengthening them
• Information, accessibility to data is within the reach of
healthcare professionals
15
Thinking Long term—Problem of plenty
Companies
Dell
Microsoft
New Innovation
Dell-Tablet; Applications Run in virtual environment
Windows Phone 7, Augmented Reality
Palm; HP Labs –Paper computing, Smart dust for infection
HP
control
Native App creating difference, usability gives apple an
Apple
advantage
RIM
Ability to talk with peripherals, privacy compliance
Vecna
Using robots for providing care
Google health as a back end database accessible from any
Google
device
Perfect Serve Intelligent message routing system
Patient Keeper Application :: Intuitive Report viewing tool
Voalte
Application :: Communication inside hospital
Application::Primary Doc to Expert doc connection
16
What Key Opinion Leaders say?
• Google, Sr. Prod Manager- ’Consumer centric Health management
might be the calling‘
• mHealth, VP- ’Mobile devices and applications will be used as
resources in Disease Management ‘
• Microsoft, Director -’Phones can be used as a window to a different
world in future’
• HP, BDM – ’If you don’t take user feedback, you’ll end up making
mistakes. Knowing your user is the key’
17
What other hospitals say?
• John Hopkins ,CIO – The ideal device might not be invented yet, but
we need to be prepared for it
• Partners Healthcare ,CTO –There’s a class of notifications, views and
transactions that healthcare consumers expect to access on the go
• VA, Director, Emerging Health Technology – Mobility needs to
support the concept of Care anywhere and everywhere
• Kaiser, Head Clinical Innovations– Devices might be hyped, but
mobility is an operating reality, it is hear to stay.
18
Our Long Term Strategies
• Mobile devices can change
their nature/form in future
Strategy
• Work on accessibility, don’t
lock a device
• Be vendor/device agnostic
• Let consumer own the
device
• Goal—Improve user
workflows
19
Proposed implementation
Set up an Innovation mobility lab –
• Collaborate with vendors(Apple, HP, Google etc) and
research labs (MIT Media, IBM IRL)
• Perform due diligence of new technologies/offerings
• Usability analysis in our workflow and support accordingly
• Users bring their device, we provide accessibility to
system
20
Criterion for selection
• Data Security
• Infection Prone
• Inter-operatibility
• Form Factor
• Connectivity
• Support
The final push by the user
21
Assumption and Risks
Assumptions
• Medical Safety will be
improved by using
technology
• Devices will continue to
evolve
• Apple will not be the only
player in the market
Risk
• Data Security
• Infection propagation
• FDA compliance
• Technology adding to
process overheads
22
Conclusion
• How mobile devices can be used in clinical settings?
• I have workflow related problems
 Can mobile devices/application solve them?
If they can help me on my pain points, definitely they
can be used
23
Recommendation
Frontend labeling
Every bedside  Bar code
scanners
ICU/ED Label Printer on
bedside
Wards Use a cart with
shelves -- Label Printer for
each phlebotomist and nurses
• Become vendor/ device
agnostic, support
applications,
• Let user decide what form
factor they need
accessibility
• Set up an Innovation
mobility lab
24
Acknowledgements
• Amy Goldman
• Brigitte Bowen
• Gina McCormack
• Henry Fieldman
• Holly Dowling
• Jan Olson
• Jane Foley
• Joe Cross
• John Powers
• Julius Yang
• Kim Sulmonte
• Larry Markson
• Larry Nathanson
• Pat Folcarelli
• Rebecca Hildebrand
• Tricia Bourie
John Halamka
25
Thank You
26