Great techspectations for the inpatient experience

Everywhere you turn technology makes our lives easier. Yet we take it for granted – until it’s not there.

I spent the holiday week in Boston with family. I observed every day, commonplace technology in my travels, our hotel stay, shopping, eating out, and more. We booked our airline tickets online. We check-in online or at an airport kiosk. We pass through security and find our current gate info on large screens conveniently located. Barely any human contact except when the flight attendant checks our seat belts and offers us pretzels and a drink. The safety information is a video and when we arrive we find the right baggage carrousel on another large screen.

Then there’s ground transportation. We decided to try the Silver Line for a free ride from the airport to near our hotel. An overhead screen told us how many minutes before it would arrive at our terminal. Once onboard, the automated voice system and digital signs told us which stop we were at – all about GPS technology. We ordered Uber rides during the week from our iPhone and got receipts sent to our email accounts within minutes of the drop off.  Uber is GPS technology on steroids. When we drove a borrowed car on the tollway, EZPass paid our tolls.  We could have used ZipCar, another transportation option based on wireless technology.

At the hotel, we could have checked in with a mobile app at an iPad station at the desk. Keycards were programmed for our room where we used wireless to connect to the world.  Remember when Internet access was not a given and didn’t always work in hotel rooms???

While shopping for gifts or doing returns, we can scan barcodes ourselves to check a price and the clerk scans to see if the item was bought there and returnable.  At some restaurants, we are handed an iPad with the menu on it.

At church on Christmas Eve, amid the candles, the minister has her homily and readings safely in her hands on her mini-iPad.

But every day, we were visiting a family member in the hospital and there, the technology experience was much different and simpler. We relied on confusing posted signage in multiple connected buildings to find our way around day one. We saw basic info such as the nurse on duty and today’s date handwritten on a white board in the room. Like many hospitals, this one had a relatively new EHR that the staff is still learning and deals with minimal paper. But the patient experience, aka the consumer, has little technology available to them.

So how could this health care experience be different for our patients and their families?

  • Way-finding apps that you can get on your mobile device to guide you from the front entrance to your destination. Yes, some hospitals are trying these but they are rare.
  • Digital patient education, information and entertainment systems at the bedside. Imagine having at your fingertips information on who is taking care of you, when your next procedure or test is, info on when you may be going home, patient education specific to you, ordering meal service on demand, and a range of entertainment options. Hospitals are at various stages of implementing these kinds of interactive patient care systems.
  • Family and friends who can’t visit in person having access to secure communication for updates,  as much info as the patient is willing to share. These kinds of online caring communities are more common for long term illnesses and much appreciated by all involved.
  • Case management information that your family can easily access during your hospital stay so they know when you will be ready for discharge and what your post hospital stay needs will be. Still largely an in-person discussion that family members have to make sure happens.
  • All follow-up visits and tests scheduled for you before you leave the hospital. It would mean using the scheduling functionality that already exists with integrated EHRs plus a focus on customer service.

Does this sound like a better patient and family experience? It’s the kind of experience you’d expect given the level of technology in other parts of your life.

Of course, we have to strike the right balance. We all care for elderly and less tech savvy patients.  And we can never lose the basic human touch that everyone wants and needs when we are sick or in a healthcare crisis.

As we focus on improving customer service, developing patient centered care models, and increasing overall patient engagement, I’m optimistic that as an industry, we will make progress in the next year to bring more of these scenarios to reality.

18 thoughts on “Great techspectations for the inpatient experience

  1. Don’t get me wrong but sometimes a technology overdose worries me. I personally don’t prefer being treated as a target and hence all those analytics running on my internet presence gives me jitters.

    I appreciate and endorse everything that makes life convenient for me but as you said striking the right balance is the key to technology initiatives.

  2. John Krauss on said:

    This is a great vision, and I look forward to the continuing implementation of improved electronic resources to provide us with just the information we need, without removing the compassion that we need to provide our patients. I have some specific comments below.

    •Digital patient education, information and entertainment systems at the bedside. Imagine having at your fingertips information on who is taking care of you, when your next procedure or test is, info on when you may be going home, patient education specific to you, ordering meal service on demand, and a range of entertainment options. Hospitals are at various stages of implementing these kinds of interactive patient care systems. This is a huge project with many steps. The most important to me as a physician is to have available to me the current physician covering the patient. Even with sophisticated Epic tools, I can spend 10-15 minutes finding out who is the nurse covering the patient, and who the first contact physician covering the patient. I have never been able to find out what time tests are scheduled for my patients. Each department keeps their own schedule, which they need to do to efficiently perform their work, but then interlocking those schedules in a daily patient schedule that is the most efficient for that patient, is impossible. The patient’s then often arrive to an MRI in pain unable to complete the test without general anesthesia, or are bumped from a test due to an emergent case using the resource (a stroke patient requiring a hyperacute MRI, an invasive IR case taking 2 hours rather than 1 hour), and then the patient, the nurse, and the physician cannot see when the next available slot is for the test.

    •All follow-up visits and tests scheduled for you before you leave the hospital. It would mean using the scheduling functionality that already exists with integrated EHRs plus a focus on customer service. While some of the functionality exists within the EHR, the request to schedule a test on a certain date, and especially the request to schedule a multiday chemotherapy regimen with associated labs and follow up physician visits and radiology tests does not exist in Epic.

    I look forward improving our use of technology, and even inventing some of our own technology, like Dr. Kevin Tremper’s Alert Watch anesthesia monitoring system, as we go forward in our journey to provide the best patient care possible.

    John C. Krauss, M.D.

    • Sue Schade on said:

      John, thanks for the feedback and reality check on where we’re at currently at UMHS and what some of the challenges will be in the future. Look forward to working with you and your colleagues to address these needs.

  3. Sue, I love your vision for the future of the healthcare environment. However, I’d like to see this expanded beyond the inpatient setting . Continue your thoughts and imagine having out-patient appointments and tests easily scheduled and GPS directions automatically loaded to your phone — not to mention any preparation instructions. I used to be concerned that technology would take the place of human touch, but now I think that the effective use of technology in healthcare will free up humans to do the important things and allow more of the much needed “human connection” in health care. Thanks for a thought provoking piece.

    • Sue Schade on said:

      Laura, thanks for the feedback – absolutely agree that there are the same needs in outpatient setting. You are right about freeing up people to do other important tasks by leveraging technology.

  4. Mike Dorsch on said:

    Sue,

    There are definitely technologies that could improve our patient’s experience. We have created a patient education application, but would like to expand that beyond one disease state. iBeacons, or “nearables”, are of particular interest since they are can help people with location (way-finding), provide the health system with information about patients and are easily implemented. I would love to ideate and help create the best patient experience.

    Thanks,
    Mike Dorsch, PharmD, MS

  5. Donna Roach on said:

    Great article and blog! One thing I would note is the difficulty in getting technology to the smaller/rural hospitals. Recently my mother was hospitalized 4 times over a period of 3 months. My parents live in a remote area, which is served by a small critical access hospital. It took several phone calls and followup discussions with the nursing staff and case management to find out what was happening. The PCP was not cooperative and resented having to answer to someone else. Now these aren’t all technology issues, but some of this could have been alleviated through technology. I appreciate your insights and your thoughtful way of looking at the issues we deal with in health care.

    • Sue Schade on said:

      Donna, thanks for the feedback. Hopefully with the Meaningful Use funds, more and more small/rural hospitals that couldn’t previously afford EHR have been able to in recent years. However, we both know it’s more than just the core EHR that’s needed when it comes to improving communication and data exchange.

  6. Jack Billi on said:

    Great post. One question: do we need to pilot these healthcare-related connections in manual form first? For example, if we can’t post the name of the treating medical team, or the steps to discharge, or plan of care for the day on a whiteboard in the inpatient’s room now, how can we do it electronically? While working on making all this info available electronically in health settings, we also need to work on the reliability of the information and even its collection in the first place. Key clinical staff often don’t all know the plan for the patient or discharge date. Collecting and posting manually is a way of working through the issues of availability and accuracy now.

    • Sue Schade on said:

      Jack, you make a great point. We need to ensure we have good process before automating it. But technology can also open up new opportunities and that’s what we need to consider when looking at current problems and gaps in our processes.

  7. Given my recent experiences in hospitals, including as a patient in the ER and a surgery patient, and accompanying my mother to the ER, I have a patient-centered view of these issues.

    1) Not only was signage confusing — the map I was given to my surgeon’s office contained the address of the building, but the signage only referred to the hospital’s *name* for the building — it was hard for my husband to see. He’s legally blind (congenital glaucoma), and a way-finding app would be invaluable to him and others with visual impairments. Plus which, it could be easier and less expensive to incorporate multiple languages into an app, than to do it in physical signage.

    2) No one knew when my surgeon would be there during his morning rounds. I was already exhausted from nurses coming in every two hours during the night to check blood pressure, administer meds, etc., but I didn’t sleep deeply that morning because from 6:00 to 10:00 a.m. I kept wondering whether the surgeon would be arriving. An app to give me the surgeon’s ETA would have given me peace of mind to get needed sleep.

    3) Access to pre-op information and instructions via an app might alleviate the problem of multiple documents saying different things, such as when to return to have sutures removed, for how long I needed to avoid submerging the incision in water, when I could expect to drive again, etc.

    4) On a lighter note, I wish I could have accessed the x-rays taken at the end of my surgery, to show people how cool and Frankensteins-monster-like the plate and screws in my neck were. 😉

    One win I observed in an ER recently was a Cantonese interpreter working via Skype (or similar). From my mediation work I know that Cantonese interpreters are rare here in Washington State (only six that work in the courts!), and this would have been a lifeline for an elderly patient and his equally elderly wife.

    • Sue Schade on said:

      Louise, thanks for sharing your patient centered experiences. Stories like this help ground us in what kinds of solutions are needed.

  8. Sue,
    Great post. We have become so used to (and dependant on) interactive technology in our daily lives. With our devices in hand, we are directed when, where and how to go places and get things done all with the purpose to be more effcient, more informed and better prepared. To some, that makes us feel more empowered, while others become overly dependent…. I laughed when I heard my brother-in-law uses his phone GPS to get to work everyday… the same office he goes to EVERY DAY!

    It’s interesting how healthcare is behind in this technology. I simply drive by Walgreens and an alert pops onto my phone with a special on something I commonly purchase there. It knows I’m driving by and my purchase history. I must admit… I have turned in and gone into the store.

    With interactive patient care, the benefits are big but the challenges are huge. To allow the patient to use an in-room device to turn down the lights, order food, meet their care team, read about their procedure, learn about post-visit care instructions, pay a bill all while providing access to email/facebook/skype/nextflix provides benefits on so many levels (for both the patient and the care teams). The challenge is Interoperbility.

    While their are companies making great strides in this space (Get Well, Oneview, Skylight, etc.), these systems need to have access to so many applications within the hospital that true integration could take some time (and money). While improving the in-patient experience remains high on the to-do list for many hospitals, they may have to wait for the technology (and the industry) to catch up. For now, the whiteboard and the wired remote with the big red “Nurse Call” button may be all we get.

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