You've developed teams of care, put patients in the center, and coalesced a contingent of physicians, hospitals and post-acute entities. A great start, but now there are on-the-go team members who have to monitor continually changing situations of thousands of people for whom they're accountable. Without a handle on that movement, transitioning to value from volume amounts to coordinating confusion.
Today's technology, however, is rising to the occasion. If mobile devices can be tied to a tracking and alerting application, in a hospital and throughout the continuum of care, patients can be caught coming and going in real time and their care effectively coordinated during their treatment and recovery. In addition, mobile apps have the potential to produce pinpoint decision support.
Within the Hackensack (N.J.) Alliance Accountable Care Organization, a care coordination application pulls data from across that system into messages sent to mobile devices. They identify high-risk ACO members presenting themselves for care and assign actions to patient navigators responsible for managing them, says Denise Patriaco, the ACO's care coordination director. "High alerts" prompt immediate attention while others provide certain status details that coordinators need to know.
If there is a change in status for a high-risk patient, a navigator will be assigned to address the situation immediately, record the measures taken and when they were completed, says Mark Stabile, CEO of TEAM of Care Solutions LLC, the system Hackensack uses. In an ACO, "You can deal with the 40,000 to 100,000 in that [ACO] population if you say, 'I want a quick way to match up the risk and activity in this population, and get it to the right person for feedback.' And the mobile apps create that ability to get the feedback in a way that we couldn't do before." [See sidebar.]
Real-time status is more important than ever in hospitals, which are migrating from high-revenue to high-cost centers. Each member of a patient's care team has responsibility to keep one another informed and managers up to date, says Christopher Wood, medical director of information systems for Intermountain Healthcare, Salt Lake City. A mobile communication tool being piloted at Intermountain identifies all clinicians caring for a particular patient, how he or she enters into the discharge situation, and whether tasks on their end are completed or are preventing the patient's discharge.
Each patient's situation is laid out on a Web-based dashboard, accessible from a mobile phone or tablet, taking reports from everyone involved in the patient's care. "Financially, we want to discharge people quickly; and, as we move from volume to value, we want to discharge them correctly. Then we want to tell care managers, 'They're going home, this is what you've got to do.' "
Alerting a clinician or navigator on the go about someone who needs attention adds value to a value-based model, but mobile devices should be able to do more than that, says Eric Leader, director of product management for Harris Healthcare Solutions, a clinical integration solutions firm. Most clinical decision support directed at smartphones is a conversion of what used to be a PC or Web-delivery application, and doesn't take into consideration that serving a mobile user is different from supporting a fixed point of care, he says.
"The mobile platform, even more so than a PC, needs to be aware of the task being performed," as well as the workflow," Leader says, adding, "Almost no mobile apps are." Mobile apps need to follow a path. For example, with medication orders, instead of scrolling through a med list, a user should get the top four relevant choices for the condition to be treated. That takes more up-front planning, but when a clinician is tapping a mobile device rather than moving a mouse around, the presentation and actions have to be simpler, more intuitive and matched to the things mobile approaches do best, he says.
Guesswork Be Gone
Just by going to the emergency department, a Hackensack ACO patient identified as high-risk trips an alert to a mobile care coordination system that notifies both an inpatient navigator and the outpatient navigator assigned to the patient's physician. "Nobody has to be at a desk to receive an alert," says coordination director Patriaco. Whoever is closer or better able to respond will notify the other so they're not both working on the same patient at the same time.
Either way, the responding navigator comes armed with details on the patient's recent history and as an emissary of the patient's primary care physician. With less guesswork, the ED doc uses fewer resources in making decisions faster, says Patriaco, adding "The really great part of that is patient satisfaction. The patient knows, 'Wow, my doctor knows I'm here already; he's sending his nurse.' " Patients don't feel so helpless and alone, "at the mercy of whoever's working in the ED that day. They feel more secure."
Having coordinators and caregivers continually in tune with a patient's encounters also helps in the field. If a task is generated for a patient who is being seen that day by a home health aide for an unrelated reason, that message can be sent immediately — say, the patient needs a flu shot — and it can be done in the same visit. A return message confirms: Task completed. "As a result, you end up giving more complete and timely care to patients in that type of environment," Patriaco says.
Through up-front planning and thinking about care pathways, IT professionals can equip physicians with mobile apps that apply targeted direction according to the situation, says Harris's Leader. For example, a surgeon should know certain things based on the patient and procedure about to be performed. There should be a way to reduce to a minimum set the most informative items and see it on a mobile display.
"You can't take the time … when you're rolling a patient into an operating room, to look at the med history or the last lab results, because you're going to have 40 results on a mobile device, and that means you'll have to manipulate the controls and probably will miss some things," Leader says. But having the four things most important "for this patient at this time for this procedure" would be great, he says, and better in a mobile app than on a PC.
Mobile devices also should be adapted to easily record quality metrics in care pathways, especially as they figure into reimbursement, says Wood of Intermountain. CFOs will want a doctor to report whether the quality program was followed and the value-based purchasing and meaningful use data gathered. On a mobile device, physicians can view and complete check boxes while working. "Check boxes lend themselves nicely to mobile devices, or vice versa. I'd almost rather point and touch than click," Wood says. "I think in the short-term, mobile devices are going to be one way that we get physicians to enter that kind of data."
Clinical use of mobile technology
Top 10 responses - % of responses
View patient information - 69%
Look up non-PHI health information - 65%
Use for education/training purposes - 49%
Clinical notifications - 42%
Secure communication regarding patients - 39%
Tracking work lists - 39%
Collecting data at the bedside - 36%
e-Prescribing - 33%
Use bar code reader on mobile device - 28%
Monitor data from medical devices - 26%
Source: Third Annual HIMSS Analytics Mobile Technology Survey, 2014