Few health-care sectors are more taxing than hospice operations, whose doctors and nurses have limited time to provide the best care for terminally-ill patients. VITAS Health, a $1.3 billion provider of hospice care, met this challenge by enabling its 8,000 clinicians to quickly admit patients at bedside via iPhones, iPads and mobile applications.
“We put incredible compute power in the hands of our clinicians,” VITAS CIO Patrick Hale tells CIO.com. Mobilizing VITAS’ clinicians is part of a broader digital transformation that includes boosting interoperability among health-care stakeholders, and introducing predictive analytics to augment staffing, Hale adds.
Health-care organizations worldwide have embraced smartphones and tablets to bolster patient engagement and improve care. NewYork-Presbyterian Hospital, for example, offers second opinions and consultations via mobile devices and software.
At VITAS, hospice care is inherently a mobile enterprise, with roughly 80 percent of the organization’s nurses and doctors traveling to meet patients at homes and hospitals, according to Hale. Yet when Hale joined VITAS in 2013, clinicians were still typing patient information into clunky workstations and laptops. And they were taking too long to do it, spending an average of six out of every eight minutes of a visit entering data rather than interacting with patients.
“We took a step back and said we have to get the technology out of the patient interaction,” Hale says.
BYOD ruled out
After evaluating solutions, Hale concluded a bring-your-own-device (BYOD) strategy was untenable for VITAS. Potential inconsistencies in performance and reliability, as well as the difficulty of managing various devices in accordance with HIPAA and SOX compliance rules made BYOD a non-starter.
Ultimately, Hale standardized on iPhone 6 Plus models and iPads, whose touchscreen interfaces help clinicians rapidly on-board patients. The iOS platform is also among the most secure in the world, though managing thousands of iOS devices is challenging.
“We picked iOS because it’s a closed system and gives us more control,” Hale says. “What makes Apple frustrating to most technologists is what makes it powerful to users.”
Mobile applications developed by Hale’s staff allow clinicians to enter patient information into or retrieve it from electronic medical records (EMRs) in real-time. He says the touchscreen interface, manual data entry via a keyboard with swipe and tap gestures, shaves minutes off of each patient visit. The new solution also meant clinicians no longer had to go to the office to scan forms into the chart, and bedside forms are never lost since they are stored digitally. With labor accounting for $800 million of VITAS’ costs, saving a few minutes a day for each nurse is “tremendous to our bottom line,” Hale says.
One feature allows clinicians to tap areas on a graphical representation of a human body to indicate where a patient says he or she is feeling pain. Previously, clinicians typed phrases like “lower left arm” into a PC or laptop. “You’re creating a narrative with swipes instead of keystrokes,” Hale says.
Clinicians can also use VITAS apps to order care-giving to a patient’s home, order pharmaceuticals and make notes using a voice-to-text transcription feature. VITAS also supports Apple Watch for clinicians who prefer more of a hands-free workflow.
Mobile, cloud-first strategy made real
To accommodate this shift to mobile intake, VITAS also had to replace an IT service management (ITSM) solution designed for the PC and workstation era. Hale opted for a SaaS (software-as-a-service) platform from ServiceNow, paired with AirWatch management software.
The solution helps VITAS provision and deploy smartphones and tablets and onboard employees and track the location of each device in the fleet, as well as what clinicians do with the devices and how much data they consume. And integration with startup MobiChord consolidated VITAS’ 9,000-page AT&T phone bill into a manageable database. “We put all of our assets in that bucket,” Hale says of ServiceNow.
Benefits from the switch were rapid and significant, reducing outbound calls between VITAS’ and hospitals’ systems from 917,000 each year to 554,000 in 2016. Replacing workstations and laptops, which included traditionally required investments in antivirus software and other infrastructure, saved VITAS $2.2 million.
VITAS’ mobile system had a major impact on productivity and time management. Training sessions to get clinicians up to speed took only one hour, versus 20 hours to learn how to access the various admission applications via a computer, thanks in part to the touch and swipe capabilities, Hale says. And when an in-take call comes in, VITAS gets an alert within 15 seconds, with clinicians getting to a patient’s bedside in one hour for 70 percent of the calls.
With the workforce mobilization challenge bested, Hale has turned his attention toward new challenges. Disparate systems and protocols, as well as checks and balances associated with cybersecurity compliance, have long been a thorn for data interoperability. VITAS’ automated workflow system interfaces with any EMR system, including Epic, Cerner and Allscripts, etc., and is equipped to accept referrals from any source, including fax, email and phone. But Hale is working to improve the exchange of data between VITAS’ Epic EMR system and the EMR and other patient management systems of its hospital partners. Removing this friction will reduce care costs, improve patient engagement and ultimately, care itself. “There is so much to be done on interoperability,” Hale says.
VITAS is also making major investments in predictive analytics, which Hale says will help the company better anticipate which clinicians, based on individual skillset, to make available to the patient population across the 16 states it serves. This is vital for an organization that services 17,000 patients each day.
“Our average stay with every patient is only two weeks, so moments matter here,” Hale says.
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