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Real Care in Real Time: Mobile devices help improve healthcare

Delaware Public Media

Only a few yeas ago, a coughing and wheezing child with viral respiratory infection might prompt an ER doctor to call a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington for a consult and a transport.

“When we would we just get a phone call, it was very easy for the critical care team to say, ‘I can’t see the patient. Send them to our emergency room,’” said Dr. Nicholas Slamon specialist in pediatric critical care at the Alfred I. duPont Hospital for Children, part of Nemours Health System.

Today, area ER doctors are more likely to reach for an iPad.

Using a video app, he or she can talk to consulting physicians at the children’s hospital “face-to-face” and turn the device’s camera on the patient. After viewing the child on the iPad, the consulting physicians may decide that he or she can stay on site.

The technology, part of Nemours Care Connect, has been a success at Beebe Healthcare in Lewes, said Loretta Ostroski, RN, director of emergency services/critical care at Beebe. “The system allows our providers, patients and families to not only speak directly to the providers at A.I., but it also allows the A.I. providers to actually see the patient, who is still at Beebe,” she said.

St. Francis Healthcare plans to launch the program next week. “With this enhanced capability, we will be able to get an improved, consultation,” said Arek Tatevossian, senior vice president of strategy for St. Francis.

The “real time” technology isn’t the only way that mobile devices are changing the way healthcare services are delivered. Consider Christiana Care Health System’s iRound technology. Equipped with iPads, nurses take patient surveys during their rounds. St. Francis Healthcare plants to launch a similar program. Meanwhile, Christiana Care’s Insight platform, also on an iPad, is a self-evaluation tool that lets patients detail their symptoms’ severity in the doctor’s waiting room.

Rooted in Research

Nemours’ iPad technology stems froma study conducted in 2012. Traditionally, the team that transports children from outside hospitals to Alfred I. duPont Hospital for Children used a cell phone to connect with doctors from the departure site. In the study, the team used that same process for 25 transports. With another 25, they used the FaceTime app on the iPad.  

The results favored the iPad. “It gave us that last piece of information that we’re looking for, that a picture-is-worth-a-thousand-words-kind of detail,” said Slamon, one of the study’s leaders.

On April 1, 2014, the program became official. But there have been changes. Since the transport team has enough to do, a dedicated iPad, locked to a mobile cart, is leased to participating hospitals. (The transport team has an iPad to use if needed.)

Instead of FaceTime, the technology employs a software that permits multiple screens – similar to those found during a teleconference – and multiple platforms, so it’s compatible with Android devices.

Currently, there are more than 20 regional hospitals participating in the program and about 45 carts have been disbursed in ERS, on pediatric floors and in pediatric intensive care units.

If a transport is needed, viewing the child on the program and talking to the ER doctors can help the team determine where to send the patient upon arrival. Since the program’s start, the number of transported children going directly to intensive care at the children’s hospital rather than to its emergency room has increased from 11 percent to about 35 percent, and studies have found that 91 percent did indeed need intensive care, Slamon said.

Improving Patient Care

Tablets are proving their value in other ways. At Christiana Care Health System, nurses equipped with iPads are collecting data on the patients’ experiences in a program known as iRound. The nurses ask questions modeled after those in the federal government’s HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, used to measure adult patients' perspectives of hospital care, and they record the answers on the iPad.

“The purpose is for us to know how we’re doing at any given time,” said Pam Boyd, senior program manager for patient experience at Christiana Care Health System. “Are we responding to call bells? Is it quiet at night?” If the room hasn’t been cleaned or a sink is dripping, the nurses can send a message via the software to immediately notify someone to handle it.

The nurse can also review past entries. “I could mention that you said it was noisy the other night and how was it last night? Was it better?” Boyd said.

More recently, iRound has been augmented so nurses know the patient’s name, physician, surgeon and the reason for admission before entering the room. Future enhancements will let nurses note such tidbits as the patient’s favorite sports team or their primary caregiver. “It’s more personalized care,” Boyd explained. “It helps us connect to that patient.”

Christiana Care’s Insight, which has received recognition from Computerworld, is used by patients to detail their symptoms while in the waiting room. The finished report goes to the printer, and a nurse navigator retrieves the data and makes appropriate recommendations.

“We’re able to address certain concerns in real time,” said Tammy Brown, clinical director for cancer care management at Christiana Care Health System’s Helen F. Graham Cancer Center & Research Institute. For instance, if a patient noted a lack of appetite or significant weight gain, the dietician on staff is consulted to set up a care plan.

Real Savings

The programs clearly can benefit patient care, but they can also benefit the insured or the insurance company’s budget. For instance, if a telemedicine consult determines that a patient needn’t come to the children’s hospital, it removes an extra facility fee and additional tests, Slamon says. If transport is needed, seeing a patient respond to treatment in the outside ER can also prompt the cancellation of a helicopter, which can cost up to $8,000, in favor of an ambulance ride. “It’s a cost savings for the family and it’s a cost savings for the insurance company,” Slamon says.

In July, Gov. Jack Markell signed a bill requiring insurers to cover telemedicine the same way that they do in-person care. That bill doesn’t go into effect until Jan. 1, but Slamon says some insurers are already doing it. “I think insurance companies are starting to recognize that there are some cost-savings potential for them,” he said. Nearly 70 percent of the hospital’s submitted cases for telemedicine are being reimbursed, which is, he concludes is “excellent.”

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