From Newsline, 2013
By Scott Herrmann, Director of Mobile Solutions
The use of mobile applications in the hospice setting are constantly evolving, almost as fast as the ubiquitous apps that are downloaded to iPads or iPhones every hour of every day.
This rapid evolution is due, in large part, to the realization that mobile applications can help staff improve on the ways they deliver end-of-life care. Whether it’s a hospice aide performing the simplest of tasks or a nurse changing the care plan based on a patient’s latest vital signs, using mobile technology at the point of care allows staff to document and share information among the entire hospice team so everyone is up-to-date and onboard about the patient and family’s current status and needs. And this is in addition to the many operational efficiencies that can be realized, such as eliminating manual and paper- based processes and ultimately reducing errors and production time.
This article will discuss the benefits, particularly those you’ll find by using this technology in hospice home care.
The Digital Visit – Good for Everyone
When a hospice uses mobile technology, every patient visit is essentially transformed into a “digital visit.” By this we mean that the clinician can easily document information at the point of care, and can just as easily share it with the patient’s stakeholders, such as attending physicians, therapists, volunteers, aides and even family members.
For example, the clinician can use the mobile device to collect vital signs or measure patient movements, and then use its built-in camera to share pictures or videos with fellow team members to obtain corroboration on the next best steps. Gone are the days when the hospice clinician has to rely only on phone calls and a single perspective on the patient’s condition. The clinician now has the ability to share patient data in real time to ultimately determine the best way to address the patient’s needs.
These benefits not only help the patient and the hospice, but also the patient’s loved ones. By providing them with such immediate information about the patient, each visit endears them to your program. They feel nurtured and loved, which increases the likelihood that your hospice will remain on the top of their minds. I can actually speak from my own experience concerning this point.
When my dad entered hospice care in 2005, I clearly remember each member of the hospice team doing their best for him. In my opinion, and in the opinion of my family, they were absolute angels. However, I can still picture the hospice nurse coming into our home with a two-wheeled hand truck in tow. She would use a fruit crate to hold her paperwork for the day’s visits which she transported from home to home on this hand truck. It seemed disorganized and disturbed me, so much so that I remember asking her about it.
Another memory that stands out was how my dad’s condition changed from day to day. The end of his life was an emotional rollercoaster for my entire family and, until we were able to make connections with the hospice staff, we were anxious and, understandably, afraid of what was happening and what lied ahead.
Of course, flash forward to today—with the benefits of mobile technology—and both the hand truck and telephone tag with hospice staff become non-issues. This new technology solves these issues as well as eliminates the risks involved with decision making at the highest and lowest levels of the organization.
It Also Supports Compliance
Given the current environment, the days of monitoring your staff activity and patient visits via paper are simply ineffective, but that’s where mobile technology can help.
With today’s mobile applications, tasks can be accurately recorded and will never go incomplete. For example, a direct-entry model through a mobile device can increase the quality of patient care documentation since it helps eliminate the mental and physical errors associated with transitioning data from paper to an EHR system. Along those lines, this direct-entry model may be able to alert hospice staff if there are incorrect entries or forgotten visit tasks.
Care plans will also always match the visit notes—which is critical to compliance. And if an audit does occur, the mobile device makes it easier to share the records via the EHR system.
The Operational and Management Benefits
Using mobile point-of-care applications also enable more accurate tracking of travel expenses, better workforce management practices, fewer phone calls in and out of the office for schedule changes, and enhanced communications between team members. These and other benefits improve the hospice’s bottom line and support several key goals of today’s hospice leaders, namely to eliminate or reduce mistakes; accurately file claims; and improve audit procedures.
As a side note, I do recognize that when auditors arrive at your door, they still want paper documentation to do their due diligence, and this does undermine some of the paperless benefits of mobile technology. However, I also think that as our industry evolves, regulators will be forced to evolve as well and move away from paper-based audits.
Don’t Overlook the Human Factor
One of the key elements that gets overlooked with any technology solution is the human factor. Despite our desire to embrace technological advances, we are generally averse to changing the way we do things. I find this to be especially true among clinicians.
So the best way to bring everyone on board—and overcome their inherent fear—is to review the many reasons for implementation of mobile technology. And this must come from leadership.
Your leadership team needs to point out the benefits that will be gained by each person and department in your hospice. For example, staff will no longer waste time filling out paper forms that need to be manually entered into the back-office EHR system; schedules will always be up to date; office staff will no longer have to validate paper visit notes against the care plan or the schedule; and patient records will never be lost again. The benefits are many to staff at all levels— they just need to be articulated.
In fact, one the biggest surprises that a hospice typically realizes after implementing a mobile service is the improved quality of the data it receives from the field. Without mobile technology, a hospice must assume visit data is correct unless feedback from the patient or family suggests otherwise. A mobile service, on the other hand, allows your hospice to manage staff proactively, and even call ahead to the next patient if visits are running late.
Improved safety is also worth noting. The Global Positioning System (GPS) available with most mobile services can greatly enhance the safety of individuals working alone. Office staff can monitor mishaps on the road, from a traffic accident to a breakdown, and support the field staff appropriately while arranging for backup coverage at the patient’s home.
Lisa McCoy, director of clinical information systems at Tidewell Hospice in Sarasota, FL, is a strong proponent of using mobile technology in the home health setting, having seen excellent outcomes in documentation and productivity among its home health aides.
“We’re able to review the care plan prior to the patient visit and, because documentation occurs at the point of service, it’s more accurate” she says. “It also allows the aide to immediately contact the nurses with any changes, and also captures the exact length of each patient visit, mileage traveled from patient-to-patient, and the aide’s location throughout the day. In fact, it has increased the efficiency of our aides since it decreases the need to return to the office to enter documentation by an average of two hours per day. That time is now spent directly on patient care.”
MDM for Secure Use
Of course, the importance of security cannot be overstated when it comes to implementing a mobile service, especially given that patient records are involved. However, those who claim that their paper-based processes are more secure than mobile applications are in for a shock.
Mobile devices used in hospices and in other healthcare settings should be equipped with Mobile Device Management (MDM) services that can control and even wipe clean all data if the device is lost or stolen. As an added precaution, many agencies have hired mobile strategists and mobile application champions to be the point people in the event these solutions fail, new employees require training, or the devices need to be reprogrammed or wiped.
Tips When Shopping for a Mobile Service
The applications you choose as part of your mobile service will provide different ways for you to share information across the hospice and to the patient’s family members.
For example, a hospice using Health Information Exchange (HIE) can securely share real- time visit information with family and friends who may be separated by hundreds or thousands of miles. By using a mobile application that sends information back to the office as well as to these portals, a family in Arizona can see what is happening to grandma in Florida—a view as to what kind of care that patient is receiving.
These types of services will provide a new level of visit intelligence to the patient, their families and hospice staff that would be impossible with paper and manual processes. They also differentiate the hospice from others, providing a competitive edge. It’s also invaluable intelligence to hospice staff since they can see what is happening to all of their patients by having secure access to the same family/patient portal.
So how do you go about selecting a mobile service—and the right applications? Here are a few tips to get you started.
1.Determine Your Goals and Priorities
Is it to improve customer satisfaction? Increase worker productivity? Better data collection and accuracy? Streamline workflow throughout the organization? Reduce operational costs and gain better accountability of staff? Any and all of these reasons may be your success criteria.
2.Select the Right Device for the Intended User
Make sure you select the right device for the intended staff. For example, a nurse may need a device with a larger screen size than a hospice aide.
3.Provide Adequate Training
The applications used by staff in various areas of your operation may be completely different. So recognize that you will need to train them on the applications as well as the device. Also, even though a device may be a pocket-sized unit, expect to train just as long and hard as you did when staff first learned how to use a PC.
4.Make Sure the Device has Security Safeguards
As I noted earlier, make sure the devices you select have the ability to lock down client data and stop the downloading of applications that you don’t want your staff using. Again, this is done via Mobile Device Management (MDM) which basically allows “remote control” of the devices. With this safeguard in place, it also means that lost or stolen devices are no longer a concern.
5.Decide if You Want Native or Cloud-based Applications
Cloud-based apps may require connectivity to a network in order to function, while a native application can collect, store and forward information in and out of coverage areas. However, there are pros and cons associated with each—so research both options carefully.
In this decade of the Affordable Care Act, our collective goals will be to reduce the costs associated with each visit, maintain patient privacy, and yet still deliver high- quality care. Personally, I believe quality means knowing that the special and unique needs of each individual entrusted to your care are being attended to, and that the quality of care delivered is based upon the most up-to- date diagnosis and visit data. This makes the use of mobile technology not just an asset—but a necessity. Better knowledge and better communication will lead to better delivery of high-quality end-of-life care.