When asked to describe their most pressing challenges, nearly every technology and IT department has similar responses: too many outstanding projects, ever-present backlogs, ever-growing demands, relentless roll-outs of new technologies, not enough time to innovate and the complexity of everyone’s favorite buzzword: interoperability.
VITAS® Healthcare’s recent successful roll-out of iPhones to thousands of hospice professionals who deliver home-based medical care across 14 states and the District of Columbia has brought me to a simple conclusion: IT and technology experts in healthcare must fundamentally change their thinking about innovation and that interoperability buzzword.
"Significant cost-effective and clinically effective results are delivered by shifting care—even for end-stage and chronic-disease patients—out of the hospital, into the home, and directly to the bedside"
Healthcare companies that survive and win in this 24/7, digital-mobile environment will be those whose technology teams acknowledge two basic tenets:
1. You will never be less busy than you are today.
2. Your opportunity to innovate and improve is never going to be better than it is today.
I know that’s hard to swallow. The fact is that the demands on our teams are not decreasing; it’s time to accept it, stop moaning about it and get on with the show. As technologists, we must borrow and apply to healthcare the mobile-first game plans and tools that are already successfully deployed in retail, manufacturing supply-chain, financial service, and other industries, from buying groceries on Amazon or depositing a check from a smartphone.
Award-winning technology makes an impact
In a project that has spanned nearly five years, the VITAS mobile technology initiative put iPhone 6+ smartphones and tablets into the hands of 8,000 VITAS clinicians. Clinicians now deliver mobile-supported hospice care, communications, orders, and interactions to patients’ bedsides, whether in private homes, nursing or hospital facilities, or assisted living communities—quickly, securely, reliably. The initiative earned VITAS the 2018 Process Excellence Network Awards (PEX) for a technology-enabled process improvement project.
The goal of these personal mobile “workstations” was to reduce paperwork, speed up admissions of patients into hospice care, and place our interdisciplinary hospice teams at patients’ bedsides quickly. The spillover impact has been “outsized.” VITAS has:
• Saved clinicians’ time. By replacing keystrokes with swipes and the power of touch-based systems, we eliminated an estimated 60–70 keystrokes from bedside interactions. Mobile workflow applications allow our clinicians to set the device down if required, making patient interactions about the patient, not the computer.
• Embraced mobile clinical systems that are 20 times easier to train, reducing orientation from 20+ hours to one hour. On their first day, VITAS nurses simply enter their login credentials into the company- provided iPhone, and the phone self-configures. Employees are deployed to the field quickly and use the phones immediately for communicating; completing/ sending forms; ordering equipment, supplies, prescriptions, and more.
• Streamlined operations. The fully interoperable solution has processed 288,863 medical records and referred 82,523 patients electronically since the 2015 launch; 97 percent of electronic referrals are handled and responded to within 15 minutes or less.
• Saved $2.2 million on hardware by replacing PCs and software with the iPhone6+ for physicians, nurses, chaplains, and social workers.
• Lowered equipment cost-per-caregiver to $43 from $71.25 while maintaining a theft/loss rate of less than 1 percent (vs. 8 percent projection).
• Reduced per-referral costs by 15 percent, for $908,000 total savings in 2016.
• Reduced inbound and outbound calls to VITAS referral centers: 21 percent fewer inbound calls (665,973 in 2014 to 529,026 in 2016) and 40 percent fewer outbound calls (918,00 to 554,00)
The hospice influence on healthcare reform
It’s apparent to me that the hospice and post-acute care professions are the proving grounds for healthcare innovation. Thanks to our ability to embrace and fine-tune technology solutions significant cost-effective and clinically effective results are delivered by shifting care—even for end-stage and chronic-disease patients—out of the hospital, into the home, and directly to the bedside.
What else have I learned?
• Results are less about the technology and more about what it enables: I’ve been impressed by our clinicians’ appreciation of their VITAS-assigned smartphones and tablets. Not only does the iPhone’s small form factor easily accommodate lab coat pockets and bags/purses, it also reduces the spread of infection because the devices do not move from room-to-room as shared workstations. Our clinicians are grateful for the extra minutes they can spend one-on-one with patients and their families—not filling out paperwork and forms.
"Success is not only about how well you work with your partners, but also how well those partners work with each other"
• Hire the right people and turn them loose:The biggest challenge is attracting the right talent, the programmers and developers I refer to as the “steely-eyed geeks.” They’re bright, innovative individuals with extreme technical skills who have the tenacity to get the job done in an environment that cultivates and supports innovation.With the hospice profession’s unique focus on quality of life at the end of life, our technologists love the fact that they are creating better healthcare experiences for our patients and families at one of the most difficult times of anyone’s life. If your best and brightest technical minds are not working on the big problems, you’ll never solve the IT challenges that keep you up at night. Our toughest challenge was creating fast, secure, and privacy-compliant real-time data transfers from our EMR to the mobile device. Once our technical architects solved the problem, we successfully developed a multi-factor data interface that was fully survivable on cellular or Wi-Fi. Adding e-prescribing functionality took about 120 days of integration with a nationwide roll-out completed over two months.
• Tech partnerships are key: AT&T’s 4G network has worked remarkably well in all 44 VITAS locations around the country, and we expect even better results from 5G. Success is not only about how well you work with your partners, but also how well those partners work with each other. The partnership between AT&T, VMware and Apple has been instrumental. Their willingness to deploy engineering talent, and their commitment to the integration of their solutions with one another, made a seamless clinical experience possible. MobiChord and Wandera were also deployed into the mobile ecosystem to configure, monitor bandwidth and usage, and prevent outages.
The VITAS mobile app, which in early 2018 experienced 101 percent growth compared to the same period last year based on downloads and open rates, will soon allow healthcare professionals to refer their patients to VITAS directly from any smartphone. Our goal by late 2018: drastic reduction (and eventual elimination) of paper records and forms.
Those of us who work in this profession understand that hospice is more than a medical specialty. It is our mission and our passion, a calling of sorts: a unique profession that attracts healthcare professionals who are committed to compassionate care and quality of life. In that regard, hospice can serve as an incubator for success for the rest of the healthcare industry.