But some new technologies won't work their magic without considerable discombobulation. Health Data Management talked to five organizations that are trying to get the maximum out of innovative technologies. They describe the changes they've asked their clinicians and other staff to make, and what they've gained.
Florida Hospital Celebration Health: Taking real-time location systems one step beyond
The technology: Real-time location system, Aeroscout.
The objective: Make more efficient use of floor staff's time.
The change: Real-time location systems, which use radio-frequency ID tags to track people and assets, are often sold as a way to deploy equipment more efficiently, so that nurses won't feel the need-or have the ability-to hide infusion pumps in the broom closet to be sure they've got one when they need it. Florida Hospital Celebration Health, Celebration, Fla., decided to try using the tags to track people, to see where they could save steps and improve care.
The notion sounded uncomfortably Big-Brotherish at first to the nursing staff on the 31-bed Innovation Unit at the 174-bed hospital-even though, as the name implies, they were used to being guinea pigs for all kinds of newfangled gadgetry. Would the tags track when they went to the bathroom, or out for a smoke? Would they be used to flag people who weren't working hard enough?
No, says Ashley Simmons, the hospital's operations performance improvement consultant. "We didn't just say, 'Here, wear this tag for fun,'" she says. "We took over a year working with the staff to show them what we were doing, what the tag allows us to see, checking the results and saying, 'Does this look right to you?'" The system generated a "spaghetti map" that showed the path of each tag wearer. The tags pinged "exciters" installed in patient care areas, training areas, and the cafeteria (but not near bathrooms or smoking areas) and revealed patterns of movement. For example, one medication room proved to be more popular than another, even if it was farther away for a given staffer, because the nearby nursing station was the social center of the unit and worth a few extra steps. That was a valuable piece of information for stocking medications, among other things.
"The biggest piece was not to use it in a punitive manner," Simmons says. Instead, she used positive reinforcement, noticing when the map showed that a nurse hadn't had a chance to get lunch, and urging her to take time to relax during the day. "She was completely shocked that I cared. Once they knew we were using the data to help them, they complied better with wearing the tags."
Though Simmons kept an eye out for behavior changes caused specifically by wearing the tags, there were none. "Now they forget they have them on," she says.
The results: Simmons has not implemented any changes yet as she strives to make sure the information is accurate. But she is better able to understand how much time nurses spend in patient rooms, making trips to the medication room, lounge, nutritional services area and other places. She's looking for inefficient patterns that may benefit from a change in procedures, and can also tell whether staff are complying with hourly rounding requirements. Simmons says the chief nursing officer at corporate parent Florida Hospital in Orlando is eager to expand use of the tags to generate similar information for the other 21 campuses in the organization.
The advice: "Really focus on the people part. You can't implement something this intrusive without understanding your people, and having them understand that it's here to help and not harm."
Inmed Group, Montgomery, Ala.: Letting the users perfect the system
The technology: NextGen electronic health records.
The objective: Improve clinical care and financial performance.
The change: Inmed Group operates several small hospitals in Alabama and Georgia that until 2010 conducted their entire clinical lives on paper. Over the past two years, the switch to an EHR with computerized physician order entry has entailed a mind shift to real-time thinking, says chief operating officer Vickie Lawrenson, who used to be an executive at America Online and was frankly appalled at the lack of computerization when she moved to health care. Batch processing is incompatible with good care, she believes. "You have to enter everything as you're doing the work," she says.
Inmed's small hospitals don't have I.T. departments, so their EHR installations were do-it-yourself, with support from their vendor, NextGen. The first go-live, at 49-bed Crenshaw Community Hospital in Luverne, Ala., offered a chance to iron out the bugs: how to equip the carts that held the computers, where to put the label printers, whether to create the equivalent of a given paper form in the computerized workflow. The initial data entry required during the switchover offered a prime opportunity to help users see how the new information flow could help them, and much time was spent walking charts through the system. The second hospital to go live on the new system, 54-bed Bullock County Hospital in Union Springs, Ala., learned from Crenshaw's experience and had a much quicker, smoother implementation, Lawrenson says.
Order sets were pre-defined by the medical staff before go-live, but as clinicians have become more familiar with them, they're looping back to figure out how they can eliminate keystrokes and save time. They have had to unlearn certain paper habits, such as requesting multiple lab draws even when an order set was configured to request a series of lab draws at set intervals.
