Ankur Seth

1. Ankur Seth Mobile Strategy for BIDMC June 4, 2010

2. Agenda 2

3. Scope • Immediate solutions for using mobile devices in scenarios— -- Medication Management -- Lab sample collection workflow • Long term strategy for mobile devices usage in BIDMC 3

4. Immediate Recommendation Correct Patient Identification requires Front end Labeling at patient bedside Every bedside  Bar code scanners with display ICU/ED Label printer on bedside Wards Use a cart with shelves – Bluetooth enabled Label printer for each phlebotomist and nurse 4

5. Long Term Recommendation • Become vendor/ device agnostic, support applications, let user decide what form factor they need accessibility • Set up an Innovation mobility lab – due diligence on new technologies/offerings usable in our workflow and support accordingly 5

6. Mapped user pain points with present technologies Methodology Requirements Gathering at BIDMC Research on present technologies Identified Best Practices 6

7. Nurses move back and forth, use shared printers • Work load can be overwhelming, human error possible • Too many different devices used in care settings • Right sample/drug, right patient at the right time • If Lab does not receive correct labels, rework causes delays and can lead to errors • Standardized processes should be followed everywhere Pain points • There should be quality check near the bedside • Turn around time is the key in ED Physicians Nurses Lab and Admin 7

8. Best Practices from other settings 8 * Ref – Publication on Effect on Bar code technology on safety by B&W –New England JoM ‘10

9. Gaps with Present Technologies • No one device fit in all solution—viewer, printer, scanner • Usability and Form factor are key decision criterion • Products cannot be customized based on user preferences • Ability to work with CPOE and eMAR in future needs to be tested 9

10. Proposed solutions—Lab Workflow & Medication Management * Maximum error prone places—Ref Clinical Pathology Quality Report Q4-09 10

11. Process Improvement required • ED – Label printed at triage and carried all the way • ICU – Centralized printer location, not easily accessible • Wards – Carry multiple devices • Ambulatory– Batch printing of labels • ED - Need bed side printing • ICU - Keep printer in central location, access to nearby rooms • Wards – Provide carts with racks/drawers to organize equipments • Ambulatory –Batch labeling should not be allowed. 12

12. Pros and Cons of Recommendation 13

13. Risks and Mitigation Risks Mitigation • Bar code scanner get stolen. • Batteries run dead • Process Adherence • Use existing active RFID inventory tracking to avoid theft • Make processes mandatory to maintain the integrity of the system • Mandatory training to nurses and phlebotomists using these devices 14

14. The Future • Consumer products are gaining popularity • Apple ahead of the race / Other players are coming with their offerings • Native applications, App store and ease of use strengthening them • Information, accessibility to data is within the reach of healthcare professionals 15

15. Thinking Long term—Problem of plenty 16

16. What Key Opinion Leaders say? • Google, Sr. Prod Manager- ’Consumer centric Health management might be the calling‘ • mHealth, VP- ’Mobile devices and applications will be used as resources in Disease Management ‘ • Microsoft, Director -’Phonescan be used as a window to a different world in future’ • HP, BDM – ’If you don’t take user feedback, you’ll end up making mistakes. Knowing your user is the key’ 17

17. What other hospitals say? • John Hopkins ,CIO – The ideal device might not be invented yet, but we need to be prepared for it • Partners Healthcare ,CTO –There’s a class of notifications, views and transactions that healthcare consumers expect to access on the go • VA, Director, Emerging Health Technology – Mobility needs to support the concept of Care anywhere and everywhere • Kaiser, Head Clinical Innovations– Devices might be hyped, but mobility is an operating reality, it is hear to stay. 18

18. Our Long Term Strategies • Mobile devices can change their nature/form in future Strategy • Work on accessibility, don’t lock a device • Be vendor/device agnostic • Let consumer own the device • Goal—Improve user workflows 19

19. Proposed implementation Set up an Innovation mobility lab – • Collaborate with vendors(Apple, HP, Google etc) and research labs (MIT Media, IBM IRL) • Perform due diligence of new technologies/offerings • Usability analysis in our workflow and support accordingly • Users bring their device, we provide accessibility to system 20

20. Criterion for selection • Data Security • Infection Prone • Inter-operatibility • Form Factor • Connectivity • Support The final push by the user 21

21. Assumption and Risks Assumptions Risk • Medical Safety will be improved by using technology • Devices will continue to evolve • Apple will not be the only player in the market • Data Security • Infection propagation • FDA compliance • Technology adding to process overheads 22

22. Conclusion • How mobile devices can be used in clinical settings? • I have workflow related problems  Can mobile devices/application solve them? If they can help me on my pain points, definitely they can be used 23

23. Recommendation Frontend labeling Every bedside  Bar code scanners ICU/ED Label Printer on bedside Wards Use a cart with shelves -- Label Printer for each phlebotomist and nurses • Become vendor/ device agnostic, support applications, • Let user decide what form factor they need accessibility • Set up an Innovation mobility lab 24

24. Acknowledgements • Amy Goldman • Brigitte Bowen • Gina McCormack • Henry Fieldman • Holly Dowling • Jan Olson • Jane Foley • Joe Cross • John Powers • Julius Yang • Kim Sulmonte • Larry Markson • Larry Nathanson • Pat Folcarelli • Rebecca Hildebrand • Tricia Bourie John Halamka 25

25. Thank You 26