Today’s health applications have made strides in capturing valuable health information, such as waveform data from monitoring instrumentation and medication regimen adherence reporting from patients. By providing clinicians and patients with fast, familiar documentation tools – or what we call “natural input” tools – the documentation becomes an automatic byproduct of the patient encounter rather than an extraneous, time-consuming task. Whether iPad, digital pen or online forms, each clinician or patient can select the tool that best suits his or her personal style and work environment, thus preserving workflow in an elegant manner.
With that said, there remains much work to be done in our industry to help support more intuitive clinical documentation, particularly when it comes to preserving a clinician’s workflow preferences with an eye toward enhancing it by evaluating efficiency gaps.
There are three key tenets that can help achieve this:
- Facilitate clinically rich documentation;
- Liberate the data for sharing; and
- Predict the needs of the physician and patient.
Let’s focus on the first one.
Facilitating clinically rich documentation
The proliferation of EHRs has exposed a lack of structured data – a new challenge for healthcare, but an important one as it is required to power analytics for both historical reporting (retrospective analytics) and prediction (prospective analytics). The legacy approach of a traditional EHR user interface incorporates drop-down lists and numerous input screens that make documentation cumbersome. As a result, many clinicians often type or dictate unstructured, free-form text into comment fields to simplify the process and preserve workflow. The lack of structure and discrete data elements, however, mean that the ability to use such information for analytical purposes is extremely limited, despite its convenience.
An elegant solution to this workflow challenge is one in which clinicians can use their skills in conjunction with capturing data at the point of care. For example, our enterprise (“private”) cloud platform empowers analytics, personalized decision support and existing healthcare IT investments. We can do this because we capture structured, clinically rich data by supporting documentation using natural input tools, including iPad and digital pen and paper. All input modalities are powered by the same cloud-computing platform; information provided in the online portal may be used to populate forms printed on digital paper or in the iPad.
The promise of liberation
mHealth can be a liberating tool for clinicians, but it’s only half of the solution. The ideal mobile documentation solution covers numerous hospitals across the country and supports the demanding needs of individual clinicians, who are often tasked to care for patients at multiple facilities. That makes it necessary to go a step further, to deliver a solution that enables clinicians to capture structured data at the point of care in a completely intuitive manner. This can be done by combining mobile hardware devices – including iPads and digital pens – with a user experience designed to be as fast as paper forms. Add in a cloud platform that manages numerous mHealth devices, converts natural input to structured data, integrates with back-end clinical and financial systems, and exports data to national registries and you have the prototype for an elegant workflow that protects the productivity of its physicians and captures valuable data at the point of care, while actively participating in its industry’s quality improvement initiatives.
Just ask Phil Haynie, MBA, MSN, CRNA, president of Resource Anesthesia, a group of 35 certified registered nurse anesthetists (CRNA) that serves hospitals, surgery centers and specialty physician groups in multiple states.
Driven by an increasingly competitive environment for hospital-based physician services, Haynie, a practicing CRNA, needed a solution to help his business deliver cost-effective, high-quality care. Just as important, because the CRNAs are often mobile, they needed a portable solution to efficiently manage clinical documentation without disrupting existing workflows. To achieve success, the solution had to be easily integrated into multiple healthcare settings with diverse EHR environments with minimal use of IT resources.
Haynie and his colleagues chose Shareable Ink’s digital pen and paper solution and experienced no disruption to their existing workflows. Clinical and business rules embedded into familiar forms deliver feedback to the clinicians and help to ensure that records are complete and compliant. Using the power of cloud computing, the handwritten documentation is converted into clinically encoded structured data and made available for analytics.
As a result of Resource Anesthesia’s deployment of this EHR, hospitals are reporting the following results:
- One hundred percent of provider adoption without any burden to hospital IT resources;
- Quality management departments have automated review of 100 percent of charts – without human intervention – for all anesthesia quality metrics, including The Centers for Medicare & Medicaid Services (CMS) Surgical Care Improvement Project (SCIP) measures;
- Documentation compliance has improved, reducing the number of days in A/R (accounts receivable); and
- Better insight into OR (operating room) utilization rates.
Success is measured when we can achieve a maximum desired effect with the smallest amount of disruption. Given the constant nature of change and challenge in healthcare, why not consider a newer, more flexible approach to some of the challenges in healthcare. Let’s start with workflow.
About the author
Stephen S. Hau is founder and chief technology officer, Shareable Ink.
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