Electronic Health Records

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Tablet use improves home health, care coordination at Sutter

By Jennifer Bresnick

The use of small form-factor tablets by home care nurses is aiding in care coordination and data access at Sutter Health’s Care at Home program.  A case study presented by the College of Healthcare Information Management Executives (CHIME) examines how mobile EHR access can help collect vital signs, ensure accurate medication lists, involve full-time care givers, and order supplies for more than 100,000 patients within the California-based system.

“Healthcare providers are facing increased pressures to minimize patients’ treatment costs, and that’s typically best accomplished by moving patients to the least expensive and most appropriate care setting. For many patients, that venue is their own homes,” the study says. “However, incorporating information technology with home care has been challenging. Home care clinicians have worked with paper records, and all the inherent limitations, for years.”

After exploring the use of laptops as the primary device utilized by home nurses to access EHR data, record information, and coordinate appointments, Sutter found that the cumbersome technology simply wasn’t optimized for the task at hand, says Phil Chuang, chief strategy officer and former director of information services.  The program, started in 2008, ran into so many difficulties that the rollout hadn’t even finished before Chuang considered pulling the plug.

“We got to a breaking point and we had to decide, ‘Do we try to fix all the issues with the existing system?’ We could have done that, gone back to square one and do it all over again,” he said. “But we decided that if we’re going to spend millions doing that, we better make sure we pick the right horse.”

Smartphones were the next technology in consideration, but the small screen, reliance on cellular network access, and poor EHR interface made Chuang look to a happy medium instead: tablets, which combine the ease of touch-screens with a larger work area and more processing power to accommodate mobile EHR software.

“Tablets have sped up the flow of the process,” said Jennifer Brecher, project manager for the mobile device project. “In the past, if one of the clinicians went to see the patient on Monday and the physical therapist would go on Tuesday, the therapist would not have the information about the Monday visit available. This is better from a productivity perspective and better for the patient.”

While choosing a tablet to work with isn’t always easy for healthcare organizations browsing consumer offerings geared towards leisure users, and Sutter is paying close attention to managing privacy and security for a device that is small enough to slip between couch cushions or be left on a bus, the response has generally been positive among staff members and patients.

Clinicians can now complete necessary documentation within 24 hours, Chuang notes, while streamlining certain patient forms and allowing home nurses to engage in telehealth features like taking photographs and sending them to expert physicians for diagnosis or consults.  The use of tablets to order supplies has cut costs by 20 percent, and patients receive their items quickly from next-day suppliers.

“It’s easy to get caught up in the device, and we’ve focused some of our education on that,” Chuang said.  “The pushback we sometimes get from some staff is they say they lose their focus on the patient with the device.  My response to that is that you can ignore the patient if you put all your focus during a visit into documentation, whether on paper or in electronic format.  WE try to integrate the documentation, which isn’t optional anyway, and better coordinate care with the tablet.  No one likes documentation but they like the results of having better documentation at their fingertips.  It’s about delivering better care as a team.  That’s what the mobile technology gets us.”




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