As some readers may know, in addition to being your HIT hostess, I cope with some unruly chronic conditions which have landed me in the ED several times of late.
During the hours I recently spent being examined and treated at these hospitals, I found myself fantasizing about how the process of my care would change for the better if the right technologies were involved. Specifically, these technologies would give me a voice, better information and a higher comfort level.
So here, below, is my step-by-step vision of how I would like to have participated in my care, using a tablet as a fulcrum. These steps assume the patient is ambulatory and fundamentally functional; I realize that things would need to be much different if the person comes in by ambulance or isn’t capable of participating in their care.
My Dream (Tablet-Enabled) ED Care Process
- I walk through the front door of the hospital and approach the registration desk. Near the desk, there’s a smaller tablet station where I enter my basic identity data, and verify that identity with a fingerprint scan. The fingerprint scan verification also connects me to my health insurance data, assuming it’s on file. (If not I can scan my insurance card and ID, and create a system-wide identity status by logging a corresponding fingerprint record.)
- The same terminal poses a series of screening questions about my reasons for walking into the ED, and the responses are routed to the hospital EMR. It also asks me to verify and update my current medications. The data is made available not only to the triage nurse but also to whatever physician and nurse attend me in my ED bed.
- When I approach the main registration desk, all the clerks have to do is put the hospital bracelet on my wrist to do a human verification that the bracelet a) contains the right patient identity and b) includes the correct date of birth for the person to which it is attached. If the clerks have any additional questions to pose — such as queries related to the patient’s need for disability accommodations — these are addressed by another integrated app the clerk has on their desk.
- At that point, rather than walking back to an uncomfortable waiting room, I’m “on deck” in a comfortable triage area where every patient sits in a custom chair that automatically takes vital signs, be it by sensor, cuff or other means. In some cases, the patient’s specific malady can be addressed, by technologies such as AliveCor’s mobile cardiac monitoring tool.
- When the triage nurses interview me, they already have my vitals and answers to a bunch of routine clinical questions via my original tablet interaction, allowing them to focus on other issues specific to my case. In some instances this may allow the staff to move me straight to the bed and ask questions there, saving initial triage time for more complex and confusing cases.
- As I leave the triage area I am handed a patient tablet which I will have throughout my visit. As part of assigning me to this tablet my fingerprint will again be scanned, assuring that the information I get is intended for me.
- When I am settled in a patient bed in the ED, I’m given the option of either holding the tablet or placing on a swing-over bed desk which can include a Bluetooth keyboard and mouse for those that find touchscreen typing to be awkward.
- Not long after I am placed in the bed, the hospital system pushes a browser to the tablet screen. In the browser window are the names of the doctor assigned by case, the nurse and tech who will assist, and whenever possible, photos of the staff involved. In the case of the doctor or NP, the presentation will include a link to their professional bio. This display will also offer a summary of what the staff considers to be my problem. (The system will allow me to add to this summary if I feel the triage team has missed something important.)
- As the doctor, nurse and tech enter the room, an RFID chip in their badges will alert the hospital system that they have done so. Then, a related alert will be pushed to the patient tablet – and maybe to the family members’ tablet which might be part of this process — giving everyone a heads up as to how they’re going to interact with me. For example, if a tech has entered to draw blood, the system will not only identify the staff member but also the fact that they plan a blood draw, as well as what tests are being performed.
- If I have had in interaction with any of the staff members before, the system will note the condition the patient was diagnosed with previously when working with the clinician or tech. (For example, beside Doctor Smith’s profile I’d see that she had previously treated me for stroke-like symptoms one time, and a cardiac arrhythmia before that.)
- As the doctor or NP orders laboratory tests or imaging, those orders would appear on a patient progress area on the main patient ED encounter page. Patients could then click on the order for say, an MRI, and find out what the term means and how the test will work. (If a hospital wanted to be really clever, they could customize further. For example, given that many patients are frightened of MRIs, the encounter page would offer the patient a chance to click a button allowing them to request a modest dose of anti-anxiety medication.)
- As results from the tests roll in, the news is pushed to the patient encounter home page, scrolling links to results down like a Twitter feed. As with Twitter, all readers — including patients, clinicians and staff — should have the ability to comment on the material.
- When the staff is ready to discharge the patient — or the doctor has made a firm decision to admit — this news, too, will be pushed to the patient encounter homepage. This announcement will come with a button patients can click to produce a text box, in which I can type out or dictate any concerns I have about this decision.
- When I am discharged from the hospital, the patient encounter homepage will offer me the choice of emailing myself the discharge summary or being texted a link to the summary. (Meanwhile, if I’m being admitted, the tablet stays with me, but that’s a whole other discussion.)
OK, I’ll admit that this rather long description caters to my prejudices and personal needs, and also, that I’ve left some ideas out (especially some thoughts related to improving my interaction with on-call specialists). So tell me – does this vision make sense to you? What would you add, and what would you subtract?
P.S. Some high-profile hospitals have put a lot of work into integrating EMRs with tablets, at least, but not in the manner I’ve described, to my knowledge.
P.S.S. No this is not an April Fool’s joke. I’d really like for someone to implement these workflows.