Better technology for better healthcare

Apple has just released a compelling video profile that examines the impact of mobile technology on patient care at Hospital Corporation of America (HCA), the world’s largest private healthcare organization.

You can click here to watch the video and read the profile. You may also click here to download the video from iTunes.

The video and accompanying profile point to specific platforms and applications that help physicians deliver better, faster treatment to millions of patients. From the profile:

Specialized obstetric and cardiac applications help deliver healthy babies, initiate immediate treatment for cardiac emergencies, and explain procedures to patients, while other healthcare apps enable doctors to manage and review patient data as they make their rounds.

“It’s amazing to look back at how technology has changed, and how it has changed medicine in the process,” says Dr. José Soler, a cardiologist at Northwest Medical Center in Margate, Florida. “Once you start using this technology, it becomes indispensable. Mobile medicine is here.”

I have used this blog to present information and evidence that show how the targeted use of mobility solutions can confront the challenges faced by the healthcare industry, which is undergoing a historic shift in the patient care model. In future posts I will continue to present real-life examples of mobility’s impact.

The bottom line: lives can be saved when clinicians have anywhere/anytime access to information presented in a visually compelling manner that supports faster, more informed and better coordinated decision-making.

For now, the new Apple case study is a thoughtful look at how a healthy dose of mobility can give providers a strategic patient care advantage.

It's All in What You SEE That Matters!

Imagine that you are a cardiologist on call. You are at home, just winding down at 11:45 PM when you receive a call from a nurse on the telemetry unit, who reports that a patient who is three days post coronary artery bypass surgery has developed new onset atrial fibrillation. This is particularly concerning because the patient is reportedly on sotalol prophylaxis.

What is going through your mind? Can you trust this person’s interpretive clinical judgment? Is there additional information that would be helpful if only you had immediate access? Perhaps the current lab values, such as magnesium level? As you consider the differential diagnoses you are probably worried that this could be a sign of clinical deterioration. Myocardial infarction? Heart failure? Bleeding?

The nurse asks, “What should I do”? You are trying to determine the best course of action for this patient given their clinical situation – and while trusting the nurses’ assessment, or waiting until rounds the next morning, or heading back to the hospital are all options – none of these are ideal.

With AirStrip – PATIENT MONITORING, you have mobile, anytime, anywhere access to vital clinical data – including waveforms in real time  – that will allow you to SEE important information, presented in a meaningful way for clinicians. In seconds you identify that, in fact, this is not atrial fibrillation – it is simply a rhythm with irregular R-R intervals - the patient is having flutter with variable atrioventricular conduction. It’s understandable that this could be viewed as atrial fibrillation by someone with less clinical experience.

This is just one of hundreds of clinical scenarios that happen thousands of times in hospitals across the globe every day. It’s all in what you SEE that matters. With a few taps of a button on your smart phone, you have overcome obstacles to data access and data sharing, you’ve improved communication among the members of the treatment team, and you facilitated more accurate, timely, and targeted treatment for this patient. And you’ll sleep better tonight. Great things can happen with mobility.

Remembering Steve Jobs

On behalf of the entire AirStrip Technologies team, our prayers and thoughts go out to Steve Jobs’ family, and the people at Apple who work their hardest to make Jobs’ innovative vision a reality.

The impact that Jobs and Apple have had on healthcare is extraordinary. Steve Jobs will be missed – but his presence will continue to be felt long after his passing.

Obviously, AirStrip Technologies owes a debt of gratitude to Jobs, his vision, and his groundbreaking mobile products. To say that Jobs has changed the face of patient care forever is an understatement. He has enabled a revolution that is really just beginning.

The future of healthcare holds extraordinary promise. Steve Jobs is among those who paved the way - putting a world of possibilities in the palm of our hand.

The Doctor's Tech Toolbox

This is a fascinating peek at just how quickly physicians are embracing the tools and functions of mobile healthcare. Of particular note: monitoring patients in hospitals is among the top three uses physicians have for mobile-based technology. (Credit to spinabifidainfo.com for presenting this infographic.)

FDA Mobile Health Application Regulations

Right now there are an estimated 17,000 medical apps in use. By 2015, the FDA expects that 500 million smartphone users around the world will be using some kind of healthcare app.

Those are staggering numbers. It is understandable that the FDA sees the need to assert a degree of regulatory guidance over what the agency calls ‘mobile medical applications,’ and has proposed a set of guidelines to do just that.

Our first solution, AirStrip OB, was cleared by the FDA back in late 2005 and first marketed in 2006. It was also the first FDA-cleared app to be made available in the App Store. In reviewing the proposed guidelines, it appears AirStrip’s compliance activities have blazed a trail for other mobile apps to follow.

We knew from the start that we wanted to work closely with the FDA to ensure a high level of quality compliance, due to the innovative intended use of AirStrip Technologies applications. AirStrip gladly chose to do this at the time and will continue to do so. 

The proposed FDA guidelines mirror the compliance efforts AirStrip Technologies has engaged in since its inception. AirStrip has benefited greatly from committing to rigorous quality compliance. An excellent safety record and growing market share tell the industry that AirStrip’s leadership in this regard is hard-earned and well-deserved.

While all AirStrip applications - including CARDIOLOGY and PATIENT MONITORING - are FDA cleared, many other apps in the marketplace are not.

The FDA is indicating that medical apps that do not adhere to agency standards will fall under increased scrutiny for non-compliance. Those app creators will now be expected to offer a level of documentation that they are likely not used to providing, and this will surely alter the mobile medical app landscape. At the same time, true innovation that shows a commitment to quality compliance in the interests of patient safety should have ample room to flourish.

The FDA is now seeking comments online or in writing. The public comment period ends October 19, 2011. You can find more information about the FDA action here.

Early Findings Following AirStrip Cardiology Deployment at Three Hospital Systems

We know that communication technologies that transmit ECGs directly to a smart phone or mobile device allow rapid viewing of ECGs by experts and can be used to overcome logistical and geographic barriers to care. This approach has been proven to reduce E2B times, reduce mortality, reduce morbidity, reduce cardiac damage following STEMI, and improve clinical outcomes. [1] [2]

We hypothesized that by improving logistics, visual clarity, touch screen manipulation, and more data for analysis, providers may be able to more quickly and accurately interpret ECG findings. We delivered this with AirStrip Cardiology™ and we added simultaneous and comparative access to historical ECGs from hospital ECG management systems and from EMS in the field. We demonstrated this technology in previous blog entries. [3]

Over the past several months, we have successfully deployed this technology at a number of hospitals. At least 50 clinicians, most of them cardiologists, are presently using AirStrip Cardiology in a dozen facilities at three major health systems across the country – and that number is expected to quadruple by mid-July 2011.

The preliminary results show a great deal of promise. Physicians currently using AirStrip Cardiology have already reported that the clear, concise resolution and touch-enabled analytics significantly improved their ability to diagnose specific conditions, fostered more timely decisions, supported more rapid intervention, and afforded them an experience of freedom and workflow efficiency. This feedback is consistent across all users. We will publish our physician surveys in whitepapers and highlight them in future blogs.

We are learning that great things can happen with mobile, digital, enhanced ECG. For example, AirStrip Cardiology hospital clients have reported improved STEMI patient care, including reduced time to intervention and reduced false activation of the cath lab. Preliminary findings by hospitals include:

• A median time of 9 minutes from ECG acquisition to view time by a cardiologist, with a resultant 7 - 15 minute reduction in time to intervention.
• A reduced length of stay of 0.85 days per STEMI case, attributed to earlier intervention. Each STEMI day saved is estimated at $2,500.
• A 4% -5% reduction in false activation of the cardiac cath lab. The savings per false activation prevented is estimated at $7,500.

How? Physicians and program directors are attributing these benefits to the following features:

• Immediate, anytime, anywhere access to ECGs, creating the “un-tethered” cardiologist
• Twentyfold improvement in visual display over paper tracings and pdfs;
• Automated interval & axis deviation measurement and more digital data; 
• Elongated strips, making pattern variability more apparent;
• Access to historical tracings, allowing serial presentation and comparison

We will continue to share lessons learned from the deployment of this mobility solution. We are offering a complimentary webinar series detailing customer results from the use of this technology. We’ll post a link to the registration page in our next blog.

References
[1]  Sanchez-Ross M, Oghlakian G, Maher J, Patel B, Mazza V, Hom D, Dhruva V, Langley D, Palmaro J, Ahmed S, Kaluski E, Klapholz M. The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. JACC Cardiovasc Interv. 2011 Feb;4(2):222-7. Patients had significantly shorter D2B times (63 minutes versus 119); lower peak troponin I (39.5 ng/ml vs. 87.6); creatine phosphokinase-MB (126.1  ng/ml vs. 290.3); higher left ventricular ejection fractions (50% vs. 35%); and shorter LOS (3  days vs. 5.5 days).

[2]  Khot UN, Johnson ML, Ramsey C, Khot MB, Todd R, Shaikh SR, Berg WJ. Emergency department physician activation of the catheterization laboratory and immediate transfer to an immediately available catheterization laboratory reduce door-to-balloon time in ST-elevation myocardial infarction. Circulation. 2007 Jul 3;116(1):67-76. Epub 2007 Jun 11.

[3]  http://airstriptech.blogspot.com/2011/04/youll-never-look-at-ecg-same-way-again.html

You’ll Never Look at an ECG the Same Way Again

AirStrip Technologies recently launched a global partnership with GE Healthcare to digitize and mobilize ECGs. At AirStrip Technologies, we feel very strongly about providing meaningful mobility for cardiology care in the form of mobile, enhanced, digital ECGs, which we believe will improve and expedite critical decision making capacity for Cardiologists. I have recorded a short demonstration of the new technology and I am positive that you will never look at an ECG the same way again.

Why? There are 16.8 million people with coronary heart disease, and 14.4 million people with cardiac dysrhythmias in the U.S. More than 10 million people suffer from cardiac-related chest pain [1] and this year, 6 million patients with chest pain will arrive at hospital emergency departments across the nation. 38% of 1.45 million actual heart attack victims will die; [2] more than 225,000 will die within one hour of the onset of symptoms and before ever reaching a hospital. [3]

No matter what the location or level of care, the 2010 International Liaison Committee on Resuscitation (ILCOR) ACS-MI Task Force confirms what we all know - ECGs are essential [4] to the diagnosis and treatment process of Acute Coronary Syndrome (ACS).

Time is of the essence in achieving the desired clinical outcomes and performance measures for these patients. The literature clearly shows that reducing time to intervention reduces morbidity, mortality, and sequelae. Hence, getting an experienced cardiologist involved early is critical in the diagnosis and management of abnormal ECG findings. [5]

Digital technology advancements now support unprecedented visual clarity, touch screen manipulation, enhanced analytics, and the ubiquitous delivery of this vital intelligence - current and historical ECGs - to a provider’s mobile device.

AirStrip Technologies and GE Healthcare recognized the potential of mobile, enhanced ECG delivery, and responded in kind with an FDA-cleared product designed specifically to make a difference. Now that's Meaningful Mobility for Healthcare℠.

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[1] Heart Disease and Stroke Statistics — 2009 Update, American Heart Association

[2] American Heart Association Statistics. http://www.americanheart.org/presenter.jhtml?identifier=3061132

[3] Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2010;121:e1-e170.

[4] Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, Deakin CD, Drajer S, Eigel B, Hickey RW, Jacobs I, Kleinman ME, Kloeck W, Koster RW, Lim SH, Mancini ME, Montgomery WH, Morley PT, Morrison LJ, Nadkarni VM, O’Connor RE, Okada K, Perlman JM, Sayre MR, Shuster M, Soar J, Sunde K, Travers AH, Wyllie J, Zideman D. Part 1:executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(suppl 2):S250 –S275.

[5] Massel, D. Observer Variability in ECG Interpretation for Thrombolysis Eligibility: Experience and Context Matter. Journal of Thrombosis and Thrombolysis 15(3), 131–140, 2003.

Great Things Happen With Meaningful Mobility

The 22nd Annual HIMSS Leadership Survey [1], released at the HIMSS annual conference this week, showed that half of the respondents from 700 hospitals cited difficulty achieving end user acceptance as one of the top three barriers to achieving meaningful use. Providers need IT solutions that fit their clinical workflow realities. IT can have the greatest impact on patient care when it is used to help providers improve clinical and quality outcomes. Mobility is the key to engaging end users, especially physicians, in meaningful use.

This is absolutely working in hundreds of hospitals nationwide who are using mobile technology to deliver data traditionally locked in clinical information systems. When we leverage the secure and ubiquitous delivery benefits afforded by mobile communications to free up the information otherwise stuck in some application or data warehouse, we transcend geographic and logistical barriers to care. This creates a cascade of benefits. Great Things begin to happen.

For example, we know that mobilizing clinical information can optimize patient throughput. No longer must patients wait for hours in the emergency department until a remote physician specialist can provide a consultation. It can happen immediately, in real time. Care is timely and efficient. Patients get better, faster. Patients and families are more satisfied. Providers experience exponential productivity gains. Clinicians are more satisfied. These are clearly Great Things for healthcare systems, healthcare providers, and the public at large.

When we build native applications that transform the data relative to the device, and deliver it as intelligence in visually meaningful ways, we improve clinical decision making at the point of care. Even more Great Things happen. We enhance cognition. We improve diagnostics. We can guide better choices by patients and providers.

When we incorporate evidence-based medicine and knowledge-based prompts with the delivery of critical information, we create an IT solution that not only helps us achieve meaningful use objectives, but one that helps us begin to improve clinical and quality outcomes. Isn't that where we started with this post?

We've learned that successful HIT Leaders who wish to overcome the big barriers to achieving meaningful use are re-examining how they leverage the data - housed in those EMRs, bedside monitors and devices, pharmacy, lab, and other clinical information systems - to improve care. Those who have added a meaningful mobility solution to their strategy are quickly seeing a difference. Mobility can help achieve meaningful use objectives, and all the while it also causes Great Things to happen.

We’ll explore more Great Things afforded by meaningful mobility in the next few weeks.

References:

[1] http://www.himss.org/2011Survey/

The Return on Investment for Mobile Computing in Healthcare

Ah, the age old question, "What's the return on investment?"

Mobile access involves chunking, transforming, and securely delivering visually compelling data from the hospital computing environment to a mobile device using a native application when providers need to make timely diagnosis and treatment decisions - regardless of their physical location. Hence, the benefits of mobile computing are primarily a function of logistics and ubiquity.

The return on investment for meaningful mobile technology in healthcare can and should be measured. There are three areas to consider when evaluating the return on investment for mobile computing. Each mobile solution or application should be expected to have a unique impact in each of these areas.

1. Strategic - How the technology will be used to help achieve greater organizational goals and objectives;
2. Clinical – Anticipated improvements or gains in quality, structure, and process of care delivery capabilities and better patient outcomes;
3. Financial – The cascade of benefits caused by increased workflow efficiency and improved communication, including those from the strategic and clinical impact areas.

 For example, the financial return on investment for our AirStrip OB product was traditionally measured in the reduction of medical malpractice claims exposure and experience stemming from our ability to target 64% of the losses to a typical insurance program. We subsequently learned that it also reduced physician splitter behavior, improved nursing efficiency, enhanced clinician job satisfaction, and improved physician assessment of nurse competency. Furthermore, first-to-market campaigns have influenced hospital market share by impacting patient and community perceptions of care.

Additional benefits our clients are seeing - and seeking – with mobility include:

• Acceleration of meaningful use objectives, in particular those involving physician adoption
• Enhanced performance of core measures, with greater reimbursement potential
• Elimination of geographic barriers to care and infrastructure to support accountable care organization service delivery
• Improved physician and nursing workflow logistics, communication, teamwork, and greater productivity.
• Better patient throughput and improved satisfaction.

We use financial modeling tools and processes to help our clients predict the return on investment for each of our products based upon their specific circumstances. Cost reductions and revenue enhancements should be considered along with other benefits, such as patient safety, which is even more important yet difficult to quantify. We are learning that many evidence-based measures can be useful in analyzing performance before and after mobile technology adoption to confirm and validate (or disprove) the original impact prediction.

No matter how you slice and dice it, "mobile computing done right", something we call "meaningful mobility" can produce a significant return on investment with far-reaching benefits for patients and providers.

Distinguishing Remote Access From Mobile Access

We frequently encounter folks who ask us about remote access via mobile devices. There's an important distinction to be made here. The usage intentions, patterns, and requirements for remote access and mobile access are very different. [1]

The purpose of remote access is to work in your computing environment when you are not on location. An example of remote access would be accessing hospital information systems and applications via a PC or laptop from your office or home. Often, remote solutions involve a VPN connection, a Windows desktop and/or web browser, and perhaps a remote license to allow the user to interact with the applications they are accessing. Mobile access is a different animal. Mobile users want to do specific tasks - check a lab value, view a waveform, see a medication list, check allergy status - while on the go. Providers want the data transformed into accessible, meaningful chunks, they don't want to have to navigate the entire medical record from their Droid in order to make a time sensitive decision. See table 1.

Some organizations have considered using Citrix to provide interpreted or emulated application access or a pdf view of EHR data and clinical information systems via a mobile device. That's like reading the New York Times on your smartphone using the internet browser. You can do it, but it doesn’t really work. Use the native application provided by the publisher. Native applications are built to run on a specific device and operating system.

We also do not recommend accessing any patient monitoring data via a non-native solution, because visual distortion is almost certain when things like medical aspect ratios cannot be controlled. Further, be advised that the FDA is mandated to regulate medical devices, including mHealth applications on cell phones and associated products. [2], [3]

We know that the reasons for and usage of remote and mobile access differ. We have learned that patient safety and provider efficiency are paramount in mobile application delivery. To optimize your provider access strategy, both approaches must be accommodated.

References

[1] Madden, B. 2010. Remote desktop access vs. mobile access: What’s the Difference? http://searchvirtualdesktop.techtarget.com/feature/Remote-desktop-access-vs-mobile-access-Whats-the-difference.

[2] Thompson, B., Kendall, L. 2009. How to Get FDA to Clear a Mobile Health App. http://www.ebglaw.com/showarticle.aspx?Show=12184

[3] Kumar, R. 2010. The FDA’s Regulation of Mobile Technology as Medical Devices. http://www.law.uh.edu/healthlaw/perspectives/2010/kumar-fdamobile.pdf.

Meaningful Mobility for Cardiology Care

A 12-lead ECG is a snapshot in time of 3 spatial views of the heart's electrical activity from 12 angles. It is generated by placing 10 electrodes on various parts of the body including the arms, legs, and chest. With a 12-lead, we are simply taking a multi-dimensional picture of heart conduction from right to left, top to bottom, and front to back.

Once the electrodes are placed, the ECG recorder is run. The recorder digitally captures the multi-dimensional picture. Although the machine will virtually record all 10 seconds of data per lead, all traditional ECG print outs and the current pdfs currently used in most mobility solutions only provide 3 seconds of data for each lead, and those three seconds are printed, static, flat, and non-interactive.

The output of an ECG recorder is a tracing on a graph. Time is represented on the x-axis, and voltage, or amplitude is represented on the y-axis. Look at the following picture describing the time and voltage for a traditional ECG tracing. Notice, for example, how one small 1 mm x 1 mm block represents 40 milliseconds in time and 0.1 millivolts in amplitude? (See Figure 1).

Now let’s look at how mobility providers can add serious value to the ECG equation. One way is to mobilize a pdf version of the ECG tracing. (See Figure 2). Helpful - but where is our data transformation in this equation? Consider it’s time to move to the next generation mobile solution. (Figure 3).

Figure 1

Figure 2

Figure 3

AirStrip Cardiology ™ provides the ability to scroll through a full 10-second ECG for all 12 leads and set any of the leads as the rhythm strip – clinicians choose the beats used for analysis. In addition, the dynamic ECG layout functionality grants full control over how leads are rendered, providing the option to see all 12 or 15 leads for the ECG or selectively, in various comparative layouts and zoom levels.

AirStrip Cardiology can help clinicians detect changes in mV signal as low as .05 mV (0.5 mm). That’s a twentyfold increase in amplitude detection over paper tracings. End users clearly see sub-millimeter variations, as well as being able to visually scan all 12- or 15-leads at once and see any relative deviations.

In terms of playback control, marking the grid with the measurements coming from GE Marquette® 12SL™algorithms, we also allow play modes for the 10 second digital segment to be full, 1/2, 1/4, or 1/8 speed, as desired. Added features such as user-driven lead selection, maintaining relevance across leads with synchronized pinch and zoom, make this exponentially more interactive. Now that’s meaningful mobility.

References:
[1] http://en.wikipedia.org/wiki/File:ECG_Paper_v2.svg
[2] http://en.wikipedia.org/wiki/File:12leadECG.jpg
[3] © 2010. AirStrip Technologies. All rights reserved

Successful Physician Adoption of Mobile Solutions

The rate of adoption is the relative speed with which providers initially take up mobile technology. It is usually measured by the length of time required for a certain percentage of the affected clinicians within the organization or clinical care area to adopt the innovation. [1] That is, the application has been installed on their device, is ready for use, and the user clearly understands how to launch and interact with the program.

 

Within the rate of adoption there is a point at which usage reaches critical mass. [1] This is a point in time within the adoption curve that enough individuals have accepted the mobile application such that the continued adoption of the innovation is self-sustaining; the program becomes the standard of care, and its use is embedded in daily workflow. It is at the point of sustained adoption that benefits may ultimately be realized. Adoption rates are primarily determined by three factors:

1. The strength and effectiveness of the communication plan and commitment by the facility to promote adoption by all targeted clinicians.
2. The availability of an approved device and appropriate data plan to the adopting clinician [3] - allowing use of personal devices is preferred to requiring them to carry multiple devices.
3. The availability and familiarity of an acceptable/effective use policy and procedure among providers and on the nursing units.

We know that organizations can improve the likelihood of adoption with good pre-implementation planning:

• Involve physician and nursing thought leaders in the purchase decision and in scheduling the rollout.
• Expose as many clinicians to the technology as possible prior to deployment
• Be clear as to expectations for acceptable use, compatible devices and data plans, and allow time to meet these requirements.
• Roll deployment projects out over time.

The way to ensure use is simple: make sure the product works every time, that it mobilizes data in visually meaningful ways, that it supports actual workflow, and that it's easy to use. Deliver value and usage will continue. If you don't deliver value, physicians will not adopt nor will they continue to use the product.

 

Finally, Lead. In writing. We are learning that the strongest adoption and utilization results are produced within hospital systems that have a defined policy and procedure regarding effective use of mobile solutions. This written policy and procedure is also helpful in assisting providers in understanding who may use the product, when to use the product, as well as to define the limits of effective use. All clinicians on the care unit should be clear that the mobility solution is not a substitute for the physical bedside availability of any team member at critical points in the care process.

 

References

 

[1] Rogers, E. M. (1962). Diffusion of Innovations. Glencoe: Free Press.

 

[2] Valente, T.W., 1995, Network Models of the Diffusion of Innovations, Hampton Press Cresskill, New Jersey.

 

[3] Markus, M. L., 1987, ‘Toward a ‘critical mass’ theory of interactive media: Universal access, interdependence and diffusion’, Communication Research, 14 (5), 491-511.

 

Improving Cardiology Diagnostics with Meaningful Mobility

Meaningful mobility transforms data into intelligence in a way that supports the improved performance of physician cognitive tasks such as diagnosis and triage. Consider the 12-lead ECG.

There are currently solutions on the market that allow the transmission of a .pdf of the EMS 12-lead ECG to emergency room physicians for AMI diagnosis and triage. [1] This has significantly shortened EMS-to-Balloon times. [2] There are also solutions that pull ECG data digitally and store the results centrally, for enhanced serial analysis. [3] But, where is our meaningful mobility data transformation in this equation?

Enter: AirStrip Cardiology. This product mobilizes the digital information obtained from 12 and 15 lead ECG so that providers can scroll through a full 10-second ECG for all 12 leads and set any of the leads as the rhythm strip – physicians choose the beats used for analysis.  It also grants the physician full control over how leads are rendered, providing the option to see all 12 or 15 leads for the ECG or in various comparative layouts and zoom levels.

Now, using a native AirStrip application on their mobile device physicians can:

• Receive 12- and 15-lead waveforms and vitals wirelessly from EMS transport, which the clinician can then access from anywhere and review on their mobile device via a native AirStrip application.
• Simultaneously scroll through a full 10 seconds for all leads while retaining the traditional 12-lead layout.
• See a full presentation of results GE Marquette® 12SL analysis algorithms for 12 leads for EMS and inpatients.
• Review and compare past ECGs, and do detailed serial comparisons of waveforms for their patients.
• See clear and accurate waveforms and detect differences of less than .05 millivolts (.5 millimeter).

No more faxes, emails or .pdfs. Just transformative data that powers enhanced visualization and improved decision support by busy, on-the-go clinicians. Care is expedited. Outcomes will improve.

15.5% of emergency department patients arrive via ambulance. That's 18 million people. The leading reasons given by patients aged 15–64 years for visiting the ED were chest pain and abdominal pain, and for older patients (aged 65 years or over) the reasons were chest pain, shortness of breath, and abdominal pain. For adults 65 years of age and over, chest pain and non-ischemic heart disease were leading primary diagnoses for both men and women. Of the 16.7 million patients admitted to the hospital or transferred to another facility, 30% were admitted to critical care, stepdown or telemetry units. [4] Of 6 million chest pain patients, 400,000 were diagnosed with STEMI. [5]

We know that coordination of care for these cardiology patients is crucial to our health care system and the technology to support improved diagnosis and triage are vital to our ability to serve this growing population effectively. We are learning that superior diagnostic support is another way for hospitals and providers to win at meaningful use: engaging emergency room physicians, cardiologists, interventionalists, surgeons, critical care physicians and a host of others in the more timely and effective care of cardiac patients – anytime, anywhere.

References

[1] Physio-Control Case Study: Prehospital 12-Lead ECGs Help to Reduce EMS-to-Balloon Times http://www.physio-control.com/uploadedFiles/learning/clinical-topics/3300653.A%20Prehospital%2012-Lead%20ECGs%20Help%20to%20Reduce%20EMS-to-Balloon%20Times.pdf

[2] Rokos, I and Bouthillet, T. The emergency medical systems-to-balloon (E2B) challenge: building on the foundations of the D2B alliance. STEMI Systems. 2007; Issue 2, May.

[3] The GE Muse System. http://www.gehealthcare.com/usen/cardiology/diagnostic_ecg/docs/ECGenius.pdf.

[4] Niska, R., Bhuiya, F., Xu, J. CDC Division of Health Care Statistics (2010). National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary. National Health Statistics Report. Volume 26. August 6, 2010. Accessed online at http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf

[5] McCaig, L, Burt, C. National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. In: Advance Data from Vital and Health Statistics, Centers for disease control and prevention, Atlanta, GA 2005.

Engaging Physicians in Meaningful Use

Amid the hubbub about meaningful use, AirStrip has stayed true to helping hospitals and physicians achieve their greater goals of clinical decision support:

1. Data access and data sharing – meaningful mobility with data transformation is a prerequisite to Stage 1
2. Understanding clinical practice - making the data available in a meaningful way for users, especially physicians in Stages 1 and 2
3. Guiding choices - incorporating concepts of evidence-based medicine in the offering in Stages 2 and 3
4. Knowledge-based prompting - providing views of data and rules that promote proactive, rather than reactive interventions to accompany Stage 3.

For hospitals to win at meaningful use, physicians MUST be engaged users - “use” being the definitive term.

We know that every hospital and physician needs useful EHR technology which provides clinical decision support in fulfillment of safe, effective, and more profitable patient care.  They've been struggling with this for 15 years, with fewer than 10% having achieved any level of success. The biggest challenges are interoperability, physician adoption, and change management. Congress hopes to use meaningful use financial incentives and penalties [1] to force hospitals and physicians to accomplish over the next 5 years what they have not been able to achieve in the previous 15 years. [2]

If hospitals want physicians to use the EMR (and LIKE it), then give them mobile (not remote) access. With AirStrip OB, obstetricians are interacting with hospital information systems an average of nearly five hours per physician per month beyond the time they are spending on CPOE or entering progress notes via a workstation. If you have 30-35 obstetricians delivering patients at your hospital or health system, that’s like adding one laborist FTE – without the cost. We are learning that other specialists are engaging at even more staggering levels with our cardiology and patient monitoring products. We need only look to the role of the physician to understand why.

Physicians perform two kinds of tasks: cognitive and procedural. Cognitive tasks include things like “triaging admissions, deciding whether a white cell count of 24,000 × 109/L with a 38.4°C temperature warrants antibiotics, whether surgery is indicated, etc. Procedural tasks include things like performing surgery, intubating a patient, placing a central line, etc. A subset of procedural tasks is administrative (e.g. prescribing orders, documentation, scheduling imaging studies)”. [3] Mobility solutions can effectively support multiple physician job functions.

Meaningful mobility transforms data into knowledge and, in turn, delivers that intelligence in a way that supports the improved performance of the cognitive tasks by physicians (diagnosis, triage, and clinical management), while mitigating the time management challenges of procedural tasks (physical assessment, interventional treatments, and prescribing). Meaningful mobility is vital to physician engagement and alignment with HIT.

References
[1] Section 1848 (a)(7) of the HITECH Act provides that beginning in Calendar Year 2015, eligible professionals who do not demonstrate that they are meaningful users of certified EHR technology will receive an adjustment to their fee schedule for their professional services of 99 percent for 2015, 98 percent for 2016, and 97 percent for 2017 and subsequent years. 

[2] Sections 1848(a)(2)(A) and 1886 (n)(3)(A) of the HITECH Act includes Congress’ identification of the broad goal of expanding the use of EHRs through the term meaningful use.

[3] Fackler, J., Watts, C., Grome, A., Miller, T., Crandall, B., Pronovost, P. (2009). Critical care physician cognitive task analysis: an exploratory study. Critical Care. 2009; 13(2): R33. 

Mobile Solutions Improve Teamwork in Labor and Delivery

Labor and delivery is a great example of a clinical care area where mobility makes a huge difference in teamwork and communication.

In the nurse managed labor model, a registered nurse is responsible for recognizing problems, evaluating labor progress, providing hands-on care, and informing the physician or other team members when needed. [1] Nurses are trained to recognize, interpret and evaluate fetal monitoring data. In addition, they are aware of the autonomous interventions that can be instituted prior to calling the physician and the expected outcome of each. When approved interventions within the scope of nursing practice do not yield acceptable results, the nurse immediately notifies the physician or nurse midwife, who then collaborates in development of a plan of care in the best interest of mother and fetus. [2]

A challenging fact in obstetrics is that communication between the nurse and physician occurs as the nurse is providing direct care to the patient while the physician may be away from the bedside - in the office, another part of the hospital, or on call at home. [3]

In the past, nurses endeavored to describe the concerning fetal tracing via telephone, often a subjective assessment, when what they actually need is validation of their visual finding. Physicians had to try to envision what the nurses were seeing. Mobility solutions today can and must provide virtual viewing of data that is incomparable to verbal description alone.

AirStrip OB is an example of this kind of solution. It allows the physician to be in two places at one time and to actually see what the nurse is seeing. This extends the physicians' ability to make critical decisions based on real-time information that leaves no room for error related to verbal interpretation.

We know that prior to this mobility solution, there were delays in collaborative multidisciplinary assessment of patient data and medical management. There was no way to efficiently escalate differences of opinion via the established chain of command, and teamwork breakdowns and patient safety issues ensued. We have learned that when nurses identify a concerning CTG pattern, they notify midwives and/or physicians who can immediately view the CTG pattern on their smartphone and can discuss the treatment plan in a time sensitive fashion. Disagreements can be escalated up the chain of command immediately, regardless of the location of the providers involved. The net results are safer patient care, improved efficiency, and better relationships among clinicians.

References

1. Murray, M.L. & Huelsmann, G.M. (2009). Labor and delivery nursing: a guide to evidence-based practice. New York: Springer Publishing Company.

2. Simpson, K.R., & Knox, G.E. (2006b). Communication of fetal heart monitoring information. In E.F. Feinstein, K. Torgeren, & J. Atterbury (Eds.), Fetal heart monitoring: principles and practices (2nd ed.) Washington, DC: Association of Women’s Health, Obstetric and Neonatal Nursing.

3. Simpson KR, Knox, GE (2003). Adverse perinatal outcomes: Recognizing, understanding & preventing common accidents. Lifelines: Promoting the Health of Women and Newborns, 7(3), 224-235.

Meaningful Mobility

Meaningful mobility is a prerequisite to Stage I Meaningful Use (data access and data sharing), especially by physicians. The key to success is to actually work with clinician workflow, rather than asking them to change it.  Mobility is important because it supports the actual multitasking and "on-the-go" realities and requirements of physicians, nurses, and clinical managers. Beyond anytime and anywhere access, mobility solutions must transform data into visually compelling information that supports better clinical decision making. Further, the mobility solution must guide better choices by incorporating evidence-based medicine and knowledge-based prompting. The goal is to improve clinical decision making at the point of care through data transformation.

It's not enough to provide interpreted or emulated application access or a .pdf view of EHR data via a mobile device. That's tantamount to booking airline tickets on your smartphone using the internet browser. You can do it, but it doesn’t really work. It’s awkward and time-consuming and lacks the value-added native application-quality data transformation that is critical to improved clinical decision-making. So, the patient's serum potassium level is 3.0 milliequivalents per liter. What is the relevance of that value in the context of that patient? Was the drop sudden or gradual? Is the low value chronic? What has been the patient's range? How does that map to the normal range? Has the patient been on potassium replacement of any kind? It is possible to present that data in an informative and visually compelling manner that promotes better choices by practitioners.

In health care we see time and again that those who make data access and data processes difficult for clinicians suffer adoption resistance and usage doldrums. We have learned that delivering mobile intelligence about assigned patients in concert with the workflow of providers is technology that is enthusiastically received and rapidly adopted, and we see high usage levels sustained over many years.

About AirStrip Technologies

AirStrip offers unique mobile technology that provides clinicians and leaders with access to real time and historic critical patient data from multiple and disparate sources. This includes waveforms, medications, lab results, and other trended, relevant clinical data presented in informative ways so as to improve the management of patients and patient populations - in particular those that are high volume, high risk, and high cost. Read more about the San Antonio Texas-based firm here.