Seemingly overnight the hospitalist movement has blossomed from a concept to an established field in American medicine. The Society of Hospital Medicine (SHM) estimates there are approximately...
Seemingly overnight the hospitalist movement has blossomed from a concept to an established field in American medicine. The Society of Hospital Medicine (SHM) estimates there are approximately 20,000 hospitalists in the country. Despite the fact that the average hospitalist program is less than five years-old, hospitalists are often caring for the majority of inpatients in many hospitals and are being asked to solve the challenges of ensuring patient safety—increasing patient throughput, and improving patient satisfaction and care—when other providers are unwilling or unable to do so (eg, shortage of critical care and primary care providers).
At the same time, hospitals are struggling with health information technology (IT) adoption. Many believe that IT, like hospitalists, will improve the efficiency and quality of healthcare delivery. But at many hospitals, the transition to computerized documentation systems, or a “wireless” setting, has been rocky at best. If you are one of the 20,000 hospitalists with a burgeoning inpatient census and a piecemeal documentation system, what can be done to make your life easier? Here are a few things to consider.
Do Away With Passwords
So, your hospital just developed a computerized information system. How many times a day do you find yourself logging in to different desktops? Do you find yourself wishing you didn’t have to log in each time you sit at a new computer? How many healthcare providers are developing repetitive motion injuries as a result? Imagine the number of keystrokes you could save daily just by avoiding the log-in process. Or do you have a hard time trying to remember the different passwords for different applications?
Logging in is a necessary evil, because access to healthcare information must be protected. In fact, the log-in process will only get more complex. Most systems now require passwords with a minimum of six characters, including a mix of numbers, letters, and non-alphanumeric characters. The longer the password, the less likely it is that hackers can randomly make a correct guess. Some of you may be using the same password for all of your accounts; this is a terrible idea, as all of your accounts are vulnerable if a hacker discovers your password.
So what is the solution? Consider portable password protection options. For example, Protecteer offers a product that allows you to store all of your password information on a USB fl ash drive, which you can carry with you. When you sit down at any computer, plug it in the USB port, and the SignupShield will fill in the information for you. For the busy hospitalist, this saves time and keystrokes.
An alternative is to convince your hospital’s IT department to use external devices that can support Smartcards. Whether you realize it or not, most of us already use them. For example, debit cards and prepaid credit cards are forms of Smartcards; as is the subscriber identity module (SIM) card in your mobile phone. With Smartcards, a single swipe of the card through a reader verifies identity and logs the user in. However, unlike the USB fl ash drive, a Smartcard system does require each computer to have an external reader.
RFID Increases Efficiency
Ask any hospitalist how much time they spend looking for inpatient charts, and you’re sure to get a frown. Until we have a paperless system in place, this will continue to be a problem. Global Positioning System (GPS) devices are now commonplace in our everyday life. How many of us use a GPS device to help us navigate in our cars? Wouldn’t it be great to have a GPS device to locate inpatient charts? With radio frequency identification (RFID) technology, the opportunity exists to tag charts, equipment, and even patients. Doing so would allow providers to easily locate objects or patients of interest in a clinical unit or hospital setting.
RFID technology is actually commonplace already, as it is used to pay highway tolls. Marathoners wear tags on their shoes to log their times. Retailers like Wal-Mart use RFID tags to track inventory, and the US government now puts RFID tags in US passports. The use of RFIDs in healthcare is less widespread. Some Veterans’ Administration (VA outpatient pharmacies utilize RFID technology to create “talking” prescription bottles to assist in the care of patients with visual impairments or reading problems. Pharmacists label the prescription bottles with “smart” labels (RFID tags). When patients move the prescription bottle next to a RFID reader, the information encoded in the label is converted to speech. A few hospitals have even utilized a RFID wristband system to replace the manual process of identifying inpatients. Jacobi Medical Center in Bronx, NY created such a system that integrated the provider order entry system, electronic medical record (EMR), and laboratory and billing systems. A RFID wristband identification system could reduce medical errors, and increase security and efficiency.
Some hospitals utilize barcode technology to identify patients. In the barcode system, a scanner is used to scan the barcode. Scanning becomes difficult if the barcode is ripped or soiled. RFID does not require a line of sight or contact, but can be scanned from many feet away. Patients may find this less disruptive, as RFID tags can be read through clothing. Beth Israel Deaconess Medical Center in Boston, MA now uses RFID technology to track equipment in the emergency department (ED). Equipment such as glucometers, pulse oximeters, infusion pumps, etc can be tagged to facilitate real-time asset location. The system can be designed to generate event-triggered alerts based on location, presence/absence duration, and status.
For example, an alert is triggered if the glucometer is taken out of the ED. In addition to equipment, some people have made the decision to implant themselves with a RFID chip. The chip contains important information, such as an individual medical record. As a hospitalist, how often have you seen patients who present with delirium or dementia and are unable to provide their medical history? Or more commonly, how often are patients able to provide you with an accurate and complete medication list? What if you could obtain all of this information by reading it directly off their implanted RFID chip? This would bypass many of the barriers that exist in today’s healthcare system. Critics warn that RFID technology only increases the risk of identity theft, however. And widespread use of RFIDs in our hospitals would also increase the IT costs (eg, servers, wireless infrastructure) but may be off set by the benefits of safer and more efficient care.
More Than Call Forwarding
If your hospitalist program is like most, it is a small group. Most programs have an administrative office with an assistant available only for limited hours, whereas others just don’t have one at all. Short of putting your mobile telephone number on your business card, how do patients and colleagues keep track of your whereabouts? Giving out your mobile telephone number as a primary source of contact doesn’t seem like a wise idea if you expect to have a life outside of medicine.
Consider the service provided by GrandCentral, which helps you manage your telephone numbers and telephone calls. You have the option of merging all of your telephone numbers into a single 10-digit GrandCentral number. The service is free if you are consolidating just two numbers, with a $10 per month premium plan that covers up to four phone numbers and includes a slew of other features. Using the settings page on the website, you can determine which callers can call which numbers. For example, you can allow specifi c callers to ring all of your telephone numbers at once. While seeing patients, you may not want to miss any calls from referring physicians. On the days when you are not working, you can create settings in which personal calls ring on your mobile phone but work-related calls go to voicemail. In voicemail, you can set specific greetings for each individual caller.
As a hospitalist, you can create personalized greetings for each primary care provider who refers patients to you. With
GrandCentral, you can also block specific contacts (eg, recruiters or sales representatives). Identify the name and telephone number as “blocked,” and when these callers dial in, they will hear a “this number is not in service” recording. You also have the option to listen to voicemail messages online. The best news? GrandCentral Mobile is compatible with most Windows Mobile, BlackBerry, and Palm Treo devices.
If you are like most hospitalists, you are scribbling your ICD-9 and CPT codes on index cards and submitting them yourself or via your administrative assistant to the billing company. After doing this for a short time, most decide there must be a better process. MedAptus is one of several companies that has designed solutions with hospitalists in mind. When billing, it is ideal to submit professional charges at the point of care rather than at the end of the day or week. Th is minimizes the risk of failing to submit a bill and improves time to reimbursement. The MedAptus Professional Charge Capture application allows hospitalists to do that by using Pocket PC devices, mobile phones, Tablet PCs, or Web-enabled workstations. The application also provides builtin coding support to improve compliance with billing rules and regulations. The application also includes numerous patient management features. In addition to billing, the application can be set up to interface with the hospital EMR and physician schedules, allowing hospitalists to manage the patient census (eg, admits and discharges), review patient demographics, and share both clinical and billing information among diff erent team members.
Whether you decide to implement only one of the aforementioned technologies, or all of the above, what’s most important to consider is how to optimize your patients’ care. At the end of the day, it’s the balance between streamlining your workflow and managing your patients that matters most.
Joseph Ming Wah Li, MD, is Assistant Professor in Medicine, Harvard Medical School; and Director, Hospital Medicine Program, Beth Israel Deaconess Medical Center, Boston, MA. He is also on the Board of Directors at SHM.