Technology tools to improve patient care

Any hospital process is lean if it delivers services that the patient wants, at a price that reflects only the value that patient is willing to pay for, says Deepak Agarkhed

Technology, Patient care, Ambulance tracking, EMR, User friendly, Computer on wheels, COW, Pneumatic chute system, PACS, Internet of Things, IOT

Overwritten medication prescription has resulted in wrong dispensing of medicine from pharmacy, in spite of sufficient porters in hospital. Patients do not get transported from one area to another when it is essential. The robotic system procured is mostly kept idle on cash account of patient refusal to pay higher cost.
The above examples are mostly encountered in any hospital. Technology no doubt plays major role in better service and recovery to patients. The dilemma of which technology tools hospital should adopt is mostly confronted by hospital management.
Any hospital process is lean if it delivers services that the patient wants at a price that reflects only the value that patient is willing to pay for. Most of hospital process will have technology as part of its input supply. Like any other industry, the wastes originated from any hospital process affect overall effectiveness and efficiency of desired outcome. Any process wastes are manly identified as below.
• Waste due to waiting for the next event/work to occur
• Waste due to overproduction as doing more than what is needed by customer or doing it sooner than needed
• Waste due to rework
• Waste due to motion i.e. unnecessary movement in the system
• Waste due to over processing i.e. doing work not valued by the customer
• Waste due to excessive inventory
• Waste due to non-engagement of employees, their idea
• Waste due to transportation like unnecessary movement of materials, specimens in system

The following are few tools of technology which can help to enhance efficiency of hospital provided it is adopted in right spirit:
1. Ambulance tracking to hospital through GPS:
GPS tracking device based ambulance services will help to allot the nearby ambulance, gauge driver’s performance, transmit real time data on its location to hospital emergency department. The service can also track the temperature of medication storage and provides timely alerts to hospital team. Wi-fi equipped external defibrillator or patient physiological monitor within ambulance will help to send early notification which maximises patient safety by letting the clinician intervene before any possible emergency situation.

2. User friendly electronic medical records (EMR):
The user friendly EMR will provide quick access to patient record for continued clinical care. The patient record can be tracked over time using EMR. It reduces human induced errors like medication, wrong capture of critical value. The communication among care providers including various clinicians  in multi care set-up will improve. In poorly-designed EMR, clinician spends more time on system than with patient.

3. Computer on wheels (COW) using EMR:
Computers on wheels are PCs or laptops that are mounted on a mobile trolley. As it can be taken at any place in hospital with wi fi set-up, the hospital clinical staff will be able to track patient records, administer medicine and view lab or radiology report. It can even keep essential medical supplies and bar code readers. Quicker access to patient’s records in real-time is possible at any place in hospital through COW.

4. Pneumatic chute system:
Pneumatic tubes are systems that push cylindrical capsule containers through networks of tubes by compressed air or by partial vacuum. They are used for transporting solid objects like blood sample, medicine from one station to another in less than 60 sec. With a hospital pneumatic tube system, laboratory samples, units of stored blood or patients files reach their destination more quickly without waiting for transportation through hospital staff.
5. Picture archiving and communication system (PACS):
PACS provides economical storage and convenient access to images from multiple modalities. Electronic images and reports are transmitted digitally via PACS. The PACS removes the need to manually file, retrieve, or transport film, the folders used to store and protect X-ray film.
PACS provides the electronic platform for radiology images interfacing with other medical automation systems such as Electronic Medical Record (EMR) and Radiology Information System (RIS).
PACS expands on the possibilities of conventional systems by providing capabilities of remote viewing and reporting even through smart phone.

6. Wireless nurse call systems:
The wi fi enabled nurse call system is electrically operated system which enables the patient to call a nurse from a duty station or a bedside station. The wireless system with auto escalation provision will ensure that if assigned nurse does not attend the call in predefined period, it goes as escalation to team leader. There is provision to keep trail of each call and data analysis can be performed.

7. Internet of Things (IoT):
Internet of Things (IoT) is device that has a sensor attached to it and can transmit data from one object to another or to people with the help of internet. As broadband internet is available and affordable almost everywhere, and wi fi capabilities and sensors have been built into a wide range of devices.
The Internet of Things has already changed the world like we can set or control air-condition temperature from far distance through our smart phone. IoT application can easily adopted in medical devices physiological monitoring system, implantable devices like pacemaker, fixed equipment like MRI wherein machine data like temperature is transmitted to  remote service station to quickly service. The application of IoT can be used for optimal utilisation of porters within hospital and even tracking doctors and nurses through EMR.

8. Remote monitoring of vital parameters:
With projection of huge demand of patients opting home healthcare in coming years, the remote monitoring of vital parameters like oxygen saturation for chronic obstructive pulmonary disease, fasting glucose for diabetes, blood pressure for hypertension is easy through IoT. The patient data can be integrated directly into the EMR  for patient self-management, patient care planning.

9. Machine learning:
The machine learning is programming that lets the computer learn how to do something rather than simply follow a series of programmed commands to do something. The Google or Facebook use machine learning to feed tailor made data to us .The machine learning models like transmitting the picture of a skin lesion to remote location and with a high degree of accuracy determination of the lesion to know is it potentially malignant based on library of picture database through analytics is praticable. Virtual assistant like Amazon's Alexa, clinician could direct the virtual assistant to order a diagnostic test or prescribe a new medication.
10. Telemedicine and telehealth:
With revolution in information technology and communication field having sufficient Internet speeds in past decade, IP based webcams, application software telemedicine has opened door for e-consults for patients.

11. Navigation system for surgery & robotic surgery:
Precise planning of the incision and the identification of small lesions, the absolute and relative residual tumor volumes are few advantages of navigation system for surgery. The shorter length of stay at hospital, reduced pain and discomfort, smaller incisions and minimal scaring are advantages of robotic surgery.
The tools of technology are many more and keeps on updating on regular basis. The tools of technology will no doubt reduce waste in process when adopted with right spirit. The hospital should only adopt value add tools of technology which will enhance effectiveness and efficiency patient care so that ultimate benefit is passed to patient.

Deepak Agarkhed is general manager-clinical engineering, quality and facility, with Sakra World Hospital, Bengaluru

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