Marion Ball, Ed.D., is a fellow at the IBM Research Center for Healthcare Management Research and a professor at the Johns Hopkins University School of Nursing (both based in Baltimore). She is also co-chair of the executive committee for the Technology Informatics Guiding Education Reform (TIGER) Initiative, which was created to develop a strategy for improving nursing practice, education, and the delivery of care through the use of health IT. Last year, Ball co-authored an article in Methods of Information in Medicine that examined why clinical information systems are failing. Recently, Associate Editor Kate Huvane Gamble spoke with Ball about the report's findings, particularly the importance of providing clinicians with the information they need at the point of care.
KG: Let's talk about the report. The basis seems to be that one of the key reasons why health IT adoption is so low has been the failure to provide healthcare professionals with effective health IT systems. Is that fairly accurate?
MB: Yes, but you have to be a little bit more precise in that they're not getting the information that they need at the point of care. In other words, we give them so much information that it's like they're being fed with a fire hose and everybody gets it from the same hose. The internists and obstetricians and psychiatrists all get the same template. If you're a gynecologist, you don't need to have the information that four years ago a patient broke her leg if she's there for an OB-GYN checkup. Instead of making their life easier, we're making their lives more difficult. So the whole idea is, how can we make them do less work and not more work.
KG: And a large part of that is not just providing the information a clinician needs about a specific patient, but also delivering it in a way that's tailored to their individual needs?
MB: That's right. In other words, the system must adapt to the user, and not the other way around. It needs to cater to what we need, and not be set up so that we're serving the computer. And we need a rapid adoption; it's got to be the iPhone of the future, where it's intuitive, where it really helps, and where people will embrace it.
Right now, we have to be adaptable to any of the vendors' healthcare systems, and that's not the way it should be. They need to be adaptable to the physician, the nurse and the pharmacist; not the other way around. And in product development, we need much more significant input from physicians and nurses who are in the line of fire, at the point of care, to say, ‘Look, this is what we need when were in the emergency room. This is what we need when we're in a doctor's office in the private practice.’
Why should they have to go to every terminal and put in a password 10 times and then change it every 90 days? It's more difficult to get into the system than to look at the patient. When you watch a nurse at the station, you can see that it is a major operation just to get to the lab results.
We've been at this for almost 40 years, and we still have, at the maximum, 18 percent physician and clinician adoption. That tells you something. It's not giving them what they want - that's the bottom line. So we need to find out what it is that we really need at the point of care.
KG: What are some of the technologies that you think have the potential to deliver that information to the clinicians?
MB: One wonderful example is the University of Pittsburgh Medical Center's smart room. It's a disruptive technology that tells the nurse or phlebotomist immediately when they walk in the room that a patient is, for example, latex intolerant. It comes up on the screen - it's not at the nursing station on a computer where they have to go through all of the dropdown menus and look up allergies to find this out. You walk in, the two badges between the provider and patient connect, and the screen says, this patient is latex intolerant. So when they take that patient's blood, they know immediately to take off their gloves, otherwise that patient is there for another two or three days.
Another scenario is, the dietician walks in with the patient's breakfast, and a light goes on in front of the screen that says, this patient is NPO (nothing by mouth). That means don't give them anything to eat because they're being operated on today. So the dietician can take the tray right out. First of all, you don't have to waste the food, and second of all, the patient doesn't have to stay another extra day because they were given breakfast on the day of surgery. These are all very simple things, but, as people will say, the devil is in the details.
We're also looking at cases where you can do charting or nursing documentation verbally while you're with the patient, and not have to take notes and go back to the nursing station and put it into the computer. We're looking at where it can be used well and where it shouldn't be used; if you can chart while you are with the patient using hands-free technology, then you can use your hands to soothe the patient or to straighten up the bed instead of being tied up in the room typing something into the laptop or the PC.
And nurses will tell you what they like. You've got Vocera and Vocollect, different companies that are starting to do that. But again, who is going to be developing these? It's got to be physicians, nurses and pharmacists, very much involved in the entire development, implementation and planning of these systems.