Clinicians, clinical informaticists and IT leaders at the 20-hospital University of Pittsburgh Medical Center (UPMC) health system in Pittsburgh have been moving forward on many fronts to improve care processes for patients and for clinicians. One of the numerous innovations at UPMC, which was developed by a corporate-level IT team, but is being implemented first at UPMC Presbyterian Shadyside (the flagship hospital facility of the health system) is an ensemble of SmartRoom technologies that together are facilitating more effective care delivery patterns among UPMC clinicians. Carol Scholle, R.N., clinical director, transplant and dialysis services at UPMC Presbyterian, has been the clinician leading the clinician/clinical informaticist teams in their collaboration with the IT professionals on this project.
For their innovative work in this area, Scholle’s team earned the third-place award in this year’s Healthcare Informatics/AMDIS IT Innovation Advocate Award program, co-sponsored by Healthcare Informatics and by the Association of Medical Directors of Information Systems (AMDIS). All three winning teams were recognized in May during the Healthcare Informatics Executive Summit held in San Francisco.
The UPMC team’s submission to the program included the following: “This team implemented a new bedside charting technology on a high-acuity abdominal transplant step-down unit. This SmartRoom technology utilizes an ultrasound-based real-time locating system, in which the nursing team wears tags that are identified by sensors located in the hallways and in the patient rooms. When the caregiver walks into the room, the touch screen mounted on the wall announces the caregiver by name to the patient and then presents HIPAA-compliant information to the caregiver. The system also allows the caregivers to do routine documentation through a touch screen interface, and they can access key clinical attributes about the patient—meds, labs, vitals, etc. Finally, the system has a patient- and family-centered component that engages the family in the care process, and provides education and entertainment. This is a new technology built at UPMC, and this unit was selected because of their leadership and willingness to try new technology.”
Among the numerous results attained: most routine documentation is now done in between 40 and 70 percent less time than in the traditional system; patient satisfaction scores have soared, because of the perceived patient- and family-friendliness of the new caregiver behaviors (including both doing bedside charting, and the deployment of the “announcing” technology when clinicians enter the patient rooms); and nurses have significantly cut down on the distances they walk daily, because of the increased proximity of computing devices, thus increasing their efficiency and their ability to spend more time at the patient bedside.
Scholle spoke recently with HCI Editor-in-Chief Mark Hagland regarding the work behind this innovation, and its implications for the future of care delivery. Below are excerpts from that interview.
What was the initial impetus or strategy behind this innovative work?
It does go back one step earlier to Shadyside. There was a situation that occurred where a patient had a latex allergy, and that information wasn’t available at the bedside, so the patient was exposed to latex—a kind of sentinel event. So some very smart people like Dave Sharbaugh [who continues to lead the SmartRoom technology development at UPMC] decided that we needed to automate the process of providing whiteboard-type information. So they came up with the idea of pulling some information from the electronic patient record and displaying it in patient rooms.
And one of the challenges was that, as the system became more mature, there was the desire to interact more with it, and one early iteration was using a light pen on the screen in the room—it was the television screen in the room, either the patient’s or a monitor screen. That was an early iteration.
And then there was an engineer who kept working on the idea, and it was determined that our CEO wanted to try this on a larger scale and in a more robust form. So at that point, we looked at Presby to see if this could be more successful. At that point, my VP, the vice president of patient care services and our chief nursing officer, recruited me to get involved. That was in the fall or winter of 2009.
You worked with IT and others in the development work?
We worked with IT and the SmartRoom Team. At that point, through our Small Business Ventures division, they pulled together a small company that is affiliated with the UPMC corporation. And the very first nursing unit to try it was Unit 12 North, which is an abdominal transplant step-down unit. And we looked at the physical environment. We have private rooms and semi-private rooms at Presby, and we initially wanted to focus on a unit with private rooms, which 12 North had; and I felt very strongly that we needed to work with a staff that would be highly engaged in developing this. And 12 North had been very involved with the Transforming Care at the Bedside work advocated by IHI [the Cambridge, Mass.-based Institute for Healthcare Improvement].
Carol Scholle, R.N.
It’s really a rapid-cycle change method—you would try something new and quickly tweak it, and then spread it. So they were very familiar with this kind of concept, and receptive to it, and were able to give us the kind of feedback we were looking for, to improve care processes and make life easier for front-line caregivers. So we met with them formally weekly, but the SmartRoom team folks and the unit leader, Marcia McCaw, R.N., talked daily. So it was a developmental process and continues to be.