A Vision for Collaboration in Patient Care: A Personal Story

Transcription

1 A Vision for Collaboration in Patient Care: A Personal Story Connecting Patients and Caregivers for Better Outcomes 10/01/17 I David demilo, Distinguished Engineer, IT

2 Notes from a personal experience Your Logo Here In October 2013, my mother nearly died from an unexpected adverse reaction to chemotherapy. She was hospitalized in the Mt. Auburn Hospital ICU for a month, spent three weeks in rehab before returning home to live comfortably for 36 more months. I was her caretaker.

3 Journal Observations: ICU (3 weeks) Team Care docs & nurses make scheduled visits to perform specialized tasks. From my questions, I can see they are not aware of each other s previous observations of my mother; each member is aware only of the their own previous conversations with visitors & patient advocates, & data. Her primary care (Dr. R) of 20+ years: According to Team Care, I m not supposed to be on this floor. From my chat transcripts, Dr. R deduced that mom was completely off her medication & needed to be on a regular Lasix regimen along with modified blood medication, & intervened with ICU staff. One day post-lasix, she is conscious, the wheezing has stopped, and she is preparing to solid food for the first time in almost two weeks.

4 Journal Observations Rehab (2 weeks) First day at Rehab still very tired, but everybody wants to go visit her. I used the cell phone group to tell my cousins to stay away for a day until I give the all clear Now alert by day three, she has a strong need for human contact & encouragement, & contact from family. I m getting phone calls during the day at work from her, & post out to the cell phone group that it s OK to visit. After everyone left in the evening she said she forgot who visited the ICU, what was said, & what happened & when. It was all blank. The record of cell phone photos and text messages helped her reconstruct the events. When I showed her the print out, she was so moved by it she teared up. My mother used this information to write thank you notes.

5 Journal Observations: Home Care/Hospice (36 Months) People to Talk with Primary doctor visits Visiting Nurse Hospital Social Worker Town Social Worker Home Services My Cousins Mom s Friends Contractors Things to Do and Schedule Caring for dad Getting new medication, dosing Sleeping hours, meal times Transportation arrangements Meal recommendations and restrictions Deliveries of equipment (oxygen machine, bed) Pharmacy visits Shopping for food Shoveling snow, etc.

6 Lessons Learned from the Journal Your Logo Here Good communication results in the most efficient and effective delivery of care to the patient, and strengthens the family, which energizes and inspires the patient. Poor communication or people operating on their own without informing each other can interrupt the provision of care to the patient and create resentment between family members at a time when the patient needs family unity the most.

7 Lessons Learned About the Patient Care Cycle Virtualizing Care centered the on billet the patient s allows everyone physical location to see each a slightly others comments different cast well of characters as vitals, selected at each EHR location. data. Hospital Caregivers can and appear patient in advocates stealth mode observe or and fully communicate visible. with the patient at different times. Family can track patient s condition Observations and progress and anywhere, communications any time, should in be any more billet easily setting sharable and communicate across this cycle. concurrently. Hospice or Home Hospice Medical Pros Social Workers Contractors Pharmacy Family Home Care Rehab

8 State of the Art 2017: The Physical Room A Synchronous Communications Model Monitors Patient Billet Physical Access Chart Medical Proxy & Family Doctors Nurses Therapists

9 Lots of Data, A Lack of Information Non-networked sensors in the ICU Source: Critical Care Bioinformatics, Mark W. Johnson, Ph.D. Case Western Reserve University University Hospitals of Cleveland Rainbow Babies and Children s Hospital

10 What s Possible in 2017: The Virtual Room An Asynchronous Communications Model Medical Proxy & Family Patient Physical Access Doctors Space/Room Cam/Phone Nurses Physical Access and Web/Mobile Access Billet Monitors Chart HTTPS CRM/BPO Rules/Policy Therapists Bot

11 Conclusions on the Value of Media ICU/Hospital Setting: Phone of limited value due to noise and privacy Text messaging, phone camera most effective for communication among family members Rehab/Home or Hospice Care: Voice/video communications, photos most valuable to the patient Text messaging most valuable to the caregiver for coordinating activity around the patient Caregivers: By integrating text messaging, voice/video, document sharing in one application space, would have been a more valuable tool than unintegrated mobile IM, , voice, and camera. Patient: The only useful medium is that which literally follows the patient, and ideally, presents itself.

12 + = Better One Health Soludeas Outcomes Giving caregivers & families a Secure Applications Space to communicate and collaborate Extending the End Points Browser Smart Phone Home Robot (Home Care) Making it Process, Case, and Rules-Driven Patient/Proxy Business/Legal Event-Aware 2017 Cisco and/or its affiliates. All rights reserved. Cisco Confidential

13 The Virtual ICU MAH Welcome to Mt. Auburn Hospital. 223 Mt. Auburn St., Cambridge, MA Lucas demilo Hi grandma I love you. I m in CA wish I could be with you. 3/11/ :25 EVENT (MEDICATION: Lasix administered (scheduled) 3/11/ :25 Jack Giragosian Color looks better today. She can t talk, but smiles and nods. 3/11/ :25 MAH David demilo (You) Mary demilo Chris demilo Dierdre O Connor Lucas demilo Jane demilo Jack Giragosian Sue Giragosian Joan Meers (CSW) Dr. Reese You Did she eat? 3/11/ :27 Jack Giragosian Nurse said more than yesterday. They gave her lasix and she watch TV for a couple hours. 3/11/ :30 Dierdre O Connor Hi David Just arrived 3/11/ :25 You Just leaving office please wait for me. 3/11/ :28 Sue Giragosian I ll come by after dinner if you can hang on. 3/11/ :45 Dr. Reese I m at MAH will stop by in a few mins ALERT MONITOR P: 72 (+1%) BP: 110/65 (-); R: 72 (1)

14 Nine Rules of the Virtual Care Room 1. The Room is created by an event (e.g., medical proxy acceptance) 2. Patient or Medical Proxy may invite people to join 3. The Room is accessible through a single URL on any device 4. When anyone enters or leaves the room, everyone is notified 5. When documents, photos, etc. are posted to the room, everyone is notified 6. Based on provider policy, vitals or care events are posted to the room 7. Doctors/caregivers may be visible participants or watchers 8. The Room is open 24/7 and closed when the Patient/Proxy closes the room 9. All notes, transcripts, documents are securely linked to the care provider system of record (Health Care CRM or EHR)

15 Early Feedback from Dr. Alvin Chin There is great value in replacing clunky communication tools Give doctors more opportunity to observe and interact with patients Organize the Posts! Filter on Team Care specialties (cardio-pulmonary specialist, organ system specialist, primary care physician, etc.) Use software bots to interface periodic biometrics; but keep it simple! Device connectivity to patient monitors could be a problem Some have ethernet, RS-232/USB interfaces, some don t But Cisco Wi-Fi is everywhere Hospitals are cheap on Wi-Fi bandwidth and IT support Best Early Venues Probably Rehab, Nursing Home, Home Care ICU is about connecting patient advocates; patient is usually unable to participate. Professor of Pediatrics (Emeritus) UPenn School of Medicine Past: UCLA & Boston Children's Hospital Stanford Medical School M.D; Harvard University B.A.

16 Please visit the Serendebyte booth for a demonstration of Pega Care Management + Cisco Spark A Better Together Solution

17 + Connecting patients & caregivers for better outcomes