Efficiency and Qualitative Improvements by Linking Smartphone Functionality and Electronic Medical Records to Nursing Services Gunma University Hospital, Sub Manager of System Integration Center Kota Torikai Abstract The system that supports the nursing scene has characteristics that are designed as an entire hospital infrastructure rather than as a simple system. A new support system focusing on using smartphones at the Gunma University School of Medicine Hospital is revolutionizing care. The meaning of "nursing," Florence Nightingale stated at the beginning of the "Nursing Memorandum", is "to encourage all patients to minimize exhaustion of vitality". In this "encouragement", care with spirit, knowledge (Science), and skill are included. As represented by listening and empathy, care is a series of extremely detailed, close-up works that focus on the patient, which set the expression that this sequence delivers greater benefits to the patient ( = Deliver mind). However, as the sophistication of medical care is improved, it is necessary for medical staff to share information regarding these new implementations, so that the records accompanying them will rapidly increase as will the burden on staff. Medical safety confirmation, such as 6R, also continues to increase and create a greater workload for medical staff. If we define the quality of nursing work in the modern age of a critical medical economy as "time directly involved in the patient's body and emotional well-being", the quality of the nursing support system is vital. In other words, I think that the main point is "how can labor-saving automation and speeding up indirect work accompanying nursing improve care". Here, "accompanying" refers to the entry of records, authentication acts, etc., which accompany the implementation of nursing. Nursing Systems Should be Designed as Hospital Infrastructure Nursing continues to be a "troop" from the era of nightingale. That is, from a system viewpoint, the ward itself is a huge department. Nursing has complementary and qualitative differences to the treatment that doctors should provide. The following two items are cited as examples. 1. While the doctor devises a strategy for the individual's disease and prognosis (Strategy), the nurse drafts the ward and measures (Tactics) for its practice. Another www.deltapath.com 1
complementarity action in this classification are the hospital systems, technicians, and the flow of information and information carried by medical personnel (Logistics). 2. While the doctor is primarily responsible for guiding the patient's prognosis, the nurse is primarily responsible for the patient's well-being. Such qualitative differences appear as a difference in medical systems. As an example, while the electronic medical record has a data structure based on the individual patient, nursing has a data structure prescribing to the ward and the nursing work. In fact, the nurse call system is a type of system that was digitized early, but it is a huge infrastructure consisting of equipment and maintenance costs. In addition, although the electronic chart has a "temperature plate" function, this function of displaying complex information can be used to further complicate already complex patient information including transposition and transformation. The introduction of electronic systems in nursing can easily be thought of as a "simple system" from the "familiarity" of nursing and "medical simplicity" of work, but the nursing systems used today are rather huge and complicated." It is necessary to recognize that it is an object to be designed as "hospital infrastructure". The problem that is always trying to be solved is regarding the data conversion of nursing in order to reduce the burden of recording data in the midst of direct, subdivided involvement with individual patients. However, in order to achieve a realistic contribution to the automation of records in nursing, we provide electronic means for "all of them" to the huge department system "ward". This leaves an extremely big hurdle to overcome. The Advancement of Smartphones Enables Computerization of Nursing Support In the past, patient records were consolidated on handwritten temperature plates, the safety of drug administration and the like were carried out by expensive dedicated PDAs. Electronic medical records increased the degree of freedom of input and viewing of nursing records, but this came at a high cost in order to align the number of personal computers to satisfy the demand of record input. Nurse call is an important tool for nursing work in inpatient wards, and interlocking with PHS has been in effect since the early days. However, the introduction of equipment compatible with each subdivided work load can be regarded as the manifestation of the degree of sophistication and complication of nursing work. By the way, in recent medical information systems, collaboration between servers and terminals is becoming readily available due to the common use of communication protocols typified by the Web and popularization of common platforms such as Android and ios. In addition, due to the sustained expansion of the information market, the Web-based server / client type of processing performance model has penetrated the market, and the information processing performance of the information terminal has improved. As a result, in the area called "smartphones", there is a circumstance that a practical information processing speed / balance of information amount and price has been reached, and the linkage with electronic medical charts has improved. Therefore, at the Gunma University Hospital, smartphones were distributed to doctors, nurses, engineers, and former hospital staff including administrative workers for the purpose of contributing to qualitative changes to nursing work. Furthermore, as a nursing department infrastructure, we installed NEC's nursing information mobile terminal "Easy Nursing Mr. Rakuraku Nurse" (A Mail Enhancement Type) and the "frsip" "Nurse Call Interlocking System" to promote a new electronic nursing department system. www.deltapath.com 2
Below, we outline the introduction of infrastructure (terminal / network / software), the issues we have addressed and the current situation of operations. The Newly Introduced Nursing Support System (Figure 1) Please refer to the end of the article. 1, Smartphones In order to continue operation with more than 2,000 staff, Covia made the CP-F 03a which is excellent in cost performance as a smartphone and operates on Android 4.4. Radio frequency supports 2.4 GHz / 5 GHz, and 5 million camera functions as a shooting function. Given the future use of IC tags, we have the Near Field Communication (NEC) function. The screen is 800 x 600 pixels and the weight is about 140 g. 2, Network As smartphone usage spreads, Wi-Fi communication by personal device and Wi-Fi services provided by telecommunications companies are also frequently used in hospitals. Wireless communication has a big problem, for example, in the 2.4 GHz band of communication, the number of independently settable channels is limited to three. For example, even in the same network, since access points (APs) have radio interference if they are on the same channel, conventionally the zoning design was made to "paint out" the hospital area with three channels. However, with this method, the number of channels for effectively painting out threedimensional outpatient and wards is insufficient, and the design for adjusting the radio wave of the AP is complicated. Furthermore, communication breaks occur every time a channel is switched on a mobile terminal, so there was concern that quality issues might be noticed in a voice call using Wi-Fi. Therefore, in this trial, we introduced a wireless infrastructure (meru) system that controls the communication between the AP and the terminal by the controller, using a technique called "single channel", and uses only one channel by time division. In Wi-Fi calling, we decided to operate all smartphones at 5 GHz and wireless notebooks, PC s, etc. at the 2.4 GHz band to prevent disruption due to the large amount of data being communication by wireless PC s existing in the hospital. Based on the experience of continuing clinical practices under the planned blackouts of up to 6 hours a day due to the 2011, March, East Japan Earthquake, as Disaster resistant infrastructure, Business Continuity Plan (BCP), Gunma University deployed AP and networks with the Power over Ethernet (PoE) method and adopted another method of for not interrupting the PoE controller in order to make it possible for smartphones to call in case of a power failure. 3, Software With smartphones, a call function, a nurse call function, a PDA function, and a video conference function are available. The call function is introduced by DELTAPATH's frsip software. (Figure 2). Phonebooks necessary for contacting individuals between smartphones is centralized by downloading data via the network. As with PHS operation, we introduced a nurse call system (Carecom Inc.) linked to the call function. When the nurse call button is pushed, a call is made to a plurality of set smartphone terminals from the server installed in the ward. Since the bed location and the transmission time are recorded in the nurse call server, it is expected that by analyzing the recorded data, it can be useful for qualitative improvement of nursing by grasping the situation during times of high workloads. www.deltapath.com 3
In speech communication, there is a sound quality problem in places where radio waves are weak, such as when getting on and off the elevator, stairways, etc. However, by appropriately adjusting the radio waves intensity and by using the AP reconnection method, the problems can be solved. Currently, while continuing operation, we are making further improvements in the software and terminal settings. PDA function introduced nursing information to mobile terminals "Rakuraku Kangoshi-san" (by NEC). (Figure 3). This software is divided into categories of order, check, camera, and mail, and that order provides schedule and viewing functions of basic patient information. About this check, we are set up so that we can perform dispensing confirmations, injections, pre-transfusion confirmations, and blood transfusion and specimen checks at our hospital. In addition to using a one-dimensional / two-dimensional barcode reading function embedded in the software, a one-dimensional barcode reader paired with Bluetooth can also be used for patient confirmations. The camera function can be used to record pressure ulcers and patient conditions via photographs by specifying the patient ID, and by recording the handwritten document / whiteboard record at the time of an incident as a snapshot. The electronic chart function was found to be very useful for rapid field information sharing. Mail that can be consulted and sent by smartphones also works in conjunction with the communication function which is a message service within electronic medical records (MegaOak HR made by NEC). As an example, it is conceivable that browsing of mails is performed by a smartphone, and contents requiring reply can be implemented by an electronic medical chart terminal. This closed mail function, without passing through the Web on the smartphone, not only to contributes to the transmission of patient information including medical information, but also provides a new transmission means called simultaneous broadcasting of character information, which, unlike information transmitted by telephone, verbal communication, or communication has a limit on transmission, and strongly depends on previous memories. As an example, by utilizing the mail function, it is possible to transfer important information directly to nursing staff who will be able to utilize the infection information and simultaneous broadcasting of real-time patients with less caution needed. Of course, in order to make mail transmission effective at the operation site, it is necessary to take measures to confirm the transmission itself and to ensure medical safety. Although smartphones themselves are becoming personal and familiar media, they still require practice including infiltration of information literacy suitable for sophisticated operations at medical institutions, and they recognize it as a problem in the future. Future Utilization of Smartphone Based Systems From now on, the quality contribution of nursing through smartphones is expected to further increase. First of all, the Web browser installed in the smartphone has a high affinity with the Web interface originally installed with the purpose of synergy by the division system to avoid system interference, acquisition of patient information, and medical information. Also, since smartphones can be used for moving image media for example, Skype is expected to take the place of speech will bring about by peer-to-peer image transmission in information communication between doctors and nurses. Furthermore, as a future prospect, receiving instructions, which is currently being done in electronic medical charts as a function linked with a mail system or order collaboration systems, enables 'more agile' instruction transmission operation by mobile terminals. www.deltapath.com 4
As a countermeasure against BCP, the medical staff can transmit information via the server so that this infrastructure can be effectively utilized even as a disaster backup system utilizing the SS - MIX 2 browser. Although the author is concerned with the problem of how to enable smartphone use by all medical staff, not "hands-on terminals", "how labor-saving, automation, and speeding up the indirect work accompanying nursing work", We strongly acknowledge that it is the start of a solution that finds a great way to go. Kota Torikai 1979 Born in Fukuoka prefecture. Doctoral program at Energy Quantum Major in 2006, Kyushu University Graduate School of Engineering. Doctor (Engineering). In the same year, at the National Institute of Radiological Sciences, after the Gunma University Graduate Radiotherapy Research Center in 2008, currently Gunma University Hospital, Sub Manager of System Integration Center (Associate Professor). In the awards history, 2008 National Invention Awards 21st Century Invention Award (Royal Awards) (April 08) "Invention of all kinds of ion accelerator using induction accelerated synchrotron method" etc. Figure 1 Smartphone system in Gunma University Hospital 1300 wireless access points including medical school are installed, and the entire campus operates with a single frequency, channel, SSID. Also, the network switch provided for each floor is uninterrupted. When the network switch is connected to the server and the AP controller by light trajectory, packet out of the Wi-Fi voice call is suppressed. Furthermore, by making the wireless notebook PC thin client, it contributes greatly to reduction of wireless data traffic and improvement of smartphone response www.deltapath.com 5
Figure 2 Smartphone Wi-Fi call function screen (frsip) Enter the number with the screen key (left). Considering the exchange of staff and information security, the phonebook data is managed, and the latest information is downloaded at the time of use (center). Call screen (right) Figure 3 Function screen of "Rakuraku Kangoshi-san" made by NEC (part) www.deltapath.com 6
As ward PDA functions, have vital numerical confirmation (upper left), vital graph (upper middle), order confirmation (upper right). As a function utilizing smartphone hardware, a description of uploading clinical articles to the medical record of the patient (bottom left), browsing of basic information on the patient such as allergies (middle lower), a message synchronized with the e- mail function in the electronic medical chart Has function (lower right) *This article has been translated by Deltapath Inc. www.deltapath.com 7