Point-of-Care Patient Education

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Point-of-Care Patient Education

By:Clifford Burdick Lisa Brown Florida International University

Fig. 1 Current work flow.

There is a correlation between effective patient education interventions (EPEI) and improved patient outcomes. Many of the challenges of providing EPEI can be addressed by the use of appropriate technology to improve efficiency, patient engagement and patient outcomes (Stellefson, 2009).Unit of Implementation: 40-bed Surgical Telemetry Unit with a mixed trauma and surgical patient population (Average LOS = 4 days). Ratio of patients to nurses: 5-6:1. Almost half (n = 45%) of the nurses hold a bachelor or higher degree. The unit has established standards of education based various patient-centered criteria.

The app will be live 2 weeks after the pilot study is completed. The app will launch on the Broward Health website. A super user staff member for each unit at all times for the first 6 weeks of launch. Also a Cerner IT person will be available for the hospital onsite for 4 weeks post launchRisks: -Wi-Fi insufficient for patient home device -Patient privacySolutions: -Priority work orders for hospital areas with low Wi-Fi strength -App automatic sign out when not in use over 2 minutes -App encryption for data sent and received from the EHR -Education module on the app about patient privacy and HIPAA laws

Pilot study: -50 patients -2-week testing period -Cerner IT will train all nurses for the app and EHR integration -Wi-Fi testing on various tablet devices in all of the -40 patient rooms -Super user team of 5 day and 5 night System usability testing (SUS): -50 test patients complete SUS before discharge -SUS administered by super-user on a tablet device -SUS hosted and tracked by Survey Monkey INC. -All nurses will complete an SUS at the end of the test period

The organizational structure of Broward Health embraces new technology, providing a supportive infrastructure to implement new technology and on-going end- user training. The facility has a 5 year plan to increase patient engagement and adopt interactive patient solutions.

Stakeholders are those most impacted by the technological change and are the most accountable for the outcomes (McGonigle & Mastrian, 2015).Stakeholders: Healthcare providers, nursing, ancillary staff, patients, families, administrative staff, third party payers, and IT staff (McGonigle & Mastrian, 2015).End Users: Patients, family members, and healthcare providers involved in any patient education task (Kaminski, 2011).The Diffusion of Innovation Theory describes the process of technology implementation by identifying the stages of transformation and the various roles assumed by organizational staff. Innovators initiate the change and embrace technology with confidence and an assuredness that technology advances are worthwhile. Early Adopters are motivated to succeed and use technology to realize potential, they are viewed as role models and respected by their peers. Early Majority are cautious adapters and prefer all the “kinks” to be resolved before adoption. Late Majority are less familiar with technology and tend to be skeptical. Laggards prefer to maintain status quo (Kaminski, 2011)

End-user, software, and hardware requirements have been identified as essential. There must be adequate training and ongoing support for end-users, including patient's healthcare and IT staff. The software must fully integrate with the current EHR. The patient app must be easily accessible for download. Additional hardware includes purchasing 10 tablets for trialing with patients. Tablets must include GPS tracking and an industrial protector case.

Mobile Application companies that can customize an app and integrate it to the Cerner EHR include: NexJ Health, iBlue Button, Liberate Health, and Cerner Smart Room with App integration. The Cerner app is the best choice for mobile integration for patient education in the hospital.Benefits of Cerner: -Broward Health EHR system is Cerner -Seamless integration of like products -Cerner allows customizeation of the app based on edcational and future need -App will automatically document patient education on the EHR when a module is completed -Patient can access the app at any time -A more secure interface of systems (compliant with the HITECH Act) (Greysen, Khanna, Jacolbia, Lee, & Auerbach 2014; Suhling et al., 2014)

Current workflow does not allow the patient flexibility with the learning. Also the education encounter has to be manually entered into the EHR by the nurse. The Suhling and colleagues (2014) study reported levels of immunosuppression 6 months after education on a tablet were 18% better than traditional education methods. Also compliance with app and tablet education was greater than traditional education methods. Patients were allowed to access the applications as they pleased. Cook and colleagues (2014) reported a combination of mobile computing with an app allows for dynamic, modular, personalized, and “just-in-time” education in a highly consumable format. Greysen, Khanna, Jacolbia, Lee, and Auerbach (2014) reported a 90% increase in patient engagement with app-based education. Education documentation on the EHR with app integration increased more than 300% within 6 months of implementation (Hess et al., 2014).

Fig. 3 Adopter category Innovator to Laggard

Solution

Function

Readiness

Workflow Analysis

Introduction

Implimentation

Testing

Point-of-Care Patient Education App

Fig. 2 Training Requirements

Stakeholders


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