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At Kaiser Permanente one way to derive value from the inevitability of more and more devices being connected -- in other words, the internet of things -- is via real-time location services.
Scott Phillips, principal of radio frequency identification and real-time location services at Kaiser Permanente in San Francisco, explained at the annual Health Information and Management Systems Society conference in Orlando, Fla., that real-time location services cannot only help with patient satisfaction and workflow, but also help better paint a picture for caregivers of what's really going on with their patients, and better illustrate what's going on within the area of the hospital they are working.
But Phillips thinks the way location services are most commonly utilized in healthcare is not the best strategy; the strategy mainly being putting tags on people and things in order to track them.
Although healthcare organizations are gleaning some benefits from this strategy, Phillips said the ideal way to approach real-time location services would be to integrate that tracking feature into the devices. Much like mobile phones today, he said.
The first step, he said, is consolidation.
"I don't think the state of running five and maybe five more location systems is very realistic … you want to at least involve some consolidation," Phillips said.
Instead of going to a desktop and clicking through to view these multiple systems and where people and devices are, he envisions that "you just bring up your phone and immediately it knows where you are and now finding assets just became a lot easier for nursing and other staff.'"
Real-time location services at Kaiser Permanente
Phillips said real-time location services serve several different purposes at Kaiser.
This includes medication management and tracking: "We did a whole pilot around anesthesia trades and being able to [keep track] of expired medications as soon as those medications were scanned by a reader," he said. "And also to tell us what quantities need to be replenished and, lastly, to make sure that we replenished them exactly … to the right count."
He explained that this has proven helpful to Kaiser's anesthesia nurses because then they have what they need, at the exact amount, and right when they need it.
Phillips said they are also using real-time location services to not only track specimens but also to monitor the temperature at which they are being stored.
He added that Kaiser is piloting a real-time location services program where physicians can walk into a patient's room with their mobile phone and the physician's picture and credentials will come up on the interactive patient care display.
Ann O'Briennational senior director of clinical informatics at Kaiser Permanente
The results Kaiser has experienced after implementing these real-time location services include:
- Identifying the closest equipment within 30 seconds. Compare this to the industry average of 36 minutes per shift that nurses spend searching for needed equipment, Phillips said.
- Remedying 3,200 out-of-range temperature alerts, Phillips said, ensuring medication efficacy, specimen quality and so on.
- The increase of security updates from 95% to 99%.
- Reducing bed rentals by about $180,000 in one department.
- Finding assets worth about $400,000 in one hospital.
- Finding a piece of equipment valued at about $70,000.
"Our patients are going home much quicker … because we've found them ways to get mobilized early, get them pain controls and they don't develop pressure ulcers in the hospital or hospital associated infections if they go home in 24 hours," Phillips said.
However, there is still work to be done, he said; mainly in consolidation.
Location services have positive effects
Ann O'Brien, national senior director of clinical informatics at Kaiser Permanente, explained at the conference that real-time location services offer even more benefits than simply locating equipment and tracking medications and people.
"You can have, for example, your patient tagged and when the patient moves from the operating room to the recovery room you'll be able to have a dashboard so the family knows that the surgery is over," she said, "which is very reassuring for families."
In addition, from a throughput and care coordination perspective, she explained that this also eliminates the need for phone calls to be made "or have a human being go into the ADT (Admission Discharge Transfer) system and transfer the patient from the operating room. That can happen automatically through your ADT system when the patient is tagged."
O'Brien said they are moving into an environment of less human intervention for everything they want to accomplish when it comes to care coordination and throughput.
Lack of interoperability a major challenge
Both Phillips and O'Brien discussed the interoperability challenges that come with real-time location services.
Phillips said the tags used for tracking don't talk to each other. "It's completely separate and it just starts to create more and more roles as we integrate," he said.
O'Brien went on to discuss how Kaiser has smart IV pumps, smart beds that alerts caregivers when a patient needs to be turned, smart interactive patient care systems, monitors, and data is sent directly to the EHR.
"But none of these speak the same language," she said. This means the nurse becomes the translator from device to device. "The nurse … has to coordinate the data and keep track of where things are," she added. "We want to decrease that need for a human being to have to do that coordination. But our current state in hospitals today is really a proliferation of more and more devices and a continued lack of interoperability."
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