Recently we announced a collaboration with and financial investment in AirStrip Technologies and their mobile patient monitoring software. Technologies like this, give physicians the ability to check important patient information through their mobile device allowing care decisions to be made much faster. My colleague, Bill, spoke about the concept of smartphones in healthcare a few months ago. And last month, I talked about direct communication between a physician and patient via email, text, Facebook, etc… Today, in light of this recent announcement, I want to dive deeper into the idea of remotely delivering real time healthcare information about a patient to a hospital, physician or other provider. To do this, I want to walk us through a real world scenario to show how this can play out in health care delivery.
A 68 year old male having chest pains arrives via ambulance to the Emergency Department (ED). He moves to the front of the line and is seen by the medical team right away. After examining him, they take multiple electrocardiograms (EKGs) and perform other tests. Within 10 minutes it is decided that he is having a heart attack and they contact the cardiologist on call to determine if this patient should proceed to the cardiac catheterization lab for immediate intervention or be admitted to a room and be seen later that day/the next morning while receiving medical therapy.
The cardiologist is paged and returns the call within 5 minutes – he needs to see the EKGs to determine if the entire team on call needs to come in to open up the lab and take care of this patient. He logs into the hospital network and looks at the images for about 5 minutes and decides to call in the team to open the lab. They arrive within 20 minutes and the patient is wheeled to the lab for treatment. The team will treat the patient in the next 25 minutes.
The total time from entry of ED to treatment in the lab was roughly 65 minutes. This is also known as “Door-to-Balloon” time. Pretty good, right? Obviously, in this fictitious scenario, the times are idealized. Every situation is different and there can be many factors that legitimately influence the time it takes to accomplish certain steps.
I point this out because time is so important here. Studies have shown that patients, having a certain type of heart attack, who have cardiac catheterization within 90 minutes of presentation to an ED have been shown to have a better outcome. But what happens if any of the times above are off? What if there is something as simple as a 5 minute hold time on 911? Or what if the cardiologist has trouble accessing the EKGs on line or has to receive them via fax? That could potentially add more than 15 minutes. Our times are now off and the risk to the patient has potentially increased.
Imagine now that there is a way for the ambulance to securely send the EKGs in real time from the patient’s house and/or the ambulance ride to the cardiologist’s smartphone in a way that is legible and accurate. Imagine that the cardiologist can notify his team to come to the hospital even before the patient gets to the ED. Now the patient could go directly to the catheterization lab for treatment instead of going through the ED. Using our scenario above this would save an additional 20 minutes; from 65 to 45! This is not only better for him but also reduces wait times for everyone else who came to the ED on their own. That becomes a game changer for how health care is delivered!
This concept not only exists but is being utilized today in some of our facilities. Now as we enter into a partnership with Airstrip, we are expanding this capability to more of our hospitals. I used cardiology in my scenario but we can (and do) also use this technology for real time treatment of pregnant women and soon hope to use it for monitoring remotely in our ICUs. This is the kind of thing that gets me really excited about the future of healthcare.
What do you think patients and providers? Any thoughts or concerns on your end? Do you think this is too idealistic to play out as I have described?
16 comments
Great post, and not idealized at all. These are the tools clinicians are asking for and patients are beginning to expect.
@Erik I agree. Thanks!
This technology is great, but fails to have the clinical impact you are trying to ascribe to it. ER physicians rarely consult with the cardiologist before activating the cath lab. The technology to get the tracing from the ambulance to the ER is the key piece for optimizing door to balloon times, and it has been available for several years. The ability to deliver the tracing remotely to the cardiologist is a nice perk, but not a significant transformation in care delivery.
@Mike – couldn’t agree more that technology itself cannot replace the people and process workflows that will always need to be addressed. If those are broken today, technology may either highlight or mask those issues and there is no improvement. One can hope that innovation will address long standing issues along the way.
This technology is amazing on two fronts. First, as simply convenient. Second, as clinically useful. Mobility of informatics is definitely the wave of the future. Those developers that can bring Apple ingenuity to the challenges facing medical informatics will come out the clear winners.
Thanks @Rocco
As Erik points out, this is what clinicians want. The technology to do these things exists, and is in use, today. Mobile, both smartphone and tablet, has great potential in healthcare and more real examples like this are needed to drown out a lot of the noise/hype in mobile health these days. Great post!
@Travis thanks for your comment. Enjoy your site by the way.
I love the use case you provided to articulate your point of view. I remember when we used to talk about this scenario as the “Golden Hour”.
The key to embracing this type of technology is successfully incorporating it into the workflow of each caregiver. Information provided at the point of care as the care is being delivered will transform how we treat patients and greatly enhance care coordination . Clinical decision support is still in its infancy. The renewed focus on quality will help bring maturity to CDS and I’m thrilled about the possibilities. This of course assumes we close the loop and capture the necessary data elements and turn data into information that we can act upon. In my opinion, that’s part what makes healthcare so unique from other industries, we have TONS of data but have yet to make real use of it. Thankfully, reform is helping to drive focus in this area and I expect BI to dominate the next 10 years – what I like to call the “post EMR era”. While I’m intrigued by the promise of Big Data, I think the premise is a bit flawed. The current premise is he with the most data wins (and Big Data will help you process it all). While sheer processing power will become increasingly more important, I think he with the best data will win. This of course is all positive for our industry and I’m excited to see how things play out in the coming years.
@Ray thanks for commenting. Good point re the importance of turning data into something we can act upon.
Oh wow. So much potential, so much risk and unintended consequences. I find this realization of technology and medicine incredibly exciting and I can’t wait to see what innovations smartphones continue to bring to our world.
I completely agree that it *can* (and a lot of times it does) improve patients’ lives, facilitate our workflow, improve efficiency, and make us better clinicians in a lot of ways. I’m always trying to think of ways to use technology to eliminate steps and make me more productive.
But lately, I’ve been reading a good bit about the pitfalls of the self-imposed electronic leash. While there are, granted, a lot of good things that smartphones (and iPads) bring to the world, it’s not hard to see–especially knowing my own proclivity to distraction–how patient care could be compromised while responding to a Facebook status, or responding to a tweet, or *gasp* commenting on a blog post. I read a news item recently about a hospital system that is now considering locking down the electronic media so as to avoid residents from planning parties and social networking during rounds.
And then there are the connectivity issues Divya spoke about with delays in logging on, bad passwords, batteries dying, software glitches, etc. It’s definitely not Commissioner Gordon’s Batphone.
I’m also concerned about the liability of having a test result on your phone, available to you, and say, you just happen to check to “see what’s happening….” even though you’re not “on.” What’s your responsibility if you see a tombstone sign? I’ve heard Ob/Gyns in particular express concerns about this with regard to Airstrip.
Great post and discussion.
Agree with comments/concerns of how this all plays out in real world – here’s a link to a nice piece that speaks to how technology can be distracting so while these tools are powerful they need to be used in correct context.
http://www.kaiserhealthnews.org/Stories/2012/March/26/doctors-smart-phones-ipads-distracting.aspx
I’m wondering if hospitals or hospitalist groups could purchase the devices and keep/maintain them at the hospital–that way personal accounts can be kept off them, and the information stream can be locked down to only what is essential to do one’s job. Only apps pertinent to the practice could be allowed on the devices and the hospitalists leave them at the hospital when they go home.
@jairyhunter we just completed testing and are preparing initial deployments of an application that addresses many of the mobile device management concerns you raise. We’ll keep you posted.
That’s all pretty exciting. Dr. Toussaint, in his book “On the Mend” addressed the door-to-balloon-time issue at ThedCare. I’ve written about that on y REC blog. I will have to cite this article as well.
Thanks!