Mobile health workforce enablement for district nursing

Mobile workforce enablementfor district nursing: A sector-led collaboration
Mitchell Pham –Augen Software Group
Judith Geary –Gore Health

Co-design & partnership -nursing team & software innovators
Solving problem facing mobile nursing
Solution vision and a focused starting point
Can grow with the adoption of feedback and learnings
Nursing perspective from problem & solution to lessons learnt
Learnings about project approach & implementing innovation for mobile healthcare
Today’s Journey

Rural, community-owned, 20-bed facility
Eastern Southland community and surrounding areas
Integrated range of health services, including:
24-hour emergency department, GP practice, Dental practice,
Maternity services, allied and community health services.
Population base approx. 21,000 people
Gore Health

Issues facing the mobile nursing team:
Duplicationof scheduled work lists. At the end of each day, work activity was submitted (paper based) for data entry into the patient administration system (PAS) by the administrator, with variable legibilityand variable accuracy.
Core information (referral & admission) is keptin the office while the clinical file is completed with the patients in their homes and remains with the patients. Core data and pre-visit interventions were not visible, and relied on notes and nurses’ memory (if the patient’s office file wasn’t checked).
Problem Areas

Issues facing the mobile nursing team (cont.):
Inability to read and schedule visits with patients, to see weekly schedules and those of other nurses, to enter clinical notes, to see visible alertsand risks.
Inefficient administrative processes including manual systems, double entry, data errors, paper-based lists, schedules, handwritten changes and edits.
Problem Areas (cont.)

Solution: Pathway
Bringing together diverse range of expertise
Collaborating with software innovators
Develop and implement a new tool
Clinicians to directly participate throughout the process
Focused starting point
Can grow with the adoption of feedback and learnings

Plan/Record interventions based on the patient’s diagnosis
Enter Clinical Notes
Schedule/Reschedule visits with patients in real-time
See weekly schedules, create multiple visits
View other nurses workloads
Record safety risks, hazards, environmental notes
Assign a visit to another nurse
Visibility of nurses progress during the day
Real-time reporting
Operate in ‘out of coverage’ areas
Tablet & Web browser based applications
Compliant with Health Workforce NZ and National Health IT Board strategies
Solution: High Level Requirements

Solution: Tablet & Web Application
Assign, manage and monitor visits; manage patient details and referrals; daily reporting; manage configuration tables.
Record clinical and memo notes, interventions, visit outcome; review previous visit documentation.
Manage visits; start/stop; add
new visits; reschedule or
reassign visits; view history.
Web Application
Resource & scheduling management, reporting, patient details & referrals, configure data values for field use.
Tablet Application
Real-time Visit Management & In-Field Documentation, on-line / off-line connectivity.

Solution: Typical Nurses’ Daily Processes

Personnel able to better keep schedules –no longer missing/late visits
Real-time visibility/reporting of progress through the day, by run and nurse
No duplication of paper based schedules
No more cumbersome paper based messaging
Ability to determine work flow issues and schedule resources smartly
Reduce mileage and travel costs
Staff location / workforce safety
Sound base for bringing together other service teams (and integrate systems)
Contractual obligations / external audits
Outcome: Some Key Benefits To-Date

Personnel able to better keep appointments
Daily schedule no longer missing visits
Real-time visibility and reporting of progress during the day, by run and nurse
Not missing client visits
No more cumbersome paper based messaging
No duplication of paper based schedules
Ability to determine work flow issues and schedule resources smartly
Reduce mileage and travel costs
Outcome: Benefits To-Date

Improved ->
Quality of service
Quality of information
Patient engagement
Staff engagement
Operational management
Risk management
Cooperation / teamwork among mobile healthcare workers

Mobile healthcare worker
Administrators
Management
Time Savings
Administration
Management Reporting
Outcome: Some Key Benefits To-Date (cont.)

“Communication is significantly improved between nurses.”
“User friendly, new users find it easy to learn and work with.”
“Patient alerts are visible to nurses at all times.”
“Data input has been stable, no glitches out in the community.”
“All information is visible at base at all times.”
“More control and better coordination of a fluid operation.”
“Significant potential for even further efficiencies.”
“Surprisingly well received by clients –a real bonus.”
Feedback To-Date: Management Perspective

“User friendly and well thought out.”
“Great being able to schedule visits directly with patients.”
“It is saving time! When can we lose the paper?”
“All patients are rescheduled as the day progresses, we have the option to tweak the patient visit order at the base at the end of the day, ready to go for the next day.”
Feedback To-Date: Nurses’ Perspective
“Less office time…”
“More responsive…”

“The Tablets were introduced and what a revelation.”
“I'm not sure what they did for you but for me as a patient they were marvellous.”
“As a patient I felt I was getting better care, appointments appeared to be better kept and I just felt more confident with the Tablets (plus the pages don't fall out, more time saved).”
“I found this very reassuring and to me it meant the whole patient/District Nurse contact was much more efficient.”
More professional, better client experience, higher confidence in our services
Feedback To-Date: Clients’/Patients’ Perspective

Gore Health: site has gone from pilot into production with District Nursing,
Now looking at bringing Allied Health team on-board.
Southern District Health Board: pilot with District Nursing in Invercargill due to finish in December 2014.
Wealth of knowledge gained from both sites, around:
Priority of functional & non-functional requirements,
How to successfully implement mobile solutions in the Healthcare setting.
AgilityTRx: Where we are at…

Efficiencies in both time & service quality: From an informed mobile workforce with effective scheduling and notes.
Data quality: Capturing accurate data once, at point of care.
Patients: Respond well to the increased use of technology, and confirmed improved service experience.
Opportunity: starting point for eventually paperless workflow
Important: Success requires strong team focus, ongoing training, on-site/in-field support, executive & management commitment, to ensure the project remains focused on achieving the desired outcomes.
Learnings: Clinical Perspective

Properly planned and supported implementation is critical.
Goals/outcomes tangible, clearly defined and agreed up-front.
Expectations set and realistically managed.
Whether in Pilot or Production –Requires strong on-site presence, rigorous change management and attentive in-field support.
Agile/iterative/responsive development and deployment.
Patient-centric and user-driven requirements.
Mobile solutions are complex –when technology stack, device platform, online/offline access, patient privacy, data security, audit control, remote management, are factored into an otherwise simple concept.
Technical integration with core systems (e.g. PAS) – will allow fuller fiscal benefit realisation.
Learnings: Project Approach

Evaluate operating environment of nurses and patients
Type of cars, features, tech available e.g. Bluetooth, 12v to charge devices, existing nav-systems
Mobility signal areas on runs
Hazards
Traffic / roadwork (ongoing)
Access to properties
Patients homes, rural, city, access types, vehicle access, animals, etc.
Connectivity and infrastructure, allow devices on office IT network even if just Wi-Fi
Managed data / calls / SIM cards
Use device to best of tech e.g. not just about AgilityTRx app
Navigation, GPS, photos, calling, chat
Processes direct and indirect, identify, adopt, adapt
Solution must have a good design, be responsive
Tap and go
Have on main screen everything needed to fulfil 80-90% need/value, remaining on another screen
Prioritise to show what is critical
Have site / group / leader champions, encourage collaboration in user community
Training, on-going support, engagement, seamlessly bring on-board new users
On-site and out in the field with users
Better QUALITY OF CARE for better QUALITY OF LIFE –$ savings not total sum of impact
Remember the client/patient buy-in and engagement very important – They are willing to engage and collaborate to support their care plan
Learnings: More Details (if time permits)

Whole team practice:
Listening
Adding value
Improving
Collaborating
Empowering
Enabling
Innovating
Keep tech up to date as available e.g. device OS, software, apps
Use app and process to full potential, to get maximum benefit
Capture all activities nurse or users do daily, measure and look for further improvements. If don't know where to spend time, then can't improve efficiencies. E.g. visits, physical or verbal, phone calls, GP calls or coordination, pharmacy commsor even getting prescriptions, lab tests organising and getting results, care for cars -who washes/services?
Potential to Integrate with many other systems, e.g. patient management, GP, pharmacy, labs, navigation, GPS, video, photos, chat, calls etc. Interoperability
Use at ground level to plan capacity and manage resource utilisations
On-going roadmap, don't just implement once and forget about it
Funding model, work with remember patient, not purely data recording model for reporting, use to full potential.
Management plays key role in setting mandate and keeping staff focused/committed
Learnings: More Details (if time permits) (cont.)

Continue to develop the solution through an on-going pilot program, expanding the experiential sample size through implementing it at more sites.
The sector and Augen to continue co-design the core functionality and develop the underlying systems and interfaces in a continuous improvement cycle.
Leanings will drive improvements: Better technology stack, integration with other systems, expanded functionality, better nurses’ & patients’ experience.
Looking for the next demonstration/pilot/trial partner.
Going Forward: An On-going Journey…

Augen Software Group & Gore Health Presentation
Level 2, 4 Hobson StreetAuckland CityAuckland 1010New Zealand
Contact: Mitchell Pham (Director) DDI: +64 9 307 8483Mobile: +64 21 623 334Email: mitchell.pham@augensoftwaregroup.com
Website: www.augensoftwaregroup.com
Gore Hospital9 Birch LaneGore 9710New Zealand
Contact: Karl Metzler (CEO) Phone: +64 3 209 3030Mobile: +64 27 209 0009Email: karlmetzler@gorehealth.co.nz
Website: www.gorehealth.co.nz

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