Apps that support clinical workflows
In the past the clinical staff at the Hôpital du Valais worked exclusively with desktop computers and laptops on trolleys. But recently it had been decided that mobile phones should be included in the workflow. The first user group to focus on was the nurses.
I had the chance to spend a full week with nurses of the Hôpital du Valais. Through observing them performing daily tasks and having insightful chats during the coffee break, I learned a lot about the obstacles that make their challenging jobs even more difficult. Here are some of the findings regarding the use of technology and analog tools:
Digital interactions are often short and spread throughout the workflow – The nurses workflow consists mainly of non-computer tasks, which are (or should be) supported by short interactions with the electronic health record (EHR). If they lack the time or all computers are taken, they might store information temporarily on paper and transfer them to the EHR when they have more time.
Hardware is not suitable for nurses tasks – The closest thing to a mobile device that nurses have at their disposition are laptops on trolleys. Since those trolleys are not adapted for transporting medical materials (e.g. dressing materials) nurses often find themselves dragging a caravan of two trolleys and additional monitoring machines into the patients room.
Nurses have created their own workarounds – The nurses bypass the lack of suitable technology by printing a table of all patients on the ward and taking notes on these sheets throughout the day.
Nurses organise their workday by task rather than patient – Many tasks, like taking blood pressure and handing out medication, are completed for one patient after the other rather than completing all tasks for one patient and then moving to the next.
Defining an implementation strategy
Part of the challenge of this project was to figure out how to implement mobile devices into the workflows of the clinical staff at the Hôpital du Valais. Should we create a complete health record that would work on a phone or rather develop separate applications tailored to specific workflows? In the end, we decided to go with the second approach in order to achieve a more agile implementation and to better cater to cross-patient tasks.
The mobile health record
- A complete electronic health record with an extensive navigation that can be used on a phone.
- Works parallel to the EHR used on Computers.
- A device per person working.
The mobile assistant
- Several separate, small applications designed for specific tasks, such as blood transfusions, medication administration etc.
- Works as an extension of the EHR.
- Starting out with 1-2 devices per ward, that can be picked up by nurse whenever a specific task needs to be completed.
First application: Registration of blood transfusions
While writing on small smartphone screens is not exactly efficient, mobile devices offer other interesting input methods such as taking photographs and scanning barcodes. The latter is especially useful when it comes to controlling identities. As this is one of the key tasks in registering blood transfusions, we decided to designed the first app for this workflow.
Register a new transfusion
After opening the application the user chooses between adding and modifying a transfusion. Next he is asked to scan three codes: the patient bracelet, and two codes on the blood product. Finally, he has to confirm that he wants to start the transfusion.
The first mobile app is under development. Upon completion it will be released to a few selected departments of the hospital. This pilot-phase will help to further improve the mobile application.