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Category Archives: Integration

An app a day keeps the doctor away.

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Healthcare applications on phone

Apps for digital health are proliferating throughout the healthcare ecosystem. Not just consumer facing, apps for clinical teams are growing as well. EHR companies have their own app stores, there’s the SMART App Gallery, and more apps are being created every day for use by healthcare professionals. As federal regulations start to kick in, the proliferation of digital apps for clinical use is only likely to increase. According to the ONC research, it shows more than 20% rise in the number of apps that integrate with certified electronic health records (EHRs) at end of 2020. The number of new clinical and administrative apps with SMART on FHIR integration is increasing at a very rapid rate.

There are many benefits of apps used by clinicians, better patient care and engagement, increased efficiencies, time management, records access, clinical decision support, education and training are just some of the tools available in app stores today. They have the potential to help clinical staff perform and manage their day better, improving patient care and staff satisfaction. It is widely reported that clinical staffing is becoming an increasing challenge to healthcare organizations, frustration with ineffective or difficult technology is just one of the issues, and it can be an important barrier to enabling staff to provide the best possible care to patients.

While there is a lot of news focused on the shortages of nurses and doctors, IT teams are also feeling pressure. Competition for healthcare IT personnel is increasing, new digital app developers, virtual first practices, and existing brick and mortars are just some of the employers seeking to hire experienced IT staff. Is there a plan to maximize the expertise and focus of these teams? What is the core competency of the healthcare organization’s IT team? Is it new app development and integration, or is it ensuring a safe and secure IT network and connectivity of existing physical infrastructure?

Much like patient care has become highly specialized, IT teams are becoming more focused to respond to increasing threats and internally connected equipment. Additional resources are often not allocated to allow IT teams to focus on adding to digital apps to the clinical toolbox. Doctors and clinical staff asking for more tools and integrations can often get lost in all the background noise, or are just told “we don’t have the bandwidth for that right now”, especially if its a small specialized department. Does the organization want to hire and train a professional team to assist in one-off choices or development?

Apps and other tools that do not meet the needs of clinical staff are a wasted use of increasingly scarce resources. Anyone working in Healthcare IT or Biomedical engineering can tell you, clinical staff are very creative when it comes using tools and equipment. Nurses and doctors will find all sorts of new uses for existing tools and infrastructure that was never envisioned by the creators, or it just won’t be used at all. But, they also have great ideas for new tools to help make their job easier and better. An organization seeking to harness this creative energy will likely need help managing the myriad of choices, or the creation of new tools.

How are new apps implemented? How are they supported? Maybe the Physical Therapy team has an idea that will save hours per day, how do we get that developed? Maybe there’s an existing app out there? If healthcare organizations are looking to increase employee engagement and efficiency, these are questions that will need to be answered moving forward. Whether a smaller physician practice, or a large multi-hospital system, retaining and maximizing existing staff resources will be key to success in the current healthcare environment. Apps and other tools can help improve efficiency and effectiveness, but getting them done right is just as important as getting them in the first place.

Tido can help healthcare organizations manage these questions. Check out Tido’s Digital Apps Strategy and Management and Custom Mobile and Web Applications solutions. See how Tido can help healthcare organizations implement existing tools, or help to harness the power and creativity already inside.

Social Determinants of Health and Network Reliability… Is there a connection?

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Healthcare Virtual Visits

Are my cables crossed? Perhaps, but consider the different systems that can power payment and insurance verification.

For the majority of readers of this blog it is probably an inconvenience when insurance verification services are down, but for people with limited income, and little to no savings, this can be an insurmountable barrier to accessing healthcare.

Increasing the utilization and access to telehealth and virtual services is one of the goals of Healthy People 2030 to improve access and quality. While we have seen a proliferation of expanded virtual health options during Covid, there can still be barriers to accessing care beyond internet availability.

Virtual urgent care or virtual ER visits can vastly improve easy access to care with a connected smart phone to access these services. While this can still be a challenge for many, they are becoming far more ubiquitous and affordable than ever before. With a connected smart phone there is no need to take time off work, or travel to a physical location with an unknown wait time to seek care. Virtual visits can be powerful tools for those in society who are not economically stable, where each hour of pay is allocated to purchasing necessities.

Most virtual visits require upfront payment or insurance verification of coverage. This author’s recent experience to a virtual urgent care visit highlighted this. Due to a recent upgrade the health system’s insurance verification was unable to be completed, requiring a credit card and upfront payment of $70. I’m fortunate in that I have both readily available, but does everyone?

Submitting a claim to an insurance company is complicated, to put it mildly. It is highly unlikely this task could be completed easily on a smart phone. Factor in that reimbursement may not arrive before the credit card payment is due. Assuming the patient has access to a credit card, will they be able to pay that balance before reimbursement? If they have to wait until they receive reimbursement they are now subject to late fees and interest charges, which will quickly add up.

If the patient cannot pay the upfront costs, will they go somewhere else? Will they just delay care? Delaying care can lead to a downstream effect of worsening outcomes and greater expenses later on.

Studies regarding medical debt are focused on amounts greater than $250, like this study from Kaiser Family Foundation, and these large amounts can be devastating. But we also know from other studies that even small amounts of medical expenses can be enough to delay care or avoid care totally. Avoiding care can ultimately lead to more expenses and missed work later on. In the event care is paid for, what necessities may be skipped? Food? Rent payment? Vehicle Repairs? The downstream impacts can be significant.

Even as more American’s have been able to get health insurance, co-pays or up front payments can be still be a barrier to accessing the healthcare system. Automatic insurance verification is a good step toward reducing unnecessary up front payments, if it’s working. If it’s not working, it can be another barrier for those seeking healthcare.

Increasing access to care is a capability which many health systems are expanding. Once the resource is built, is it functioning as intended, or just creating another to barrier to care. Check out Tido’s end to end monitoring and digital apps test automation solutions. Ensure the most vulnerable customers are able to easily access high quality affordable care.

Hospitals are losing billions in 2022, how can IT improve ROI with existing infrastructure?

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healthcare financials

Hospital margins have been challenged by increases in labor expenses and shortages coupled with declining admissions and procedures. As financial pressures increase so too does the pressure on all departments to provide more value, more savings, and a greater ROI. Costs are rising faster than hospitals can raise revenues and prices.

There are a lot of solutions out there that offer promise of greater efficiencies for clinicians, new cloud based software that can provide greater insights into care practices and increased billing. Beyond the internal benefits, there are additional advances in hospital at home programs, and remote monitoring for chronic conditions. There is a learning curve to these systems, and for most it can often take months or years to realize the promised return.

How do you provide greater cost savings and efficiencies in care through existing IT networks and infrastructure? What can IT departments do now that doesn’t require education and training campaigns, massive investments in infrastructure or new systems?

In healthcare we know that early identification of problems is key to the most effective treatment. This is no different when it comes to IT systems ensuring safe and effective patient care.

How about monitoring the reliability of their current networks? All of these interconnected solutions require connected networks to function optimally and provide the necessary advances in patient safety and clinician efficiency. Buying the latest cloud-based AI solution to improve diagnosis, treatments, safety, and insurance denials, is only useful when the network is functioning.

Back in 2018 network reliability was identified as one of the risks to patient safety, what have systems done since then to ensure reliability? The pandemic likely radically changed or accelerated certain IT investments, moving up some upgrades or canceling others.

Calculating a basic ROI for pro-active network monitoring can be accomplished, just looking back at previous blog posts we can often see the time used by staff on this activity. If end-users are monitoring the network and checking for transmission of data and reports, their time is easily measured and value assigned. Are the IT departments measuring this time? Unlikely, but the unit managers can tell you how many hours each person spends on this.

  • When we considered the Cath Lab in a previous post, an RT or RN spends 3-5 hours every week checking feeds. Multiply this by every imaging area in the hospital, the numbers add up very quickly, at the most basic there may be 4 different imaging areas connected.
  • Pharmacy systems were also previously reviewed, how much time is spent reporting issues? It can be up to 20 minutes of a nurses time on the phone troubleshooting, likely with at least one additional call back.
  • How about remote monitoring programs? How much time will a nurse or physician spend on the phone with a patient trying to troubleshoot transmissions only to find that a connection was interrupted within the hospital’s own system?

Taking a look at the overall IT infrastructure the numbers can quickly add up throughout a hospital or health system. How often are feeds interrupted? Likely not that often, but even a single interruption after a monthly update can have significant ramifications to productivity when spread across an organization.

Those are the simple calculations to measure ROI, more difficult to measure are the ramifications to patient safety, staff satisfaction, and perhaps even future IT investment. If “nothing ever works around here” then there will be difficulty getting clinician buy-in to adopt the newest and best technologies.

Pro-active monitoring can enable early detection and warning. A simple message from IT can alert staff that IT is already aware of a problem and working on a resolution. Is IT optimizing the existing infrastructure to provide the best ROI?

Tido provides automated end to end monitoring solutions that will automatically alert your teams there is a disruption.

B+ when transfusing blood.

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Blood Groups

Blood transfusions in hospitals are a common occurrence to treat a number of conditions and diseases, from traumatic events to sickle cell. They are becoming more and more common for a variety of conditions, it now a medical specialty called transfusion medicine. Blood must be matched, at a minimum by type (ABO compatibility) for emergencies, but as transfusions have become more common to treat other conditions, additional testing and matching will occur for various other antibodies. Transfusions are largely regarded as a last resort when other treatment methods have failed, and related critical events are rare, depending on source 0.2%-1%, but they are still common and necessary occurrences. Critical to the safety of transfusions is ensuring that right blood gets to the right patient.

Each blood component must be tracked to ensure that when a patient needs it, they are receiving blood that is compatible, from the blood type to different antibodies in the components. Information systems help ensure this safety by providing a means for tracking blood products, which go through multiple processing steps after donation and are often collected far from the recipient.

Once blood products arrive in the hospital, they will often undergo additional testing to further discriminate sub types and antibodies. Patients that have received multiple transfusions are more likely to have antibodies against certain bloods, increasing the risk of a transfusion, increasing the need for more checks. Within the hospitals ordering blood products follows a similar pathway to medication ordering and administration, which was discussed in last week’s blog.

Similar to pharmacies, blood banks (where the blood is stored and distributed) often have a dedicated system for testing and tracking blood products. These systems are connected to the hospitals EHRs for physician ordering, distribution, and finally administration by the nursing staff. At any point along the chain if a connection is broken there can be a safety consideration that is missed. Healthcare workers are extremely vigilant when ordering, dispensing, and administering blood products, each step along the way involves checks and double checks to ensure safety.  As complexity in matching grows, the risk for missing a critical element increases.  As a safety double check blood products will be electronically scanned at each step, including administration, to make sure the right blood is being administered.

As the utilization of blood products increases to treat more and more diseases and conditions, and more specific matching becomes ever more critical, there is always an increased likelihood that a break in one of these systems can cause a critical check or piece of information to be missed. Transfusion events are rare, but they do occur, and it is often because of an unknown on the patient side. Until a patient receives a transfusion, we may not know how they will react.

If a transfusion event does occur, there is a process that occurs to figure out why. Critical to this process is knowing what blood was administered, it’s components and sources, and why the patient had a reaction. All of this information is documented, not only in the EHR, but also in the blood bank systems, to ensure that the risk of future events can be minimized, not only for that patient, but for other patients as well.

Interconnected systems ensure the safety of the blood supply and the safe administration of life saving therapies for patients in need. Are we positive these systems are operating as they should be? Can we B+ that all critical information and safety checks are happening as expected?

Tido provides automated end to end monitoring solutions that will automatically alert your teams there is a disruption.

Blood donation and transfusions remain safe and effective treatments to help those in need. For more information on donating blood, please visit the American Red Cross.

Systems reliability and the impact on safe medication administration.

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Medications Tablets

 

Inter-operability among systems in healthcare offers great hope for the exchange of patient information, ensuring clinicians are acting on the most up to date information possible and offering a double check for safety. Technology has become so central to a functional clinical environment that it powers pharmacy systems, saving time by performing critical checks. This technology has become so entrenched in the hospital that there are alerts and checks at almost every point of the medication transaction, from the time of order right through to administration.

How much can technology help patient safety? According to the NIH computerized physician order entry has reduced serious medication errors by 55%. Patient wrist band scanning is associated with a 51% decrease in adverse drug events at the time of administration. All of these systems, from prescribing to administration require connections to function properly.

The systems are there as a double check for patient safety, in a busy patient care environment mistakes can happen due to quick glances at labels or errors in manual dose calculations. No clinician wants to harm their patient, and we’ve come rely on these systems to make sure we haven’t missed anything. What happens when these systems are bypassed? Most of the time nothing happens, most errors may result in administration at the wrong time, or a dose that is not therapeutic. However there are times when a medication error can cause harm, at the most extreme death from an adverse drug event.

Why would any clinician bypass these safety systems? Emergencies are one area where automated safety checks are bypassed and manual checks are the norm. The other is when connections are down. If allergies aren’t updated in a pharmacy system from the EHR, an interaction may be missed. If medications aren’t updated from the pharmacy to the EHR, doses may be missed or medications over-ridden in the dispensing system.

Who monitors these connections to ensure they are operating? Most often, nobody. They are assumed to be working until someone reports a problem, because most of the time they do work.

Picture a busy unit in a hospital and let’s consider a broken connection between pharmacy and the medication cabinet.

    • Physician enters the order in the EHR, it is sent to and received by the pharmacy system.
    • Pharmacy reviews and approves the medication to be removed from the cabinet.
    • Nurse sees the order, 30 minutes later goes to the cabinet, does not see the medication on the patient’s list, and overrides it to give to the patient because they need it (safety concern).
    • The nurse double checks the patient, medication, dose, route, allergies to confirm the medication is appropriate, does not check interactions because they are in a rush and the patient is only on a few meds. (safety concern).
    • Nurse administers the medication, but has to override the bar code scan because the approval was not received from pharmacy (safety concern).
    • The nurse assumes pharmacy is just slow and goes on with their day.

In this instance, there is no error and no harm, everything went as expected despite the nurse missing the check for interactions. Will that be the same for the next nurse administering the next medication? It may not be several hours until the nurses realize that no new medications are being approved from pharmacy, at which point someone will call pharmacy, who will call the IT help desk. This will begin a chain of tickets to IT specialists and vendors to start checking pharmacy feeds. Several hours and countless medication administrations after the feed went down.

This isn’t a made up scenario, it occurs countless times in hospitals all over the country. Hospitals rely on physicians, pharmacists, nurses and others to manually check when systems go down. But if nobody realizes the system is down, some checks might get missed. This poses a safety concern for patients and removes critical check for busy staff who rely upon it. It could take an entire shift for a nurse, doctor, and pharmacist to manually check every medication for a single critical patient.

What if these systems could be automatically monitored and IT teams notified immediately if a feed was interrupted? Staff that rely on safety check in systems can rest assured that they are working, that the system is operating as intended. If there is a problem, they can be quickly notified and make sure they are following processes meant to ensure safety when systems cannot.

Tido provides automated end to end monitoring solutions, that will automatically alert your teams when there is a disruption.

Low visibility tech that has a high impact for clinical staff.

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Cath Lab Technology

How to avoid staff sentiment of “nothing works like it’s supposed to.”

Low visibility tech that fits so seamlessly into a workflow, we don’t know it’s there until it tells us it is.    Tech that actually saves clinical workers time and allows them to focus on patients, could it exist?

Absolutely.  There are so many systems healthcare is reliant upon, when they fail to connect, big problems arise that will have a big impact on clinical workers.  This can be such a problem that many clinical areas within hospitals will dedicate a person to check information is flowing where its supposed to.  They are not IT, they are patient care professionals taking time to check these systems because they know the problems that arise when patient information doesn’t flow.

Consider a Cardiac Catheterization Lab, the simplest lab might have 3 different systems, the most complex, maybe 10 or more.  A typical solution to checking systems within a lab:

  • Everyday, or every week, a Cath Technician or Nurse may spend 3 – 5 hours checking reports to make sure they went to the EHR, and images to make sure they went from the local system to the PACS/VNA/EHR/DICOM.  At best any interruption in transfer is caught before the patient leaves the procedure area, at worst, it is not caught until someone is looking for the results.
  • Once the interruption is caught a staff member will check operations on their end to make sure it wasn’t an issue with what they did.  Then they reach out to the IT help desk to report the problem.  IT will ask several questions and have the staff member perform checks manually to make sure everything was done correctly on the user end again.  
  • At this point the IT help desk will forward the ticket to another area or vendor if needed.  In a serial manner, the issue will get passed until the proper team or vendor is found that controls the part of the feed that was interrupted.

This is what happens during normal operating hours.  Most interruptions to connections occur when upgrades to one of the systems happen, most often during the night or weekends when staffing is lightest.  Cath labs have staff that are on call for emergencies, but not on site during those times.  If they are called in for an emergency they may discover the problem when they arrive and have a ‘network failure’ message on one of the systems, or it may not be discovered until after they have left the building and someone is looking for more information.  This will result in the physician or staff being called at home to provide the missing information.

Systems that don’t connect will inhibit the flow of patient information, and frustrate staff trying to provide patient care, this often leads to the sentiment “nothing works like it’s supposed to.” 

Low visibility tech that monitors these feeds can save staff time when things are operating normally, and can save frustration when its not by alerting the right people; often before the issue is even noticed by the user.

Imagine a Cath Lab solution with such a technology in place:

  • Cath Lab Technologist or Nurse is providing patient care, not checking different systems.
  • Feed from the imaging system is interrupted and a message alerts the appropriate IT team and/or Vendor as well as the Cath Lab.  In an ideal world this will be done on a hospital’s secure messaging platform so everyone can communicate a problem or resolution instantly.
  • All teams are checking for a problem on their end simultaneously.
  • Cath lab calls IT, confirms they have checked systems on their end, they are told that problem is known about and all teams are looking into it at the same time.
  • From experience we know that by the time the Cath Lab team finishes checking systems on their end, the other teams will have too.  The problem is often resolved by the time the Cath Lab is calling the help desk.

Since most interruptions occur during an upgrade, if the problem is found immediately, the IT team is notified immediately, likely before they are even finished with the upgrade and have left for the night.  

Implementing such a solution means you have freed up 3-5 hours per week of a highly trained patient care worker, and eliminated a major source of frustration for caregivers when systems don’t connect.  Low visibility tech that ensures smooth and hassle free operations for your staff, allowing them to focus on what really matters, the patient. 

Talk to Tido about their end to end monitoring packages to let your staff focus on their patient.

 

How to keep healthcare uninterrupted; staffing challenges

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healthcare applicationsAll health systems, no matter if they are small, medium, or large are dealing with increasing number of applications. The COVID-19 pandemic has accelerated digital transformation in every major sector, vastly increasing our reliance on technology to meet many of our daily needs. And healthcare is no exception! Our health systems have greatly expanded their digital footprint to better serve our patients, empowering them to perform routine tasks without leaving the comfort of their home—such as paying bills, requesting medication refills, and even receiving personal health updates digitally.

More than 30 percent of health systems are reporting that they can’t locate enough candidates to fill open positions, and all are feeling the effects of staffing shortages. Beyond recruiting, retention is even more difficult with the increase in turnover and employee burnout.

On top of this the applications that health system IT deals with are becoming increasingly complex. Most if not all applications whether it’s a desktop application, web, or mobile, integrate with each other to transfer information in real-time.  There are very few standalone applications in today’s integrated environment.

So we have increasing number of complex and integrated applications in a health system with fewer people to manage and support them. This presents a significant challenge for IT departments and can also impact patient care. Helpdesk ends up relying on end-users to report production application issues to start the process of diagnosing and resolving the issues. Reliance on manual identification and reporting causes significant delay in diagnosing and fixing issues. This interruption can impact patient safety and outcomes.

Currently, most healthcare organizations have basic monitoring in place for their digital assets, such as operating system errors and breaks in connectivity. However, typically there is no active end-to-end monitoring of the production environment that would catch issues in real-time and alert the appropriate staff proactively. To keep healthcare uninterrupted, we recommend using end-to-end monitoring of applications and interfaces in your production environment.

At Tido, we realized that there had to be a better way to proactively monitor applications and interfaces in production, to make IT staff aware of the issues immediately; before the end-users are even aware that there is an issue with the system. To address this ongoing problem, we have developed high-quality automated monitoring services for healthcare systems.

  • Tido’s monitoring framework uses Microsoft Azure Monitor to reduce reliance on manual reporting—helping to detect 95% of application and integration issues automatically in the production environment.
  • Tido’s end-to-end monitoring framework automates application, interfaces, and data checks in EHR and all downstream applications in the production environment: PACS, Pharmacy, LAB, Cardio, Ambulatory, and more.
  • Tido’s monitoring solution sends automated notifications to responsible parties and the IT help desk within seconds, alerting them about live application or interface issues to avoid unscheduled downtime and reduce patient safety issues.

Contact us to find out more about how your healthcare organization can subscribe to Tido’s end-to-end monitoring packages, to proactively maintain the quality of all the applications and interfaces in your digital health system and keep healthcare uninterrupted.