Being a caregiver today is extremely challenging. Time constraints, continuous interruptions, information overload and the need to coordinate the care team can contribute to the challenge. Physicians and nurses want to provide perfect care in a timely manner, but even with the best electronic health record (EHR), gaps in quality care remain. Why is this? As humans, we have a limited capacity in short-term memory to consume, remember, process, correlate information and make a decision before we reach cognitive overload.

The EHR has certainly helped – organizations can build order sets that prompt physicians to remember key elements of care, provide clinical reminders that identify potential adverse events, and use graphs and innovative user interfaces to help correlate information. Yet we still have a long way to go before we and our patients can be assured of high-quality, safe and cost-effective care every single time.

A big portion of the remaining gap is in the management of clinical processes – the collection of time-based and interrelated tasks for addressing a specific problem. For many elements of patient care, there are core processes that are essential to follow:

  • Quality bundles, such as a bundle to address ventilator-acquired pneumonia
  • Acute event management, such as a myocardial infarction
  • Rapid follow-up and intervention when there are important changes in patient condition, such as when a new lab result indicates a significant change.

Managing the Process of Care

The EHR today offers limited functionality for managing and communicating the process of care to the care team. This is especially true when caregivers are not logged into the EHR or viewing a patient’s record. Providers now can help address this gap by setting up novel visual communication tools that:

  • Mine the selected data in real-time from the EHR and other systems
  • Apply advanced analytical capabilities to evaluate time or event-based care processes
  • Present the state of the processes so caregivers can review the status of care
  • Prompt the caregiver and care team to complete key tasks, even when the caregiver is not logged into the EHR.

By means of a large screen on the wall of the unit, caregivers can see at a glance “what are the most important things I need to do right now” according to the organization’s priorities and protocols.

Closing the Quality Gap wall unit

A quality monitoring solution can help caregivers with task-based complex care bundles. This example depicts a ventilator-associated pneumonia prevention bundle with the current status (green, yellow, red) for compliance with associated quality metrics. The Summary column shows other bundles assigned to the patient, since the white board rotates among bundles.


Providing Visual Care Cues

Other complex industries such as telecommunication centers, power plants and factories use real-time visual displays to constantly assimilate and analyze information generated from operations. The visual communication tools are used to drive extremely high levels of reliability and execution of processes in those industries. A unit in a hospital is no less complex. To successfully implement visual communication tools in healthcare, organizations need to support and enhance the work process of caregivers. The care team spends a large portion of their time creating data in the EHR of their patient interactions. The value of a point-of-care visual communication tool is in surfacing and making the EHR data visible so all the care team can share it at a glance and act on it immediately, if necessary.

To decide what is most important to display, organizations should use retrospective analytics. Identifying the highest-value opportunities will help them avoid overwhelming caregivers with too much information.

Closing the Quality Gap whiteboard

An electronic white board can be used to make selected EHR and operational data visible to the care team in a shared view. The example above shows visual cues for the data against the hospital floor plan. A hospital can use a board to show important information such as results availability, orders for completion, fall risk, medication due, allergies and bed availability.


Maximize Operations and Care

With pressures from reform and declining Medicare reimbursement, it‘s more important than ever for organizations to find ways to improve financial performance and quality. By maximizing patient throughput and capacity, organizations can eliminate inefficiencies, waste and inadequacies in care delivery while improving revenue. Streamlining throughput means they can provide better care to more patients more efficiently. Visually connecting the care team assists them in maximizing productivity and the quality of care.

Visual communication and real-time analytics are powerful tools for organizations to augment and tap the value that resides in their EHR. These tools not only help an organization improve care delivery, but also “give back” to caregivers by helping them better manage their cognitive burden. And if patient interactive feedback is included in the visual care process, caregivers are better able to improve outcomes and patient satisfaction.


Five Keys to Providing Visual Care Cues

There are five keys to successfully implementing visual communication tools in healthcare:

  • Present information for rapid assimilation: Information is organized and displayed so that, at a glance, caregivers can quickly identify and synthesize information as they move throughout their day on the unit.
  • Eliminate additional work for caregivers: The visual communication tools should mine and visually surface data that is being generated over the course of care. Having data available at a glance without having to log in reduces the need to access EHR data via a PC.
  • Prevent information overload: Only the most important processes should be targeted for visual communication tools.
  • Engage the entire care team: Visual communication tools should be deployed in a manner that engages the entire care team and drives shared accountability for patient care processes.
  • Access clinical content: Healthcare processes are complex, with many exceptions to the standard path. The tool should provide continuously updated industry-standard content that can be accessed so it works “out of the box” with the most current clinical evidence.
 
Andrew Mellin

About the author

Andrew Mellin is a vice president and medical director for McKesson, where he currently provides strategic direction for the Population Health & Risk Management group for McKesson Connected Care & Analytics. He received his MD from Duke University, completed his residency in internal medicine at Barnes Hospital in St. Louis, received his MBA from the University of Minnesota, and is board certified in Internal Medicine.