Creating an environment for patient-centered care

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1 Cerner Smart Room: Creating an environment for patient-centered care Prepared by Cerner Corporation TM

2 When Cerner came along with this technology, we said, that s it that s going to make a huge difference. - Dr. Allen Weiss, President & Chief Executive Officer, NCH Healthcare System Background Beginning in early 2012, NCH Healthcare System in Naples, Fla. started down a journey of integrating new, innovative technologies into its existing electronic health record (EHR) system in order to increase patient safety, improve clinical workflows and enhance the inpatient experience. With the foundation of an EHR already in place, NCH looked to implement a value-added platform that would create seamless integration between medical devices and clinical applications. To achieve this vision of interoperability, NCH implemented Cerner Smart Room technology within two patient floors of NCH North Naples Hospital. The Cerner Smart Room is a collection of health care technology solutions that improve clinical workflows and engage patients in the process of care by bridging the gap between medical devices, clinical applications and real-time patient information. Building upon a deep level of integration between solutions residing inside and outside the patient room, the continual focus of the Cerner Smart Room technology lies around automating and simplifying workflows to positively impact patient outcomes. We are all about outcomes, states Dr. Allen Weiss, President and Chief Executive Officer of NCH Healthcare System. When Cerner came along with this technology, we said, that s it that s going to make a huge difference. Engaging the community NCH was able to use the Cerner Smart Room project as a way to engage the Naples, Fla. community it serves. In the months leading up to the implementation, the Annual NCH Healthcare System Hospital Ball was used to introduce the new technology to members of the community, generating interest into what the health system was doing to advance the delivery of care. People in the community have exceeded interest in Smart Rooms, says Weiss. Having a community that is so supportive, and has been over the decades it is very, very encouraging. It gives us more motivation to do the right thing for our community and for the individual patients that we serve. A Cerner Smart Room at NCH North Naples Hospital.

3 The Smart Rooms allow [clinicians] to interact and spend more time with their patients because everything is at their fingertips. - Helen Thompson, Chief Information Officer, NCH Healthcare System An integrated approach to technology At the core of the Cerner Smart Room technology is CareAware, Cerner s interoperability architecture which creates a platform for scalable growth and diverse expansion of medical device and EHR application integration. Residing on top of this platform are several solutions which enable a transformation of the inpatient environment, helping to optimize workflows and improve patient outcomes. The solutions making up the Cerner Smart Room units at NCH North Naples Hospital include: CareAware AlertLink CareAware CareView with CareAware Tracking CareAware ibus CareAware mystation CareAware RoomLink CareAware VitalsLink NCH put a strong foundation in place for its Cerner Smart Room environment by implementing the CareAware ibus for bedside medical device integration. This established the platform onto which the individual solutions would be implemented. The CareAware ibus enables all of the Smart Room technology to function the way it does, explains Robyn Hamm, Application Architect for Cerner ITWorks at NCH Healthcare System. It is definitely the middleman of the technology. Transforming the health care experience The initial deployment of the Cerner Smart Room technology at NCH took place within a total of 64 patient rooms on the fifth and sixth floors of NCH North Naples Hospital. Clinicians on these floors have access to real-time patient information through the CareAware platform, enabling the efficient delivery of patient care. The Smart Rooms allow them to interact and spend more time with their patients because everything is at their fingertips, adds Helen Thompson, Chief Information Officer of NCH. Workflow and patient care is optimized with CareAware VitalsLink, a streamlined and automated solution for capturing and charting patient vital signs at the point of care. Real-time alerting from the EHR and medical devices is provided through CareAware AlertLink, which routes secondary alerts directly to mobile phones carried by nurses. Response hierarchies created in the CareAware AlertLink staff assignment application deliver an integrated platform for smart alert escalation between caregivers, enabling optimal response. The timing is instantaneous, says Michele Thoman, Chief Nursing Office of NCH. It allows them to make the decision right there, go see the patient and ensure the patient is okay. Digital room signage through CareAware RoomLink is installed outside of every patient room on the two floors, communicating attributes like patient allergies, fall risk information, NPO orders and isolation status. Patient information entered within the EHR is automatically updated on the CareAware RoomLink screens, improving the availability of real-time information. Additionally, integration with CareAware Tracking enables the real-time location of clinicians to automatically generate changes within CareAware RoomLink. Light colors and presence information on the device The CareAware RoomLink digital signage sits outside the patient s room.

4 CareAware mystation presents the patient with educational videos to enhance the care process. It s transformed the patient s experience with the provider. - Michele Thoman, Chief Nursing Officer, NCH Healthcare System changes with the entrance or exit of a clinician in the patient room, helping to improve communication on the floor through visual cues. The inpatient experience is transformed with CareAware mystation, which provides patients with a system for accessing entertainment offerings, educational videos and personalized plans of care through the bedside television. Integration with CareAware RoomLink and CareAware Tracking triggers presence alert pop-ups to occur on the CareAware mystation screen whenever a clinician enters the room, notifying the patient of who that particular care provider is. Thoman explains, Now, I m fully informed as a patient. I know who is in my room. I know what they re there to see me for. Thompson states that the entire suite of technology is helping to transform the health care experience for both patients and providers, creating a patient-centric environment at NCH. It really does engage our patients more in their own health care, and that s really where we need to go. I think that our Smart Rooms are the way of the future. Realizing the value The Cerner Smart Room technology in place has helped NCH move down the path of creating a safe, efficient and effective health care environment for patients and providers alike. Thoman says, The technology is cool, and there are a lot of oohs and ahs about that, but I think it s the whole package. It s transformed the patient s experience with the provider. One of those transformations took place within the secondary alerting process at NCH North Naples Hospital. Prior to implementing CareAware AlertLink, patient telemetry alerts were called into the unit floor from a central monitoring station, adding a number of steps to the process and increasing the time taken to respond to alerts. Before, with any type of alert, the secretary would be called or paged, describes Heather Dill, Nursing Manager at NCH North Naples Hospital. She would then have to find the nurse s number, call the nurse she would then have to get a response, and then explain what was going on. A survey distributed to floor nurses prior to implementation found that 89 percent of respondents were at least slightly concerned about not receiving patient alerts directly to their communication devices. Additionally, 75 percent of respondents believed there to be either moderate or significant room to improve nursing response times to alerts on the floor.

5 The Smart Room technology is more engaging for the patients. It absolutely makes a difference. - Paul Clarke, Patient Experience Coordinator, NCH Healthcare System Since using the CareAware AlertLink technology, the processes in place have improved, and nurses are receiving real-time information more quickly. Alerts are now sent directly to the communication device of the pre-assigned nurse, enabling faster response. Dill states that alert responses are now much quicker. With this, it is just direct contact with the nurse. Efficiencies have also been gained in other workflows at NCH. The use of CareAware VitalsLink has completely changed the process for capturing and charting patient vital signs, as nurses and clinical care technicians now wirelessly chart vital sign data into the EHR at the point of care, instead of manually transcribing the data. This new workflow has saved NCH clinicians an average of 1 minute 24 seconds per vitals session, or over 14 minutes for the typical 10-patient vitals round. The nurses and clinical care technicians are very excited about the efficiencies they are gaining, says Thoman. No longer are vital signs written on paper towels or on the pant leg of their scrubs. Likewise, patient safety has improved, as clinicians now have the most up-to-date vital signs information at their fingertips. The time latency gap between when vitals were taken and when they were charted into the EHR has been reduced from an average of 46 minutes 20 seconds down to only 27 seconds with the CareAware VitalsLink technology. Dill believes this change is absolutely safer for the patient. The faster we can respond to any fluctuation in a vital is much better. Finally, the integrated uses of CareAware mystation, CareAware RoomLink and CareAware Tracking, in addition to the other Cerner Smart Room technologies, have helped to transform the patient experience at NCH. The Smart Room technology is more engaging for the patients, says Paul Clarke, Patient Experience Coordinator at NCH. They are able to view necessary, important information just by the click of a button. It absolutely makes a difference. NCH recently realized some of its highest patient satisfaction scores in history, and after deploying the Cerner Smart Room technology, saw increases in a number of its top box scores in discharge surveys used for the mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. The fifth floor (NN5) of NCH North Naples Hospital realized a 24.4 percent year-over-year increase in patient ratings of the hospital environment, while the sixth floor (NN6) saw a 25.8 percent increase. Additionally, NN5 realized a 12.4 percent year-over-year increase in patient ratings for recommending the hospital, while NN6 saw an 18.2 percent increase. The delivery of educational content at NCH has also improved, as a number of patient HCAHPS ratings around the medication teaching process have increased for both NN5 and NN6. Thoman attributes these positive changes to the improved delivery of patient-centered care.

6 We would do Smart Rooms again in a nanosecond. Among the better or best decisions we have ever made. - Dr. Allen Weiss, President & Chief Executive Officer, NCH Healthcare System Patient-centered care is really about bringing the patient into the center of their care. You can do that through facility design, through the use of technology, and through way the providers and nurses interact with the patient. The Smart Room technology allows that patient to be active in their care not just be a recipient of care. Health care of the future NCH Healthcare System is using Cerner Smart Room technology to advance the way patient care is delivered. The solutions have helped create a patient-centered environment at NCH North Naples Hospital by enabling workflow optimization and enhanced patient engagement. NCH has also leveraged the CareAware architecture in place to implement additional platform-native solutions, like CareAware Smart Pump Programming, to continue improving care quality in other areas of the hospital. With an initial focus on two patient floors, NCH has plans to continue rolling out the Cerner Smart Room technology across the rest of the health system, as well as implement new integrated solutions like the Cerner Patient Portal, which will provide patients with a web portal to access health information, schedule appointments and securely message care providers from home. This is a continuous journey, states Weiss. Every time we reach a plateau, we want to push a little bit further. The advancements made so far at NCH have shown the value that integrated technology plays in helping deliver optimal outcomes. Weiss affirms, We would do Smart Rooms again in a nanosecond. Among the better or best decisions we have ever made. The patients can have a better experience, and together, we ll have better outcomes. wp12_360_13_v1

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