Paperless Value: Utilization of Technology to Maximize Rounding Efficiency, Team Communication, and Patient Safety

The United States healthcare system is struggling with rising costs, poor outcomes, waste and inefficiency. The Patient Protection and Affordable Care Act (PPACA or ACA) represents a substantial effort to improve access and emphasizes value-based care. Value in healthcare has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. The ability to define value is further complicated by the potentially competing interests of the five major stakeholders in healthcare: patients, doctors, payers, hospitals and manufacturers.

We advocate that the best way to deliver patient-centered valued care is for physicians to reassume a central role in health care in at least two ways: by helping to establish the definition of value and by designing clinically relevant methods of delivery. With the institution of the electronic medical record (EMR), one strategy to improve value is by incorporating this technology into day-to-day patient care in innovative ways.

To this end, the neurosurgical service at our institution has begun to examine the efficiency of patient rounding on the oncologic patients. Historically, patient information had been held and transferred via the creation of a daily paper list. The time consuming maintenance of this list was a woefully inefficient mode of information transfer largely due to errors in transfer and the static nature of the list itself. By simply incorporating tablets with wireless technology into our necessary daily rounding duties, we have been able to streamline the compilation, updating, and retrieval of patient data.

Patient lists are now continuously updated and are thereby as accurate as the EMR itself. They can be accessed, reviewed and edited by all members of the healthcare team at any point during the day. Not only does this provide a platform for constant, real-time attending-resident communication, it also allows for daily “to-do” lists and patient plans to be distributed to the entire team.

We have already observed more robust and reliable communication among team members. Another advantageous, yet unanticipated, byproduct of this technology was the automation of patient plans from the rounding list to the daily progress note which subsequently increased our success at charting of hospital mandated disease complexity. Most importantly, this innovation has reduced the time required for, and the safety of, patient hand-offs, with extra time being devoted directly to patient care activities.

Preliminary reports from the residents, faculty, patients, and ancillary staff from other disciplines have indicated that our strategy is meeting its proposed objectives. Furthermore, it seems the sky is the limit with regards to how much we can push the envelope to incorporate technology to achieve improved patient outcomes. Future work needs to focus on objective measures of efficiency, safety, and value to patients from the use of this tablet technology.