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mHealth Makes Rounding an Active Tool in Value-Based Care

University of Chicago Medicine nurses are using iPads and an mHealth platform to conduct rounds, giving the hospital a real-time window to patient perceptions and a chance to improve engagement and outcomes.

Source: ThinkStock

By Eric Wicklund

- An mHealth rounding platform is helping University of Chicago Medicine to add “the voice of the patient” to its care plan – and promoting value-based care.

Nurses at the 560-bed hospital have been using iPads since 2014 to capture patient perceptions during their time in the hospital. The standardized questionnaires, developed for inpatient as well as ambulatory and ED stays, have helped hospital administrators identify care gaps, improve patient-facing services (such as food delivery and housekeeping), encourage better patient engagement and boost satisfaction ratings.

“Rounds really help us [develop] the relations ship with the patient and their family,” says Sue Murphy, RN, BSN, MS, UC Medicine’s chief experience and innovation officer. “We put value to how we are delivering care.”

Rounds have been a part of the hospital experience seemingly forever, but were long limited to paper questionnaires mailed to patients or phone calls from an outsourced call center days, weeks, even months after the fact. With mHealth platforms, administrators have been able to develop specific questions for specific departments, place them on a tablet or similar mobile device and deliver them to patients at the point of care.

The impact, says Murphy, is immediate. A patient’s complaint or concern can be answered quickly, and trends among patient responses can be addressed while the patients are still in the hospital. In addition, patients are more apt to answer questions on a mobile device at the hospital, whereas they’d be more likely to toss a mailer from the hospital into the trash or ignore a phone call when at home.

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The mHealth platform also gives hospital administrators a more effective means of collecting “good data” on the health system. Praise and positive comments can be gathered and reported back to staff, thus improving morale. Likewise, a staff member who is cited in a few complaints can be pulled aside and counseled more quickly, before bad habits become permanent.

“That real-time measure of accountability really helps,” says Murphy, who has delivered several presentations on mHealth rounding and will host an educational session at next week’s HIMSS17 Conference and Exhibition in Orlando.

UC Medicine administrators say they’ve seen an increase in patient satisfaction rates since adopting the mHealth platform. Within four months of deploying Vocera’s Care Rounds solution in 2014, the hospital had collected about 12,000 responses from more than 9,500 patients, including more than 2,800 “positive staff recognitions.” That helped the hospital see an almost 40 percent improvement in its Press Ganey ratings for “Likelihood to Recommend,” as well as an 8 percent boost in the hospital’s overall ratings.

Just as significantly, the hospital saw a 1.5 percent reduction in readmission rates – an indicator that the rounding platform could also be used to affect clinical outcomes.

That’s the next evolution of the mHealth platform, says Murphy, who notes that nurses and doctors have different expectations and reasons for conducting rounds. In fact, nurses have for some time been including clinical questions in their rounds, asking about pain management and – with readmissions – reasons for returning to the hospital.

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With the shift to consumer-directed healthcare and an emphasis on value-based care, mHealth advocates see digital rounding platforms as an ideal tool for including the patient’s perspective in the medical record. A patient’s feelings and comfort level, they argue, may very well play a part in clinical outcomes, including adherence to care plans and medication.

Murphy says UC Medicine is looking to make the questionnaires more dynamic. With returning patients, that means developing a platform that will pull up past questionnaires and complaints, so that the nurse making the rounds has a better understanding of each patient’s history with the hospital.

“We’d like to use the technology to be more proactive than reactive,” she says.

Murphy also notes that making rounds isn’t as easy as simply picking up an iPad and asking questions.

“We train and develop people how to round,” she says, describing a process that’s similar to health systems and telehealth providers training doctors on how to conduct a virtual visit. In fact, those nurse leaders charged with making rounds “see it as a sacred time” during which they’re engaging with patients and getting vital information.

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“It’s not as much about the technology as it is about patient feedback and interactions,” she says. 

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