The trusted source for
healthcare information and
Hand-held computers and telemedicine top list
In this digital age where 12-year-olds pass notes in class using hand-held computers, it’s a conundrum as to why hospices have been slow to embrace technology. Limited capital needed to acquire expensive systems can explain part of it, but it doesn’t completely explain why commonly used technology still hasn’t found its way into the mainstream of hospice care.
"Hospice is still a cottage industry," says Tim Cousounis, vice president of Jefferson Home Care in Bryn Mawr, PA, which includes hospice care. "It is still fragmented and made up of mostly small hospices that don’t have the capital that would allow them access to technology."
Perhaps the very essence of hospice care — health care that relies almost solely on touch — prevents it from implementing technology into its low-tech, hands-on approach to patient care. After all, hospice care is a species of old-fashioned nursing care that many believe has been pushed aside with the advent of expensive gadgetry.
But hospice caregivers need not feel that way, says Stephen Conner, PhD, executive vice president of research and professional development for the National Hospice Association and Palliative Care Organization (NHPCO) in Alexandria, VA. Instead, certain types of technology should be seen as tools to help organizations be more efficient.
"Any system that makes it possible to spend more time at the patient bedside is good," Connor says.
With new technology emerging so quickly, hospices also face the challenge of having to discern between what is actually useful and what is simply technology for technology’s sake.
The two factors that should guide hospices when choosing to update their technology should always be quality and efficiency. The technology should in some way improve care and help workers do routine tasks in less time, allowing them to spend more time on patient care, says Calvin H. Knowlton, PhD, CEO of Hospice Pharmacia, a pharmaceutical care consulting and medication distribution company in Philadelphia.
Both Knowlton and Connor say the use of hand-held computers and telemedicine is the most promising technology for improving hospice care. They can allow nurses to spend more time with patients, decrease the time nurses spend doing routine tasks, and speed up the exchange of information between clinical staff, patients, and physicians.
Real-time drug information
Hand-held computers, also known as personal digital assistants (PDAs), are nearly as popular as wireless phones. The term "Palm Pilot" has transcended the lexicon of gadget freaks into the mainstream. These devices have added a whole new dimension to the way people manage information. A husband can no longer wiggle out of missed appointments by claiming he simply forgot, when his wife can coordinate his schedule by easily downloading their scheduled appointments onto his PDA.
But as popular as this technology has become, the hospice industry is just beginning to find ways to use it. For example, Hospice Pharmacia is outfitting several hospices with hand-held computers that contain software developed by Numoda Corp. The devices will enable nurses to access patient medication profiles, request medication refills, perform pain medication calculations, and access step-care protocols in a wireless, real-time fashion.
If the trial works as planned, staff will be able to eliminate many cumbersome tasks, such as updating medication profiles used by a number of caregivers for one patient. Currently, the physician, nurse, pharmacist, and hospice all maintain separate profiles, a system that necessitates meetings and memos to communicate any additions or removals from the list. The new software and PDAs should allow a nurse to update the list on her PDA and download the information to a central system that can be accessed by other staff and physicians who get the most up-to-date list.
The hand-held devices also permit nurses to collect and transmit data on patients’ pain levels and associated symptoms. These applications provide for evidence-based decision-making at the point of care, patient pain management, and outcomes reporting, says Knowlton.
The hope is that the experiment will increase efficiency, reduce costs, and allow for measurement of pharmacotherapy outcomes in real-time. "Hospice Pharmacia’s addition of wireless applications reduces the amount of time our nurses spend on pharmacy issues, allowing them more time for patient care," says Susan Lloyd, executive director of Delaware Hospice in Wilmington, one of two programs being set up with these devices.
"We hope it will make clinical staff more efficient, while improving our outcomes," says Cousounis, whose hospice is also participating in the project with Hospice Phamacia.
For now, staff will be performing routine tasks using their hand-held computers, such as getting prescription information and making prescription recommendations, says Knowlton. They will have access to a Hospice Pharmacia database that will allow them to make evidence-based decisions using available outcomes data for specific drugs based on the patient’s current drug therapy and his or her disease. But Knowlton admits that all this is small potatoes compared to what he envisions the technology being able to do.
The NHPCO also sees promise in hand-held computers. The organization is working with Brown University in Providence, RI, to develop a data collection system that uses PDAs as the point of data entry. The hope is that hospices can collect satisfaction survey and outcomes data at the bedside, saving time that it takes to collect the data manually and enter it into a separate database.