by Dr Deepa Bhide, PMP
6 a.m. – The beep of the mobile wakes up Dr. Rao as his eyes try to adjust to the glare of his mobile screen. He has just received a message on his phone regarding a patient (Bhushan) that he had admitted the day before. Dr. Rao reads the message and replies with his orders to process the care. The nurse on duty has informed that Bhushan’s blood pressure has risen again and that he is feeling uneasy. Real-time patent information helps Dr. Rao assess the need of immediate response for intervention, if any.
Bhushan, a 45-year-old male patient, is a case of uncontrolled hypertension (increase in the blood pressure) and diabetes mellitus since five years ago. He has had a couple of admissions earlier for chest pain. Bhushan regularly sees Dr. Rao for checkups and follow-ups.
7 a.m. – Dr. Rao knows about the complaint, and that it does not need an urgent reply. He is well aware of Bhushan’s case and decides to take it on when he visits the hospital. It’s time for grabbing some exercise, so Dr. Rao is off to his gym—his Fitbit ready. The digital app helps him track of his all-day activity, and at least reassures him of some exercise to his body.
8 a.m. – It’s time to leave for his rounds. With one more glance of his messages, Dr. Rao buzzes off to his car. The car is equipped with applications designed to route and display messages on the mini-screen. Dr. Rao loves it as it helps him check his schedule for the day—and also reports of some admitted patients. He specifically checks for some x-ray reports that he needs to track for rolling out orders. Dr. Rao checks on the details of the latest message sent by the nurse. Bhushan’s vital parameters seem to be on track, though his blood pressure shows a steep rise.
9 a.m. – Dr. Rao reaches the hospital and starts his rounds. He clutches his tab that has the patient details, the Electronic Health Record application, loaded on it. The EHR application has all the details of the patients, including their demographics, symptoms, assessments, daily progress and the reports from lab and radiology investigations. The EHR facilitates up-to-date information to the physicians on current and historical patient details.
While in the hospital, Dr. Rao checks for the MRI studies and CT scans on the Radiology Information System (RIS) that flashes the digital images. The nurse is quick to get Bhushan’s reports to Dr. Rao. His progress note from the earlier night seems fine. Dr. Rao examines Bhushan and makes a note of his findings in the application. He instructs the nurse to administer a medication to lower Bhushan’s blood pressure, and also carry out a few more tests on him.
It’s vital to have real-time patient details to make notes and plan for risk assessment. Dr. Rao keys in his findings and plan of care to keep the record updated; e-Prescribe helps him send out prescriptions that minimize risk of adverse events. Dr. Rao has his pager alerts enabled in case he needs to be notified of an emergency case. The pagers, though outdated and superseded with more current application, are important to a physician in a hospital setting.
All physicians have access to alerts and notifications related to incorrect medications or adverse events. These are critical for both the patient and the physicians to be able to go ahead with averting medication-related adverse events and to follow safe prescribing practices. It’s also a vital tool to save the hospital and physician from legal issues. Dr. Rao alerts the nurse to send him notifications about Bhushan’s progress on his mobile.
Noon: In his office now, Dr. Rao is more relaxed. His Fitbit displays his activity so far, and the numbers reassure him. “Coffee is not a bad idea,” he thinks as he grabs his phone to order a cup from the canteen
He get to his laptop and logs in the physician portal that he has an access to. The portal is a gateway to his world of medical information. The Electronic Medical Record (EMR) has a scheduling application that shows his lineup of patients for the day, and also other activities such as prescriptions refills, answering questions from patients and so on that need to be accomplished. The portal is also enabled by a single sign-on (SSO) that helps him to check on details of admitted patients.
As Dr. Rao checks his patients, he records the information in the EMR application—which helps him keep a check on the time and movement of the patient queue. This keeps the patient information updated at all times. As an aid to his clinical skills, the Clinical Decision Support Application (CDSS) makes it easy for Dr. Rao to gather information or validate his assessment of a problem. Falling back on evidence-based medicine guidelines is a good practice to follow.
Dr. Rao needs to know the past history of each patient and details around the care plan for the ailment that he or she had been diagnosed with. Applications enabled with the Health Information Exchange (HIE) facilitate this information for Dr. Rao. He has access to the patient’s history from a different health organization. Having a complete set of information is important to make the right judgement. Smart cards are one of the key applications that help with identification and patient authentication, matching patients to their unique data, synchronizing data from disparate sources while enabling secure access control.
Privacy and security of a patient’s data is critical in any healthcare setup, and is governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The law makes some stringent guidelines for the healthcare providers to follow to be able to safeguard patient’s healthcare data.
One copy of a patient’s note is provided to the patient by copying the summary on his Personal Health Record (PHR) that the patient carries on a flash drive. This obviates the need to carry a pile of paperwork pertaining to his past admissions and visits to various doctors. The patient can access this record and keep it updated so it’s available for any future references
Dr. Rao isn’t finished yet; he has a few more patients to check until he’s done for the day. He logs into the Portal to check on Bhushan’s vitals. The Portal gives him an access to his patient’s charts. He notes that Bhushan’s blood pressure has stabilized now and that the reports of his latest lab tests are well within range. The CDSS system has helped him validate a few medication dosages. There is no new intervention that is required at the moment. The thought is reassuring.
To help ease his memory, Dr. Rao has subscribed to an app to look up drug information and interactions, find other physicians for consults and referrals, and quickly calculate patient measurements like body mass index (BMI). Dr. Rao is happy to see that these seemingly trivial yet important activities are facilitated by the applications in this digital age.
5 p.m. – “All work and no play makes Jack a dull boy!” goes an age-old adage. Dr. Rao is through the patient queue and ready to leave for the day. It’s time to catch up with his colleagues. That’s not difficult, considering how technology savvy Dr. Rao is. There is an application for socializing with fellow physicians and communicate with them. The application helps send HIPAA-secure faxes through the phone, and follow news and trends in one’s specialty. Keeping a tab on critical cases such as Bhushan while playing a game of tennis is now easy and manageable…now that’s something!
8 p.m. – The day has been a long one, and it’s time to get to some reading. Keeping in touch with ever-changing medical information can be a challenge to physicians. To help manage this challenge and be as up to date with the medical knowhow as possible, Dr. Rao has subscribed to a journal library that he reads with the help of his Kindle a reading application. It’s an application for downloading medical literature, articles, studies and a host of other sources including peer-reviewed articles.
Dr. Rao is a part of a team of doctors taking care of high-risk patients in his hospital. As a part of this team, he has agreed to be available for video chat and responding to typed patient questions. This is an important source to be able to get to know the patient’s condition in a more systematic way, and thus to make the right judgement.
As the last activity for the day before he retires to bed, Dr. Rao wishes to check on a few patients as a part of remote patient monitoring. The digital equipment is placed in the vicinity of the patients at their residence and the readings are sent over to the respective team of physicians for intervention (if any). These patients are at their home, with the remote devices monitoring their vitals.
Bhushan is still on Dr. Rao’s mind. His case has been unique in a way. With an atypical presentation, Bhushan presented a conundrum for Dr. Rao, challenging his medical knowledge and clinical skills. The digital applications have been a great aid to Dr. Rao in the diagnosis and management of Bhushan and patients like him. With the information at point of care, these applications have helped Dr. Rao make some quick, timely and appropriate decisions that have helped avert a medical emergency (in the case of Bhushan). That being said, Dr. Rao has been prudent in his dependence on technology.
Dr. Rao believes “Life doesn’t give you another chance.” With a sound faith in his own skills and knowledge, he considers digital technology to be an aid/support only—and not his primary means of diagnosis and management.
10 p.m. – Just before Dr. Rao dozes off, he glances at his Fitbit just to check how his metabolism has been keeping up with his chores and routine of the day. Relaxed and assured by the healthy reading, Dr. Rao smile to himself: “Not bad after all…I’ve won the day!”
Healthcare information technology is seen as a catalyst for economic and social development of a country. It’s a powerful tool that is seen to create a robust healthcare infrastructure for today and the future. It helps with seamless communication and channelizing activities without wasting time. In my opinion, the top gains with healthcare information technology are:
- Better access to evidence-based medical care
- Reduction of medical errors/adverse medical events
- Better access to quality data for clinical research
- Improved cross-organizational synergy and working
For a physician who is a project manager for his patient, this world of digital application helps with minimizing the risk in treatment of the patients, and in delivering quality patient care.
By no means an exhaustive list, this is an indicative list of the digital applications as mapped to the knowledge areas defined by A Guide to the Project Management Body of Knowledge (PMBOK® Guide). While all applications are meant to take care of most of the activities, here are the primary applications that can be mapped to a specific knowledge areas:
|Knowledge Area||Digital Application||Benefits|
|Integration||Enterprise computer-based Health Information SystemsElectronic Medical Record||Integrating patient care activities from consultation to order processing|
|Scope||Alerts/notifications||Scope of decision making at the point of care;receipt and reciprocate patient alerts with or without lab/radiology information|
|Time planning for the day – hospital/office and other activities; streamlines shift planning, combinations of doctor scheduling, calendar synchronization, waiting list features and so on|
|Cost||Billing applications||Manage e-billing/claims for patient care services; revenue cycle management applications that streamline patient billing, claims filing estimating patient obligations and estimate performance across entire revenue cycle for the practice|
|Quality||Reporting applications; patient care portals for feedback and suggestions||Reporting quality parameters to a governing body [for example, Physician Quality Reporting System (PQRS) is a quality reporting program that encourages physicians to report information on the quality of care to Medicare]|
|Human Resources||Enterprise computer-based health information systems||Care team planning, communication, workflow streamlining|
|Notifications alerting patient’s vital parameters to the care team|
|Risk||Clinical decision support systems||Notifications alerting medication discrepancies, change in patient’s vital parameters (thus averting adverse events)|
|Procurement||Enterprise computer-based health information systems,supply cabinets||Streamlining operation theatre, hospital and practice procurements – inventory management, billing of high-value equipment such as MRI/radiology machines, charge capture, reporting and so on|
|Stakeholder||Enterprise computer-based health information systems||Enabling communications between varied stakeholders such as care teams, specialists, patient and care givers – emails/managing discussions/virtual chat/video sessions|
Enabling the physicians and other healthcare workers to be in control of the patients and their health, the digital age promises a whole new dimension of care.
Disclaimer: The names in this article were changed for privacy purposes.
Acknowledgement: My sincere thanks to my friend and colleague Sunanda Gundavajhala, PMP® for her excellent suggestions that helped shape this article