11:20 - 11:40 amSunday, September 29
LK 130
Hacking for luddites: technology design for disorganized clinical environments
LK 130
Hacking for luddites: technology design for disorganized clinical environments
Assistant Professor, University of Texas Health Science Center
Background Healthcare requires information technology with high performance and high reliability that is also backward compatible with legacy systems.  It must operate in a regulatory environment with... Read more

Description

Background

Healthcare requires information technology with high performance and high reliability that is also backward compatible with legacy systems.  It must operate in a regulatory environment with hefty fines for security breaches and where downtime can cost lives.  Given these constraints and high maintenance costs, it should be no surprise that attitudes towards innovation are often very conservative, with managers preferring the relative safety of the status quo over the perceived risk of adopting new technology.  However, both healthcare and technology continue to rapidly change.  In medicine, an increasing emphasis on safety, quality, and efficiency metrics, coupled with rapid adoption of mobile devices has created enormous demand for clinical apps that can be used at the bedside.  Unfortunately, enterprise HIT systems weren’t designed for rapid, lightweight development cycles and are often unable to accommodate the evolving needs of clinicians.  Without an integrated solution, clinicians who lack technical skills resort to non-technical solutions – piles of paper forms for data capture, e-mailed documents, and a proliferation of spreadsheets.  For the more skilled, a shared drive with hundreds of uncoordinated Microsoft Access databases can substitute for “The Cloud”.  Is it any wonder that physicians, who have access to some of the most advanced technology on the planet, sometimes wish they could smash to pieces such poorly designed information systems as a form of protest, not unlike what the Luddites did to machinery introduced during the Industrial Revolution?

With a pressing need for data on quality metrics and few resources to attain it, I present here my own effort to “hack around” the limitations of an EMR.  Drawing on my experience in software development, data visualization, and biomedical informatics, my solution incorporates widely available, open source technology for capturing clinical data using mobile devices at the point of care.

Design

The application is designed for the mobile web and is built using the jQueryMobile framework.  Patient identification is accomplished using a mobile device camera to capture an image of the patient’s printed name, date of birth, date of admission, and age.  This image is securely transmitted to a server where optical character recognition is performed using Tesseract OCR.  Once confirmed, additional data specific to quality of the care provided can be entered using standard mobile web controls, and the data is resubmitted.  Once validated, it is then securely stored using the Research Electronic Data Capture (REDCap) platform, an open-source, HIPAA compliant data repository.

Conclusion

While clearly a hack, this approach has the potential to change the dynamics of data collection in poorly coordinated clinical environments.  It separates clinical documentation from quality reporting, and clinical needs from the reality of what enterprise HIT systems can realistically provide.  The interface is lightweight and low cost to develop, yet builds upon a free, robust, well-established data repository technology.  While the solution described here specifically addresses the capture of quality data, a similar approach could be applied to a variety of other clinical problems.

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