Episode Topic: Value of Integrating and Automating In-Hospital Room Technology
Ken Kleinberg, POCP Innovation lead and host for this episode kicked off the episode by welcoming guest, Scott King, Chief Technology Officer at Vibe Health, by eVideon and co-host,Pooja Babbrah, POCP’s Pharmacy & PBM Lead.
Ken set up the episode topic explaining this episode will explore use cases and technology like hospital in-room technology integrated with the EHR and other systems that can keep the patient and their families informed as well as support provider staff.
Ken explained that so often we talk about patient engagement and data access through the lens of patient-facing apps or ambulatory doctor visits but what about during hospital stays? The discussion will cover the use cases Vibe Health works to solve, the role of APIs, FHIR or not, and the interoperability landscape from policy to standards.
Ken then asked Pooja to briefly introduce herself and for her to explain what she’s looking forward to exploring and learning today.
Pooja explained that because a lot of her work in interoperability deals with client-facing data, she is really excited to learn more about the technology that is being used in-hospital rooms because that isn’t an environment normally discussed when thinking about patient-facing data.
Scott King then introduced himself as the CTO of Vibe Health by eVideon. He went on to describe the Vibe Health platform as an interactive patient experience platform that is generally in and around the hospital room. He explained that over the last several years it’s also become a staff experience platform. Scott described that platform as running on multiple devices in the room like the smart television, digital whiteboards, companion bedside tablets, and digital signage outside the room. The idea is to put the right information and controls in the right place at the right time.
Scott delved into the staff experience component of the platform by giving an example of the whiteboard in most patient rooms. Many times, the nurses are expected to keep the information on the whiteboard up to date, but when it’s digitized and the information can be taken directly from the patient record and displayed, the nurse’s time is freed up to focus on more important duties.
Ken thanked Scott for providing the introduction and background information. Ken went on to set the stage a little more for the rest of the discussion by saying that, we so often think of patient access to their data, patient engagement, and education as happening between doctor visits or during a doctor visit but a patient’s experience during a hospital stay is also really critical. Ken went on to ask Scott to describe the unique challenges a patient might face in their hospital room and how smart-room technology including access to their data and customized education might help.
Scott responded by saying that in the past the television and other tools in the hospital rooms were simply one-way mediums. The television was there to provide entertainment, and the whiteboard was there for the nurse to capture important information for the patient and other staff on duty but as technology has advanced, there are more opportunities to digitize these tools and make them interactive tools that can be more useful.
Scott went on to compare hospital rooms equipped with interactive, smart TVs to hotel rooms where the patient can be greeted by name with personalized information on the screen. With smart TVs, the patient can use it to access relaxation content, set white noise to drown out beeps and buzzes common in the hospital setting. Additionally, it can be used as a tool to get the patient ready for discharge by using the smart TV for educational videos and content that will help inform the patient about their condition, dietary recommendations, or post-visit instructions without requiring the nurse to have to set it up.
Once a patient views this assigned education, it can be noted in the medical record automatically which is another thing the nurse won’t have to do.
Ken agreed that most of us have either had a hospital stay or visited family at the hospital and that we can all imagine the challenges he described and how more real-time access to data would be helpful to patients, their families as well as the staff taking care of them. Ken then asked about what happens when the patient leaves the hospital and whether they will still have access to the data and education videos and content they could see in their room via the Vibe Health Platform.
Scott responded by explaining that patients are in high-stress situations in the hospital and may very well get home and want to re-watch an education video when they get home and are less in pain or groggy. Through Vibe Health technology partners, many times hospital systems will make links to these videos and other content available to the patient post-discharge.
Ken then asked Pooja to share her thoughts, because her work has her thinking consistently about patient-facing data exchange.
Pooja shared a personal story about her daughter suffering a head injury earlier this year and there were still some COVID restrictions in place that impacted the number of visitors resulting in her husband and her having to take turns visiting. Additionally, overnight visitors were not permitted. Having an interactive way to have the most up-to-date information about her daughter without having to wait for a nurse or a doctor to come by would have been really helpful and made the situation less stressful.
Pooja went on to say that she does work with the CARIN Alliance which is the patient-facing HL7 Accelerator. She described the patient stories she’s heard that support the need for more data and more interactivity. Pooja posed a question about how this type of technology might positively impact medication adherence, which is another area Pooja is passionate about. Patient education and instruction about how to take medication are really critical and the patient getting the instructions while they’re in the hospital and having the ability to access it afterward could have a significant impact on adherence.
Ken thanked Pooja for her insights and went on to ask Scott to cover a topic covered during the prep conversation about the move by many hospitals to have cameras in all hospital rooms to enable virtual rounds, and monitoring and to give patients access to video calls with family members. Ken asked Scott to explain how Ken also asked Scott to talk about whether patients who might want to opt out of that for privacy reasons can do so.
Before Scott answered Ken’s question about cameras in the rooms, he went back to Pooja’s comments about medication adherence. He explained that there is more that can be done to improve adherence. He pointed out that many times part of the problem is that patients never pick up their medications. The Vibe Health platform can help automate getting those prescriptions filled by the hospital’s outpatient pharmacy, if they have one, so the patient has their medications in hand when they are discharged.
Scott then came back to Ken’s questions about in-room cameras. One of the main use cases for in-room cameras is offering ways for family and friends to visit the patient if they can’t come in person. This was a big deal during the pandemic but continues to be important when the patient may have family across the country. Vibe Health offers the Hello platform to help support these visits and reduces the nurse or other staff having to serve as a help desk video calls.
Scott described another emerging use case for cameras in hospital rooms for virtual monitoring. This has started to become standard in ICU rooms but now hospitals are seeing value in putting cameras in every room. This allows for specialists that may work out of a hospital across town to seamlessly visit the patient without having to drive through traffic to get to the patient in person. Some patients also require a sitter for patients that are a high fall risk, cameras in the room allow for this monitoring to occur virtually. Virtual rounding is another use case where cameras in-room can improve efficiencies.
The Vibe Health platform can also integrate with telehealth platforms to automatically start virtual visits through the smart TV and then after the visit is over the TV can automatically go back to what the patient was doing or watching before.
Patients are always made aware if there is a camera and if it’s on. Over the last few years, the resistance to having a camera in-room by patients has come down a lot.
Ken asked Scott to talk about the locationing capabilities of the platform and to describe some of the use cases around that.
Scott explained that real-time location systems or RTLS can be used in a lot of different ways. One of the more common use cases is for locating equipment like IV poles, that have been labeled with a radio tag. It can also be used for patient tracking to make sure the patient is where they are supposed to be. Where Vibe Health has seen great value in using RTLS for staff tracking. For staff wearing a badge, the system can update the screen with the provider’s name and picture on the screen to give that additional info but it also gets documented on the digital whiteboard so the patient and the family can see everyone who has been in the patient’s room recently.
Ken then switched gears a little and asked Scott to describe the health IT approach Vibe Health uses to make these integrations. Ken asked if Vibe Health is using FHIR and what the health systems Vibe is working with are using
Scott explained that their first system went live about 15 years ago. At that time, they were told to support HL7. Admission, Discharge, and Transfer (ADT) data is the foundation data. So far, Vibe Health hasn’t transitioned everything to FHIR because they need real-time information that is pushed from the EHR to the digital whiteboard or other tools vs having to query the system. There are some use cases where Vibe Health uses FHIR, but they are waiting for the FHIR subscription standard to get published.
Ken found the explanation interesting and wondered if there is an opportunity for data exchange and access in the patient hospital room setting for some new use cases for the standards community to take on. So, somewhat tangential to the standards discussion what are your thoughts on where the industry is with interoperability in general and the role policy requirements play? Do you think ONC naming specific FHIR Implementation Guides in upcoming policies will help progress the industry by having a common playbook or is it too limiting?
Scott responded by saying that the transition to more modern standards is a good thing. One of the things Scott has noticed is that there seems to be a shortage of developers that know HL7 standards including FHIR, so they are seeing the use of JSON and RESTful APIs.
Ken asked Pooja if there is anything she’d want to add or ask here.
Pooja added that as the chair of the board for NCPDP and currently working on the strategic plan, one of the comments recently was that they shouldn’t be building standards for standard's sake. She went on to explain that standards have to be usable, workable, and make sense and that how patients access their data is still an area ripe with opportunities for standardization.
Ken thanked Pooja for her input and then recapped the discussion briefly saying that Vibe Health platform serving up patient data and educational content has been covered. Ken then wanted to know about writing data into the EHR. Can a patient, for example, update their health family history?
Scott confirmed there are some use cases where the Vibe Health Platform can write information back into the EHR like when a patient has finished watching an education video and then capture the post-educational comprehension survey and that completion can be written back into the EHR.
Other information like pulse surveys on patient satisfaction with food or if another request was satisfied, while important data for the hospital, wouldn’t be written back into the EHR.
Pooja asked where there was a health equity piece to this capability as far as confirming understanding and comprehension and even maybe capturing consent after confirming the patient understands what they are consenting to. She went on to say that she sees this as an opportunity.
Scott agreed to say that right now the system knows the age, ethnicity, preferred language, preferred pronouns, and all of that and it's possible to correlate that information with how the education or other content being provided is being served up and understood.
Ken closed out the discussion by asking Scott if he had any final message or calls to action for the audience.
Scott responded by saying that he’d want folks to realize that there are so many different technologies in the hospital setting and it's Vibe Health’s goal to try to automate and allow all these different technologies to talk to each other and work contextually. He gave the example of having the TV automatically mute or turn off during a code blue.
The second thing Scott wanted to highlight is that the sooner the FHIR subscription standard can be published, the better.
Ken thanked guest, Scott King, and co-host Pooja Babbrah before reminding listeners that they can find and subscribe to The Dish on Health IT podcast on Apple Podcast, Spotify, or whatever platform listeners use to pick up podcasts and that videos of episodes can be found on the POCP YouTube Channel