How to Design Mobile Solutions for Value-Based Care

[Claudius]

There is little disagreement that mobile solutions are poised to have a dramatic impact on the delivery of healthcare services in the years ahead. For the healthcare industry, the coming mobile health revolution holds the promise of reduced errors, better collaboration, increased efficiencies and lowered costs. But this doesn’t mean that every mobility strategy implemented will be successful. Without proper planning, projects are very likely to fail. A key component of successful mobility strategies is a design that seeks to solve specific real-world challenges and address clearly identifiable process inefficiencies. At the same time, the solution must ensure the security of data and comply with privacy guidelines. When these factors are in balance, you are more likely to achieve your mobility goals.

At SAP, we refer to the design and implementation of new technology and processes that respond to specific problems and inefficiencies as design thinking. It’s a methodology that seeks solutions and efficiencies that correspond directly to clearly identified problems and processes. It requires you to first understand the actual problem that needs to be solved, so you’re not making assumptions about the impact of a new process or being wowed by new technology. The goal is to make decisions in an environment void of preconceived ideas and biases. Design thinking also forces you to first understand on a step-by-step basis current processes and workflows. Often, design thinking requires user shadowing so that you can see what workarounds the users engage in on a regular basis. Sometimes these are things the users would never articulate and may not even be aware they’re doing.

For example, a healthcare organization may want to give clinicians mobile access to patient image x-rays and MRIs. Mobilizing the organization’s image archiving system will make these files more accessible to staff. But introducing this system will likely also hinder workflow unless it also connects to relevant patient data housed in other systems. A design thinking-based methodology would uncover this issue before the new mobile-based imaging access system was implemented, since a shadowing exercise would reveal that clinicians have to exit the application to go into other relevant medical record databases to get a complete picture. Too often, healthcare organizations fail to take this high-level approach to planning out their mobility projects, and the result is that they don’t see true business value from these projects. A recent study done at one of the largest and most renowned hospitals in Europe provides an example of a design thinking-based approach to a mobile strategy. The 14-week study conducted at Charité University Hospital in Berlin provided a group of neurologists with tablet computers to access mobile electronic records, and then compared to a control group in which neurologists didn’t have access to tablets. The study concluded that, as compared to the control setting, neurologists with tablets spent more time in face-to-face consultation with patients. The presence of tablets also resulted in a better workflow as the doctors were able to check records more quickly when they were making rounds and meeting with patients. The study concluded that overall the tablet computers with mobile records enhanced clinical workflow and increased bedside time.

While the implementation of this mobility solution was done under the guise of a study, it still offers insight and guidance. The Charité study serves as an example of not only the efficiencies mobility solutions can offer, but also the benefits of a design thinking-type approach. In this situation there was a singular process that the hospital was attempting to address or improve: neurologists conducting patient rounds. More specifically, this process involved neurologists accessing medical records while checking in on admitted patients. In this case, the solution was a system that included devices in the form of tablets, a secure network and application that allowed the devices to access patients’ medical records.

Too often, medical providers see mobility solutions as a take-it-or-leave-it proposition that requires them to make large-scale changes to their IT infrastructure and implement many mobility solutions at once. Providers are generally scared off not just by the daunting and dramatic nature of such change, but also the cost. And for many of those not scared by the cost, there’s sometimes an erroneous assumption that throwing money at the issue will guarantee success. In these situations, organizations adopt major changes with the generic goal of being more efficient or technologically advanced. But these advances are not the result of pilot testing and there has not been identification of processes that are to be improved. The best technology doesn’t guarantee success from a value and end user perspective. Technology is not usually the impediment – it’s making sure the solution fits the workflow.

Small and clearly-defined mobility solutions like the one that was the subject of the Charité study usually present a value proposition that favors adoption. For the costs of the tablets, the secured network and a single application, that provider saw a return in the form of increased efficiency among one of its most valuable resources: neurologists’ time. Focusing on a clearly-defined issue also helps to prevent a situation in which mobility solutions are being introduced in an ad hoc and reactionary manner. It’s not uncommon for providers to adopt mobility solutions in response to sta who are complaining about a small part of their workflow or who have already downloaded medical applications to their own mobile phones. While situations like this demonstrate the value of mobility solutions, providers must avoid implementing plans that are simply responsive. It’s important to have an overall vision of the mobility strategy so that the least number of vendors can be used across the organization, and to make sure they are interoperable. This reduces complexity and decreases the risk that comes with having multiple connection points across a number of vendors.

In addition to adhering to the fundamentals of design thinking, the Charité study also exemplifies another key component to a successful implementation of a mobility solution: metrics. Even if done on a smaller scale, the implementation of mobility solutions represent a cost for providers. Given that cost, it is imperative that providers devise a system to clearly understand and compute any value that results from mobility solutions. That value doesn’t necessarily have to show itself initially in financial benefits. Value could come first in the form of time savings, efficiency and better clinical decisions, but demonstrating that it exists in each individual setting will be key to the industry-wide rise of mobility solutions.