Health care administrators nationwide realize adults and children who are hospitalized may experience discomfort and the fear of uncertainty while being away from home. Leaders at the Mount Sinai Health System in New York City turned to technology to help comfort, educate and address the needs of patients.
While compassionate care is an essential part of the healthcare journey, patients can now pick up a bedside tablet to find answers to several questions. The leadership at the Mount Sinai Hospital launched a pilot program to help put patients at ease. Bedside tablets have been made available for patient use in more than 450 rooms at the Mount Sinai Hospital and leadership is exploring the possibility of expanding to other hospitals in the Mount Sinai Health System.
How the bedside tablet works
What are the benefits and best practices? Mount Sinai wanted to give patients real-time access to the MyChart Bedside application — a patient-friendly app from Epic Systems that lets users view their medical records, lab results, daily schedules, medication information and care team member profiles. They also wanted to provide disease-specific educational content, entertainment options, spiritual resources, videoconferencing and social media access.
One of the oldest and largest teaching hospitals in America, the Mount Sinai Hospital has always been at the cutting edge of digital innovation — they introduced electronic health records (EHR) into operating rooms in 1991. For this project, the hospital partnered with a software vendor that put all the applications and content they wanted onto one tablet.
Using a leading configuration tool, the software vendor customizes the user experience for each unit of the hospital, so pediatric patients see different content than new mothers or cancer patients. The tablets are containerized and locked down, so patients can’t change settings and can only access hospital-approved applications and content.
The tablets sit in a basket at the bedside and are kept plugged in so they’re always ready when patients need them. Most applications are available to use immediately, but anything with sensitive patient information (PHI) requires the patient to log in with a four-digit PIN. Any time the patient touches the home button or leaves the tablet idle for more than a couple minutes, all patient data is wiped from the device.
Patients in recently renovated units also have “digital whiteboards” — smart TVs display information about care team members, daily schedules, patient goals and other information that would usually be written on a dry-erase board. The hospital plans to integrate the tablets and TVs so patients can stream content from the devices onto the larger screen. More than 50 rooms currently have digital whiteboards.
Improved care provider experience
Sometimes screens can stand in the way of human connections, but not in this case. “This solution allows us to be both high-tech and high-touch,” says Robert Freeman, vice president of clinical innovation at the Mount Sinai Hospital. “Instead of having to press the call bell for something nonurgent, the patient can ask us a question or make a request through the table. The next time the care team is heading into that room, they’re prepared. Patients get basic information from the tablets, so nurses get freed up to have deeper conversations.”
Thanks to a translation app, the tablets also help clinicians communicate with foreign patients, while nonverbal and intubated patients can write, draw or point to what they need on the device.
Enhanced human connections
The solution lets patients connect with their support systems and share information with their families. “Hospital patients are confronted with so much information — medications that are hard to remember and laboratory values they might not understand. It can be overwhelming,” says Freeman. “So, they can use a tablet to talk to their trusted community and family members. Being able to share that information creates a certain level of comfort.”
In some cases, the tablet even connects patients with fellow patients who understand what they’re going through. For example, patients who have ostomy surgery — a lifesaving but life-altering procedure — are welcomed back to their rooms with a video of someone who has been through the same experience and can provide a firsthand overview of what to expect.
Informed patients are engaged patients and engaged patients are more likely to stay healthy when they get back home. They also have a better patient experience.
Patrick Healy, associate director of clinical innovation at the Mount Sinai Hospital, recalls a perfect example: “We had a young patient who needed emergency surgery. When we first admitted him, I got him set up with the tablet. Initially, he appeared to be anxious. When he logged on the tablet, had access to his medical information and received details about his stay, the patient had a greater sense of calm. He also called his cousin, a nurse, who explained everything we did and reassured him we were doing all the right things.”
According to Healy, “the patient went from scared and uninformed to informed and engaged. Then he just played chess and entertained himself for the rest of the stay.”
Nurse productivity boost
Nurses are the front line of patient care, but they spend much of their time doing paperwork, responding to nonurgent patient requests and answering basic questions. The tablet helps alleviate some of that burden so they can have deeper conversations with patients.
“For example, in our mother-baby units, patients would fill out a paper log about the baby — how often they’re feeding, how often they’re changing and diapering the baby. Then the nurse would have to enter all that information into the computer. Now patients can log it all through the tablet,” said Healy.
Improving the patient experience is a team effort
Two years into the bedside tablet program, the Mount Sinai Hospital has improved HCAHPS scores and decreased readmissions. The secret to their increased success has been seeking feedback from everyone involved — nurses, patients and others.
The clinical innovation team realized early on that the project would need to engage nurses to succeed. So they formed a group of “champions” who have advised them throughout the process. “The nurse champions are doing peer-to-peer education and also coming up with use cases,” said Freeman. “They work closely with our IT colleagues and medical record colleagues, and they help us design the future workflows. That nurse engagement has been the key to scaling this across a very large hospital.”
Mount Sinai also polls patients about their tablet experience using a five-star rating system (the tablet program currently has more than four stars) and asks patients to suggest future improvements. Hospital leaders take this feedback very seriously. For example, one patient suggested a meal ordering option through the tablet, and the hospital recently implemented it.
Healthcare technology empowers patients
“We needed devices that met our security standard and worked well with MyChart Bedside,” says Freeman. “We wanted the ability to wipe data, and we needed tablets that were durable enough to be sanitized between patients. Our hardware partner met all those requirements and has given us a lot of ideas, including the digital whiteboards. And having a software vendor that manages the tablets has allowed us to leverage new technology and scale efficiently.”
Dr. David Reich, the hospital’s president and chief operating officer, echoes these sentiments and says the solution is helping his organization meet 21st century healthcare needs. “Hospitals have a habit of buying static blocks of equipment, and then the technology fully deteriorates over time. With the tablet-based solution, we really have a much better maintenance approach because it refreshes itself over time.”
This approach also aligns with the hospital’s vision to eventually have smart patient rooms across the hospital. Dr. Reich believes this will take the patient experience “to the next level.”
“There’s a need for hospitals to focus on new and improved means of engaging patients. The federal government has recognized this by creating standardized patient satisfaction surveys and holding hospitals accountable financially. It’s our belief at Mount Sinai that if we create a full ecosystem where the staff and the patients feel engaged with one another using technology as the platform, we can get to the next level, where people feel safe, engaged and empowered by the data they receive.”