“Alexa, bring me an aspirin.”
At Prince of Wales Hospital in Sydney, Australia, patients who are unable to press a call button, due to spinal injuries and other mobility issues, are using AI-enabled voice assistants to summon caregivers. Patients at the hospital make voice requests to Amazon’s smart speaker at their bedside. Depending on the need, Alexa routes those requests to a tablet at a nurse’s station, the nurse’s mobile phone, or to other medical staff.
“If a patient is hungry, if they need to go to the bathroom or if they are in serious distress, they get what they need when they need it,” says Jennie Barry, general manager of Prince of Wales Hospital.
Using virtual assistants is just one way that health care providers are redesigning the patient experience in the same way many companies have created new digital experiences for consumers. Using tablets and apps, caregivers are giving patients the same kinds of digital conveniences they enjoy at home. In return, nurses and other medical staff can manage their time more efficiently around the clock.
If a patient is hungry, if they need to go to the bathroom or if they are in serious distress, they get what they need when they need it.
Nicholas White, a principal at Deloitte and co-creator of the new app, built on the ServiceNow platform and called DeloitteASSIST, says the idea came after a colleague’s father died in hospital when no one was available to respond to his call button.
“We realized the technology that was supporting care teams was quite old in conception and design,” says White. “We started to think about what technology was out there that could provide a better solution to supporting the care teams with the care they work so hard to deliver.”
White and others are now digitizing clinical processes and technologies that have been in place, in some cases, since the time of Florence Nightingale, the English social reformer who invented modern nursing. Back in the 1850s, Nightingale implemented the first nurse call buttons, adapting them from the bells wealthy homeowners used to summon their servants.
Today, White and others are running Nightingale’s playbook by repurposing off-the-shelf consumer technology, and re-fitting it for healthcare needs. In some cases, they are doing this via patient portal apps on smart tablets. They are also syncing AI-enabled robots to hospital records and tasking those robots with nursing chores, freeing up nurses for the job they prefer: caring for patients. And at every step of digitization they are taking into account new security concerns.
Apps for patients
Among the fastest-growing tools for patient workflow digitization are the ones that consumers best understand and are most accustomed to using—mobile apps. An estimated 20% of U.S. hospitals are giving patients access to medical information on smart tablets, according to a Washington Post article that quotes Gartner healthcare analyst Barry Runyon.
The general sense from patients is that it helps them be more prepared when their doctors and specialists come in to talk to them.
At the Wexner Medical Center at Ohio State University, patients use their own devices or hospital-issued tablets to log into the MyChart Bedside app. Patients can see their daily care schedules, medical information, medications and dosages. They can also order meals, see photos of their doctors and nurses, and message their caregivers.
“They can even see their labs and meds and test results,” says Ann Scheck McAlearney, executive director and professor of family medicine at the Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) at Ohio State’s College of Medicine.
“The general sense from patients is that it helps them be more prepared when their doctors and specialists come in to talk to them,” McAlearney says. That saves doctors time while giving patients a sense of control in an environment where they have traditionally had little, she adds. Since introducing the system at six hospitals in 2016, McAlearney has seen requests for patient tablets rise along with overall patient satisfaction scores.
At NYU Langone Health in New York City, officials have supersized the app approach by adding 75-inch monitors to patient rooms in their new 21-story midtown facility. Known ay MyWall, patient use a table to control the system, which can display the patient’s Electronic Health Records, present photos and bios of their health care team, and of course movies.
Moxi, the robot nurse
Mechanical robots are also starting to lighten patient workloads for hospital staff and improve the patient experience. A handful of Texas hospitals, for example, have been testing a robot-on-wheels named Moxi to handle a variety of repetitive and non-patient-facing chores that nurses are normally tasked with performing, from delivering blankets to transporting lab samples and bags of soiled linens.
Moxi’s artificial intelligence framework includes social intelligence (she has an expressive “face” and social awareness), mobile manipulation, and human-guided learning. Moxi takes orders from the hospital’s electronic record system. Nurses set up rules and tasks so when a patient’s digital record is altered, say she has been discharged and her room has been cleaned, Moxi gets a command to bring in fresh supplies so the room is ready for the next patient.
Moxi was designed by Austin, Texas-based Diligent Robotics, whose engineers shadowed nurses and doctors for more than 100 hours to understand their workflows and to learn how they do their tasks and determine which chores could be automated. Moxi isn’t meant to replace humans. She’s there to take up the 30 percent of nursing tasks that don’t involve direct patient care. And with the U.S. Bureau of Labor Statistics reporting that the number of nursing jobs will grow 15 percent from 2016 to 2026, due to a projected increase in patients, nurses could use the extra hands so they can devote more time to direct care.
Joshua Tippy, a nurse manager at Texas Health Presbyterian Hospital in Dallas, in an online video the hospital posted last year, explained his new robotic colleague’s appeal. “Moxi is a teammate,” he said. “She’s there to actually relieve some of the pressure of task, and the hunt and gather that we all have to do all day that takes our time away from the patient.”
Security is job one
Healthcare providers are major targets for hackers and other online malefactors. According to the healthcare data security company Protenus, cyber criminals stole more than 11 million patient records in 2018. Because of the wealth of data in patient records (date of birth, social security number, address, email, credit card numbers) each one can fetch up to $1,000 on the dark web, according to the consumer credit reporting company Experian. The cost to healthcare organizations themselves is about $408 per stolen record, according to a 2018 study by the Ponemon Institute.
Health care facilities “are probably the most vulnerable [to cyber attack] because we don’t lock it down like we should, like in the financial services sector,” says Drew Koerner, chief healthcare strategist at ServiceNow. These facilities are often running outdated software with unpatched flaws. As a result, its increasingly vital that they pay attention to the three main buckets of cyber security: attack prevention (strong firewalls and encrypted data), detection (anti-virus software and AI to detect breeches), and remediation (how to patch the holes).
As more patient data gets put online, and as more medical devices connect to the internet, software platforms need to put security first. “When you talk to healthcare CIOs and CSOs,” says Koerner, “most of them consider it a matter of when, not if, they get breached.”
With security as their top concern, healthcare providers continue to seek digital solutions to alleviate physician burnout and improve patient care. In addition to in-patient facilities, companies are looking to transform outpatient care using telemedicine and the internet of medical things.
For instance, cancer patients are sometimes re-admitted to cancer centers following bouts of depression. Theoretically, patients could be outfitted with a wearable device that could track the number of steps they take each day. If a healthy patient typically takes 2,000 steps, but the tracker shows only 50 steps taken one day, that could mean the patient has been in bed all day. This would trigger an alert into a call center staffed by nurses.
“And so the nurse could call the patient and figure out what’s going on so the patient doesn’t get re-admitted,” says Koerner.