By: Iltifat Husain MD & James O’Neill MD
You’re the Attending Emergency Medicine Physician in a busy Level 1 Trauma Center, working in the ER. You hear the crackling of the EMS radio, and EMS is telling you they have a patient in their mid 50s with chest pain, and their portable ECG is concerning for a STEMI (heart attack). They wire you the ECG from their ambulance, and after taking one look you see classic tomb stoning in the inferior leads. You need to activate the Cath lab, but you remember how one of the protocols changed a few days ago in regards to how to get the cardiology team on board.
In the usual scenario that is played out in other Emergency Rooms, you would look for the document near the attending desk or look through your E-mail documenting this change. But your ER recently went mobile, and everything is stored on the cloud in an app. You open up an app on your iPhone, and search for STEMI — quickly pulling up the PDF document you were looking for detailing the nuance changes, and you’re able to implement them quickly before the patient even arrives. You’re not searching for a paper document. You’re not asking your charge nurse. You’re not looking through your E-mail.
This is the future of how workflows are going to change in subtle but profound ways in Medicine.
Last week Dr. O’Neill and I wrote about the efforts of our Emergency Medicine (EM) program at Wake Forest University School of Medicine and its efforts to go mobile.
This article is one part of a series that will explain how we went mobile by using a Cloud based solution. Before we explain the software we used, it’s important to understand the workflow that existed prior.
Understanding this workflow is essential is explaining the benefits of mobility and a Cloud based solution. There are two key aspects of an EM program workflow I’ll detail: Academic Learning & Implementing changing policy.
In all Academic centers, there is an assortment of software that is employed in disseminating key documents and information to Residents and Faculty. Usually this is through an online portal where PDFs, Powerpoints, and Word files are saved. These documents contain key medical literature that Residents and Faculty use for learning.
For many academic centers, this portal is SharePoint — an Enterprise system created by Microsoft. SharePoint is a powerful platform, but is limited by the fact that the majority of users in a residency program do not have the time to become comfortable with its many nuances.
The are many issues that SharePoint presents:
- Static: You are presented with content, but can’t upload content yourself. In order to upload content, you need special permissions. Usually there are a few people in the department with access to this, and they are the ones that do the bulk of the uploading.
- No mobility: In the version of SharePoint that we use, there is no mobile version. Viewing the website is decent on the iPad and tablets, but on mobile phones it’s tedious.
- Searching: It is difficult to search for files on Sharepoint. They are organized in a traditional folder architect, and unless you know exactly where to go it’s hard to find files.
- File size limit: In the version of Sharepoint we have, there is a limit to the size of the file you can upload. This is okay for PDF and Powerpoint files, but doesn’t work if you want to upload a video, such as a recorded conference or a video teaching file.
They other way key information is disseminated is E-Mail. As is common practice with most academic departments, if you have a particular policy change, you E-mail the Faculty and Residents in a mass E-mail.
The example given at the introduction of this post highlights how policy change occurs within a department. Although this way of disseminating knowledge is utilized by almost all academic departments, and it does the stated goal, there are issues that can arise:
- Searching: Searching through E-mails is not ideal. Depending on how your E-mail is set up, or where you are, having quick access to E-mail can be difficult.
- Often times the policy is updated and tweaked multiple times in a short period. Trying to figure out the correct e-mail that tells the “final” policy can be tedious.
The initial example showed how cloud based solutions can drastically improve overall workflow. But there are great teaching examples as well.
In the past, if an Attending physician or Resident finds a great academic PDF file that pertains to a patient that is currently being cared for, they print this off for their peers for later reading. Those of us who have been on the receiving end of this know that printed documents hardly find daylight later. Often times they are trashed or haphazardly read.
Instead, using our new cloud solution, the Attending or Resident can upload the literature PDF file on their phone or on a desktop and they can share it either amongst a few residents or all the residents — much more efficient and having enormous potential to improve learning.
In the next article we’ll talk about various cloud tools available and the one we settled on for our Residency program.