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Mobile IT applications

January 1, 2009
by Gregory L. Alexander, PhD, RN and William R. Kehr, PhD
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Reap quality care, cost savings, staff retention, recruitment, and regulatory compliance

The use of mobile information technology (IT) to assist healthcare professionals in making treatment decisions at the point of care is expected to improve the quality, safety, and value of care delivery.1 Added value from these applications is extremely important for the growing number of seniors who want to independently age in place in the least restrictive environment possible. Early adopters of mobile IT systems in long-term care environments are beginning to recognize benefits to resident care, clinical support, and administration.2,3

Resident care benefits

The potential for IT to enhance resident care is created through better clinical decision support. Clinical decision support uses electronically stored clinical information to help alert healthcare providers to important information that might otherwise be missed in a paper record. Providers can be alerted through the decision support system through wireless e-mail messaging, pager systems, or other electronic means. The wireless capabilities of IT allow healthcare providers to be alerted about potential resident problems from anywhere.

Another benefit of technology to long-term care residents is in the ability to provide a better quality of service and improved safety. Quality is improved through IT because it makes the resident the center of care. IT reduces documentation times and allows staff to spend time focused more on meeting patient needs and providing activities. Furthermore, IT enables staff to communicate from virtually anywhere without having to make physical connection, thus improving efficacy and efficiency at the point of care.4

Aside from mobile hardware, another example is the mobile IT sensor network. Mobile IT sensor networks support resident care by enabling remote monitoring of elders by providers while residents continue to maintain active lifestyles. One such network is being piloted through the cooperative partnership between an independent living facility called TigerPlace and researchers at our institution, the University of Missouri in Columbia.

The mobile sensor network being installed in residents' apartments at TigerPlace allow off-site healthcare providers to remotely monitor sensing activities in apartments, including motion, physiological vital signs (pulse, respirations, bed or chair restlessness), falls, stovetop temperatures, kitchen activities, etc. The sensor system architecture is composed of non-wearable sensors, with a short range wireless interface for communication with user control devices, and a data manager that collects data from the sensors, date time stamps the data, and logs it into a file that is sent to a secure server as a binary stream stripped of resident identification. The network is capable of performing data processing tasks through clinical decision support modules to notify providers of early changes in resident conditions that would go unnoticed in apartments without sensors.

One benefit to residents using this sensor system is that it unobtrusively monitors their daily activities of living. Monitoring these activities allows remote providers to gain access and observe trends in daily activity patterns which, if went unnoticed, might result in poorer health outcomes, placement in more restrictive environments and greater expense. An example of how our sensor system detects a change in daily activities might include an increased amount of time a resident is spending in or out of bed. If a person is having difficulty breathing while lying in bed, resulting in increased bed restlessness, and the resident moves to a recliner to sleep, our sensor system is able to detect these changes and notify a provider of the changes.

The residents with sensors installed in their apartments, as well as nurses and physicians, were interviewed and showed the data interface. The interviews were instructive: Residents had difficulty viewing the data and graphs, and experienced information overload and difficulty with understanding the terminology. Nurses and physicians used the data, however, to interpret clinical information and watch for warning signs, such as reduced movement, changes in activity levels, and changes in patient status preceding an adverse event, such as a hospitalization.

Mobile IT sensor technologies are being explored to determine their capability of supporting notification of clinical support services when adverse events occur. Typically, residents who live in independent living don't qualify for facility-provided clinician services because they are stable and living active lifestyles. However, these residents often experience periods of decline in their health that might be reduced in length and frequency if attended to in early stages. Periods of decline in health can be detected by the mobile IT sensor technology through decreased resident activity levels being monitored by the sensors. Also, through the clinical decision support system, clinical support services such as nursing, physical therapy, and social services could be alerted to the changing activity levels and prompted to check on the resident. Early recognition of these events could lead to earlier intervention, reduced hospitalizations, and fewer placements in facilities having more restrictions.