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By Dennis Miller, BHC Senior Writer

At the World Healthcare Innovation and Technology Congress (WHIT v5.0) this week in the Washington, D.C. area, industry leaders heard from preeminent policy makers and technology experts on some of the most important trends and developments driving healthcare technology forward. Keynote speakers such as former President Bill Clinton and former Speaker of the House Newt Gingrich (click here for BHC's report and a full transcript of his address, plus hear a one-on-one exchange with BHC's Editorial Director, Robin Jay) offered their thoughts on the broad changes needed to reform and reengineer healthcare delivery, while breakout sessions explored specific emerging technologies that hold the potential to revolutionize healthcare delivery.

One such technology is voice-assisted care, which is now making inroads into long-term care facilities. This technology helps free nurses and other allied caregivers from time-consuming documentation duties, enabling them to focus on their primary mission: caring for patients directly. It also offers succinct and accurate guidance on each patient’s care needs, verifies that each task has been performed, and keeps nurses and allied caregivers in constant communication with doctors and administrators.

WHIT v.0 attendees were offered a case-study presentation on this technology by Amar Kapadia, Director of AccuNurse Acute Care of Vocollect, Inc. The AccuNurse system is one of the first to be rolled out to long-term care facilities and hospitals nationwide, where it is already having a substantial impact on improving the quality and efficiency of care and documentation. “AccuNurse is essentially a hands-free, eyes-free, charting system for nurses or any clinicians in nursing or allied nursing functions,” explains Kapadia. “What we do is we provide small, variable computers — devices called AccuNurse Life Assistant. The devices are probably about the size of a pack of cards. They’re worn on a belt or inside a pocket and they are connected to a headset.”

These palm-sized devices connect wirelessly to a central computer system. Through it, nurses receive detailed guidance and prompts on each patient’s needs, and are able to verify by voice as each task is completed. This coordinates care seamlessly while simultaneously creating a complete electronic care record in real time. “It’s not just a dictation system. It’s a workflow system,” Kapadia explains. “It guides you through protocols and converts everything to an electronic format and saves it to your EMR.”

The benefits of such a system are manifold, Kapadia believes. “Your staff is likely to be much more productive, because there’s no extra time taken to do documentation. You don’t have to transcribe on paper and then get it onto the computer. Quality of care is likely to be better because your staff is able to spend more time with patients as opposed to documentation. And also, you’re guiding them through protocols and through procedures, and are able to send them reminders for common activities. That can lead to better outcomes.”

Kapadia sees applicability for the system in behavioral healthcare settings as well, such as long-term care facilities for patients with Alzheimer’s or dementia, and other types of inpatient mental health and treatment facilities. For example, the system offers the capability for tracking completion of care protocols, such as assessing for suicidal ideation, and creates an electronic paper trial verifying that the protocols have been closely followed. “I was just looking at protocols for assessing someone who is close to being suicidal — what sorts of things they need to do,” Kapadia explains, “It says, ‘Assess for presence of destructive behavior every eight hours.’ Well, how are you going to ensure that someone actually does that every eight hours?”

According to Kapadia, the AccuNurse system offers the ability to do exactly that. “As you do it, you say, ‘Okay I just did this,’ and it’s documented, along with timestamps. So you have that for either insurance purposes or just for recordkeeping in case of litigation or in case of any issues with the patient or the family later on. So I can absolutely see the potential for this in behavioral health as well.”

To learn more about the AccuNurse system, click on the audio icon above to hear the complete interview, or continue reading for a written transcript. You can also visit the AccuNurse website for more details, including a video demonstration of the system in action.

BHC: Give us an overview of the AccuNurse System and what it does.

AK: Sure. AccuNurse is essentially a hands-free, eyes-free charting system for nurses or any clinicians in nursing or allied nursing functions. And that’s kind of the [short] description. To get one level deeper than that, what we do is we provide small, variable computers, devices called AccuNurse Life Assistant. The devices are probably about the size of a pack of cards. They’re worn on a belt or inside a pocket and they are connected to a headset.

The way this works is, when you are about to start your shift, you put on your headset, you put on your device, and you ask the system, “Who are my patients today?” It will tell you, “Okay, you’ve got these seven, eight, ten patients assigned.” Then you can say, “Okay, I’m heading to the first patient in room 220. Tell me a little bit about this person’s background.” It’s going to tell you, “Okay, Mr. Jones in room 220 is 80 years old. He’s had a hip fracture. He’s taking these medications, He’s got these allergies,” or whatever is the pertinent information about that person. And you can keep drilling in and get more information about the patient.

Now, let’s say you are a caregiver or, say, a nurse aide or a nurse and you’re going to take vital signs as part of your work during a particular shift. You can get all the background information and then you can say, “Okay, I’m taking vital signs.” AccuNurse is going to walk you through what part is involved in taking vital signs. And it can just kind of verbally say, “Temperature: 98.6; pressure: 120/80,” etc. And all of that is converted into text and saved directly onto your electronic medical record. So it’s not just a dictation system. It’s a workflow system. It guides you through protocols and converts everything to an electronic format and saves it to your EMR.

And one other feature we provide is being able to send reminders — for turning, for positioning, etc. So, for instance, if you have a patient who was prone to ulcers, you can send reminders for turning that person so that they’re less likely to get an ulcer. We also provide communication capability. You can just say, “Okay, call nurse Jones.” And you place a call between two people, or page a unit.

So in some ways the benefits that AccuNurse provides, are: 1) your staff is likely to be much more productive, because there’s no extra time taken to do documentation. You don’t have to transcribe stuff on paper and then get it onto the computer. 2) Quality of care is likely to be better because your staff is able to spend more time with patients as opposed to documentation. And also you’re guiding them through protocols, through procedures. And also you are able to send them reminders for common activities, and that can lead to better outcomes.

So that’s kind of what AccuNurse does in a nutshell.

BHC: And what sort of performance improvements and care improvements have you documented in facilities where this has already been deployed?

AK: That’s a great question. AccuNurse has been pretty widely deployed in long-term care facilities and more recently we have started offering AccuNurse in hospitals as well. So I’ll first talk about long-term care, and then I’ll talk about hospitals.

Some of the performance improvements that long-term care facilities have seen are, as I mentioned, ulcers — decrease in pressure ulcers. One long-term care facility, EPMC, in Pittsburgh, saw over a 40-percent reduction in pressure ulcers after they installed AccuNurse. Other long-term care facilities have seen, for instance, a reduction in falls, because, again, if someone needs to go to the bathroom, if you can proactively go and help them, or when they are trying to call you, you can respond to them faster, then the chances of that person who may not be able to walk on their own trying to get up on their own are lower. Therefore, you can potentially reduce falls.

So those are some of the clinical outcomes. I already talked about some of the documentation outcomes. It’s not unusual to see a reduction in maybe 40 minutes, 50 minutes, even an hour per day, per clinician, in terms of decreasing time spent on documentation in long-term care.

In hospitals, some of the results we are starting to see – and again this is fairly new. We are just starting to build our presence in hospitals, but the only results are one hospital that we work with, Butler Memorial Hospital near Pittsburgh. They’re actually seeing significant reductions in documentation time, even though they were already on electronic medical records — up to 75-percent reduction in documentation time. They have also seen that the processes have gotten more streamlined.

So, for instance, before, they had a fairly complex procedure for sending pages to caregivers for new requests — new requests for, say, changing an I.V. on a patient. We streamlined that process so those requests come in as basically a voice page with all the pertinent information. So there’s less going back and forth between the person providing the care and whoever is sending the request.

Some other results that we’re starting to measure are, for instance, reduction in infections. Because with this hands-free, eyes-free capability, you’re going to be touching a lot fewer devices. You’re going to be touching keyboards less, monitors less, mice less, potentially phones, pagers — you might still use some of them but usage is likely going to decrease. So that’s something else we are planning on measuring in the near future.

BHC: In terms of the nuts and bolts as to how this actually works, are the nurses actually wearing a small headset throughout their shift, or just dialing into a system to receive the voice prompts and make entries?

AK: It’s the former. As you said, nurses wear a small headset throughout the shift as opposed to dialing into a phone. The reason for doing it that way is a couple of reasons. One is, as I was saying earlier, we want to provide the capability to get everything you need at the point of care. We don’t want you to go back and forth and, say, dial into a phone and maybe the line isn’t available. Everything is available right there at the point of care. The second thing is that we want to ensure the system works even if you don’t have great connectivity, like wireless connectivity or phone call range or, for instance, dead spots in the hospital.

This system is designed so that your path and your activities are cached onto the device. Which means that as you start your shift, you get all your work assignments. And if you’re out of wireless call range, it doesn’t matter because this device is fairly intelligent. It’s almost like a computer. So it’s going to save all of your work onto the device and synchronize it back to the server over the wireless network as soon as you get back into wireless coverage.

BHC: How have nurses taken to the system? Are they at first a little resistant to it or do they immediately kind of love it?

AK: That’s a good question. In concept, nurses love the idea of not having to kind of walk back and forth to a computer or writing stuff down on a sheet of paper and then going to a computer and entering everything. There is sometimes some resistance to the idea of wearing a headset. There is some concern about, “How are my patients going to react to that?”, etc.

What we’ve seen in practice is that it doesn’t really tend to be an issue. When patients are told that, “This is actually meant to improve the quality of your care. It’s not meant to be a distraction. The nurse is not talking to someone else about say, last night’s TV show. They are actually working to provide you with the best care using the system,” their acceptance tends to be pretty good.

So in practice, yes, we’ve seen some initial resistance, but hasn’t really stopped nurses from adopting it. Lots of nurses we’ve talked to have said that it has improved the quality of care that they are able to provide. It’s enabled them to not spend as much time in the evening doing documentation. So I think, in general, there’s a little bit of resistance initially, but the response has been very good.

BHC: Amar, for our audience of primarily behavioral health professionals, such a system might be useful in a long-term care facility that’s dealing with patients who have dementia or Alzheimer’s, correct?

AK: That is correct, yes. Right. And as you said, this system is being used in long-term care fairly broadly, and I can see some similarities between long-term care and behavioral health. For instance, I was just looking at protocols for assessing someone who is close to being suicidal — what sorts of things they need to do — and I have it here in front of me and it says, “Assess for presence of destructive behavior every eight hours.”

Well, how are you going to ensure that someone actually does that every eight hours? How are you going to ensure that there are six steps in this protocol? How are you going to ensure that someone is actually following that protocol and also keeping track of their activity so that if there ever is an issue, if you need to show Medicare, Medicaid or maybe the patient’s family, or maybe you get sued and you need to show the exact set of steps you took with each patient; how are you going to show all that?

Where we can help is one with the procedural guidance. Like, for instance, in this case, assessment for suicide risk every eight hours. Sending in my nurse saying, “Okay, it’s time now to go and examine Mr. Jones to see if he’s still okay or if you need to take any remedial action.” And so on — walking through this entire protocol.

And obviously, all of this is being [documented]. As you do it, you say, “Okay I just did this,” and it’s documented, along with timestamps. So you have that for either insurance purposes or just for recordkeeping in case of litigation or in case of any issues with the patient or the family later on. So I can absolutely see the potential for this in behavioral health as well.

BHC: What are some of the challenges involved in transitioning to AccuNurse?

AK: That’s a great question. Of some of the challenges involved in transitioning to AccuNurse, one is that a lot of hospitals have experimented with a device for speech recognition before, and they want to know, “Okay, is this the same thing?” Because an experience may not have been that great in the past. And [they need to] understand that this is a pretty different model. This is not your physician-dictation kind of model, which is meant to be accurate, but not 100-percent accurate. Because the physician’s one can be fairly complex, and it’s not currently possible to be 100-percent accurate on that, and you have someone going through that documentation later on and correcting it.

That model we don’t think works for nursing or for allied healthcare, for instance. You need to get it right the first time. Which is why we validate all the information right away, as soon as you say it. So [they need to] understand that with this model, you are going to get really high levels of accuracy. Being comfortable with that is something that needs to happen. Some other things that you need to be thinking about include that most healthcare facilities are already using some sort of electronic medical record or are in the process of rolling something out.

How are you going to get the most out of this while leveraging your investment in electronic medical record systems? And a related point is that studies have shown that, yes, for the long term, electronic medical records can improve patient care, but in the short term, they can have an impact on productivity. Because you might end up spending a lot more time logging into the computer and entering everything at a time. Can you do both? Can you improve quality and be efficient at the same time? That’s something else that healthcare facilities need to think about and work with us to figure out how we can help them do both.

BHC: Amar, looking down the road, are there any plans to adapt this system to work in other settings or for other applications in healthcare, say for example, addiction treatment facilities?

AK: Yes, absolutely. As I was telling you earlier, we started offering these products in long-term care about three or four years ago and more recently — just in about the last six months or so — we started offering them in hospitals. But there are more, a lot more possibilities for it down the line. We’ve been asked by clinics, for instance, if this can be used in that setting. Outpatient clinics, for instance. Physician’s offices, rehab facilities. And I don’t see why it couldn’t be used in the behavioral health setting as well.

Home health is another emerging market from the perspective of the growth in that market. And the need for providing home health services, from what I understand, that’s been growing pretty fast. And that might be another market we offer our products in sometime in the future.

BHC: Amar, I really want to thank you for talking with us today. Tell us where people can go if they’d like to get a little bit more information about the AccuNurse System.

AK: Sure. The website is www.accunurse.com. And thanks for having me Dennis.

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