By Matt Phillion
COVID-19 profoundly changed the point-of-care ecosystem. Business as usual was no longer possible, and healthcare organizations had to reassess the point of care in order to keep staff and patients safe. Making the best of an unprecedented situation, the industry saw new ideas, new workflows, and new technologies emerge, enabling game-changing best practices that are set to continue long after the pandemic is over.
Prior to the pandemic, “there were a lot of legacy operational processes that have stayed intact for many years,” says Jon Wells, president and CEO of Midmark.
When we think of the point-of-care ecosystem, Wells says, traditionally our minds go to the face-to-face interaction between patient and caregiver, as well as all the related logistical elements leading to it, like parking and signing in. Now, he notes, “the pandemic has put a spotlight on opportunities for technology to assist in the work being done.”
Midmark has been a proponent of optimizing the exam room workflow: getting away from the traditional “box table and container of tongue depressors” style of care and moving toward more meaningful patient engagement and increased safety for patients and staff.
COVID-19, as we know, led to major growth in telehealth and a change in the point-of-care philosophy. “The thinking was if you’re sick, stay home, where before it was if you’re sick, come in,” says Wells. “That spike in telehealth proved that many visits can be done virtually.”
It also made clear that many kinds of patient encounters still need face-to-face interaction. “We started to think about what those interactions were, what they mean, the volume, and the richness of the in-person visit,” says Wells. “It helped us rethink how that work is being done.”
For some cases, this means moving things like minor procedures to outpatient clinics. “These used to be pushed into hospitals, but now we can do more in these outpatient facilities than we used to,” Wells says. “These offices need to be built for efficiency, workflow, engagement with the patient—the best possible experience.”
Outpatient clinics are often designed for excellent patient engagement, from exam to diagnosis to treatment. And that’s vital. “Whether it’s medication or physical therapy, the patient needs to be engaged and respond accordingly,” says Wells. This starts with care and empathy, but is also data-driven: making use of visual tools and giving the patient access to their own data, all in service of improving the ecosystem as well as patient outcomes.
“When we think of design, it’s more than just fabrics and color; it’s creating an empathetic, inviting, and efficient space that is effective,” says Wells. “Healthier patients, effective treatments, making sure that the patient looks at their health in a proactive way and that their behaviors mean something long term.”
The pandemic advanced the use of emerging technologies to improve areas like the electronic medical record (EMR). These improvements generally aim to “eliminate errors for the best possible outcomes,” says Wells, who notes that Midmark’s own product, IQvitals® Zone™, imports blood pressure, height, weight, pulse oximetry, and other data directly into the EMR.
There’s been a shift in how data is entered into the record, even in terms of the physical data entry itself. Rather than having the workstation on the far side of the room, newer technology enables the provider to bring their PC, laptop, or tablet closer to the patient.
“They’re documenting the treatment but also having direct eye contact, forming a direct connection with the patient that can eliminate disengagement,” says Wells.
Other emerging technology and methods include modernization and improvement to operational and clinical workflows. “With real-time location systems (RTLS), we can eliminate the waiting room,” says Wells. “The patient can come directly into the exam space.”
Improving accessibility using newer equipment also improves operational workflow as well as patient and staff safety. For example, rather than using a fixed-height exam table, a practice might opt for one that can be easily raised and lowered (Midmark has created a table that can be lowered to 15 ½ inches in height). This can enable a safe transfer for patients from a wheelchair or walker. “That’s what we need in these spaces when we talk about design for diversity and inclusion,” says Wells.
In the past, caregivers might have deemed it was safer to simply conduct the exam while the patient remains in their wheelchair, but that doesn’t offer the same experience to all patients. “Patient safety for patients with mobility limitations also applies to receiving the same care as ambulatory patients, so they can get the best possible treatment,” says Wells.
Workspace design should improve safety for the caregiver, as well. Different equipment can help staff transfer patients with less risk of injury to themselves or the patient. “Nurses are among the highest in work-related injuries, in part because of [patient] transfers.”
Wells hopes that well-designed products like Midmark’s examination chair become an industry standard in workspaces everywhere. Consider the transition from round doorknobs to latch designs—a win for accessibility—and how the latter are now so commonplace that we don’t think about them as different.
“It’s about empathy for our users—patients and staff,” he says.
Thinking about space
When we think of improving clinical care, the conversation often turns to additional training, but considering the workspace itself can go a long way to ensuring effective patient/caregiver interactions, Wells says. “It seems obvious, but having the [EMR] closer to the patient is of clinical value,” he adds.
The pandemic has also amplified a conversation about patient-centric spaces—setting up the workflow so that the patient stays in place and staff such as phlebotomists come to the patient. “Think of the traditional practice, designed for each doctor: with three exam rooms and a business office,” says Wells. “In the future it will be focused on the patient—the patient won’t move. Everyone else will.” Without having to move or be transported from place to place, a stationary patient is exposed to less risk, he says.
“Practices are already going down this path,” says Wells. “You see it in oncology centers, for example. If the patient has many hours of treatment, you can consolidate this time by having it patient-centered.”
Infection prevention focus
We can’t talk about the impact of the pandemic without also discussing its impact on infection control and prevention. Wells sees a move away from traditional business furniture in favor of items made to be cleaned and disinfected properly.
“We see furniture, recliners and such, not made with a clinical perspective—it’s common,” says Wells. “We’ve known these spaces were always at risk for cross-contamination. Patients arrive sick, so they are more vulnerable. We need to make it a safe environment and have the right infection control protocols in place.”
While products containing quaternaries, bleach, and hydrogen peroxide are effective for cleaning, their chemistries can change to improve effectiveness. Patient spaces can also make use of fabrics that respond best to the cleaning products the practice uses for disinfection.
“There’s doing the right thing in space design, and thinking about the risks for your staff, patients, and organization,” says Wells, noting that those risks are present in outpatient as well as inpatient settings. “Let’s help them have confidence in the protocols they’re using, the equipment they’re using,” he says.
The industry is moving away from just using padded tables at a fixed height to designing spaces with a better understanding of patient-centric thinking. “These kinds of spaces are truly becoming the center of healthcare,” says Wells. “They’re moving from reactional and transactional to proactive.” This includes making it easier to comply with infection control protocols, such as with exam chairs designed to be moved for easier disinfection. (Midmark has, for example, created an exam chair with a roller system for easier maneuverability.)
“It’s the essence of design,” says Wells. “What’s the job you need done, and what constraints keep you from doing it?”
From an infection control standpoint, COVID-19 has brought more attention to the concept of patient-centric care. Change can be hard, Wells says, but data helps. “Having trusted data and an understanding of areas that need to improve and what tools are needed to improve becomes a call to action,” he says.
Shifting to a new way of doing things, like roving phlebotomists or an RTLS program, requires the buy-in of multiple departments and can’t happen overnight. “You cannot implement a full RTLS system in four weeks,” says Wells. “Our more sophisticated customers have been on a journey for three to five years.”
And these types of changes require a holistic view of the point-of-care ecosystem. “Operational, clinical, infection control, patient safety, all of these things we take into consideration,” says Wells. “It’s foundational to the best possible practice so we can help our health systems ensure wellness and also examine, diagnose, and treat patients safely and effectively.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.