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How one hospital uses Cisco's Cius to improve patient care

by David Raths

November 17 2011

Palomar Pomerado Health deploys tablets, custom Android app development, and RFID with favorable results.

Most of the tablet-based innovations in healthcare these days involve Apple’s iPad. But Orlando Portale, chief innovation officer at Palomar Pomerado Health in Southern California, has started his mobile initiative by rolling out Cisco’s Cius tablet to hospital-based physicians. 

“Most tablets are consumer-oriented and have the shelf life of a banana,” Portale said in explaining his choice. “You are on your own if you are an enterprise trying to develop for it. We felt the Cius is really the only tablet on the Android platform that is backed by an enterprise level company like Cisco. It fits right in with our other Cisco deployments, including Unified Communications and TelePresence, which allows for real-time teleconferencing. The Cius also has security hooks into our virtual private network for authentication.”

The introduction of the Cius in the summer of 2010 coincided with a significant R&D project at Palomar Pomerado Health, which includes 319-bed Palomar Medical Center in Escondido and 107-bed Pomerado Hospital in Poway. The healthcare organization chose to build its own mobile platform called MIAA, which stands for Medication Information, Anytime, Anywhere.

“We focused on building out the back-end in a native Android platform,” Portale said. “The value proposition is to make life easier and to tame complexity by making all patient info available on a mobile device anytime, anywhere.”
The Palomar strategy is to focus on building a back-end system that is mobile device agnostic to get real-time data from the Cerner Millenium electronic health record, including medications and lab and radiology results.

The company started with Android, and the next step will be to port to the Apple iOS platform. “We don't want to exclude doctors outside the hospital who want to use a mobile device or tablet such as an iPad,” Portale says. “Ultimately, it will be a hybrid environment.” Palomar has piloted the Cius with 15 to 20 doctors, and Portale expects to expand the pilot to approximately 50 more soon, Portale said.

In the hospital environment, after physicians log into MIAA, they see default lists of their patients. Those patients have RFID tags on their wristbands and the hospital uses real-time locating systems. So as physicians are doing their rounds, the closest patients automatically move to the top of their list. In conjunction with Cisco's telecommnication system, the Cius can be used as a VOIP phone as well. Doctors can touch a spot on the tablet and a list of care team members pops up. If a button next to their name is green, that means they are online and available. The physician can request to do a phone session or a real-time videoconference.

Information about patients from a regional health information exchange also is available at the push of a button.

"This new technology will improve patient care by taming the complexity of health care, and reducing the current hassle inherent in a highly fragmented industry," said Ben Kanter, M.D., chief medical informatics officer and pulmonologist at Palomar Pomerado Health, in a prepared statement. "Physicians who are on the go, at home or on call, will have the ability to access real-time information in context. This will lead to more accurate medical judgments, ultimately improving patient care."

So far, the MIAA app is for viewing information only, but Portale said the MIAA team is starting to prototype order entry. Physicians would then be able to order medications and lab tests from menus.

The entry of physician notes is a bigger challenge with tablets. Voice entry may be a possibility for command and control. For instance with labs, a doctor could say, “Display abnormal results” and those results would pop up. “The next step is to see if you can talk some of the notes entry,” he added. “We are working on interoperability with the Google Talk speech engine to make that happen.”

So far, Palomar Pomerado Health has done an early stage pilot with 15 to 20 physicians to get feedback in terms of user experience. “The thing I have learned is fail early and small rather than large and late,” Portale said. “We have worked with a group of physicians [who are] really into experimenting with technology. We will capture their feedback, clean up the user experience and do a larger rollout.” 

David Raths is a Philadelphia-based freelance writer focused on information technology. He writes regularly for Healthcare Informatics, Campus Technology and Government Technology magazines.
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