New nursing apps from IBM/Apple

  1. You'll find a few details about four new IBM-developed nursing apps for iPhones, iPads, and yes those pricey new Apple Watches. The apps are:

    • Hospital RN
    • Hospital Lead
    • Hospital Tech
    • Home RN

    IBM MobileFirst for iOS Healthcare

    I just looked and none are available through the app store yet. They may actually be distributed through individual hospitals.

    If you've been part of the beta testing, we'd love to hear your comments.

    My quick take is that Hospital Lead, if fully utilized, is likely to be the most controversial. It "empowers" leads to manage and, if they want, micro-manage the care being given by RNs and Techs. They'll be able to assign what's to be done first by staff and to see if their orders are followed exactly as prioritized.

    Indeed, as I was looking at the Hospital RN and Hospital Tech apps screens and saw "302 patient needs ice" I thought. Why is this listed? The tech could probably get that ice faster than she could enter it on an iPhone and later check it off as "Done." And does the lead really want to be managing care at that low a level? You get good staff so you don't need to micro-manage every detail.

    Take a look and see what you think.
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  2. 2 Comments

  3. by   CraigB-RN
    If I recal there is a separate location for enterprise apps. Not sure you'll see those in the app store.
  4. by   GuEsT78
    You're right Craig. I forgot that. The fact that these apps are listed in the app store means nothing.

    That brings up an important distinction. I suspect most nursing apps are chosen by nurses themselves, based on what they like, with perhaps no more than a recommendation from their hospital or supervisor.

    This app set probably won't work like that. A hospital will buy a service from IBM that includes these apps along with additional software and hardware. Units in a hospital may be able to opt in or out of using the service, but individual nurses won't have a say. That's why I suspect it's important for nurses to give IBM feedback now and not later.

    I've not used these interlinked apps, but they strike me as more suited for the Getting Things Done world of business, particularly that of managers and executives, than of floor nursing. I see that primarily in the emphasis on work based on priorities.

    Take business. You're the VP for sales of a mid-sized firm. Each of your state branches just submitted their sales plan for the next year and you've got two weeks to approve, change, or reject them. Setting priorities would work well there. You start with the states where sales are the greatest, including California, Texas and New York. It's most important to get them right. About a week later, you realize you're not going to get through all the plans, so you delegate the smaller states to an assistant. Still later, you and he realize that the two of you still won't have time to effectively review them all. You agree to just glance out and sign off on several smaller states. They're only a fraction of 1% of your sales anyway. Doing work like that based on priority makes perfect sense.

    That's the sort of task management I see in these apps with only one addition. The Hospital Lead app makes it easier to delegate via apps tasks to RNs or Techs and to dictate their priority. I'm personally skeptical whether the lead will really want to do that level of micromanagement, but that does fit the business management model. When tasks take ours, delegation time matters little. When tasks take seconds, delegation and tracking time can take longer than the task itself.

    What IBM will almost certainly be supplying will be software that ranks how well RNs and Techs are at working on a priority basis. If an RN often does something low priority before something given a higher priority, she'd be rated down. I surmise that because, if the system isn't doing that, what purpose does tracking those ranking accomplish. If what the apps do isn't a good match for what staff need to be doing, there will be serious morale issues. The most efficient RNs will often be rated as the worst.

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    My sense is that this priority-based list may appeal to hospital administrators, whose own work load might benefit from it. But I'm skeptical that it will work well on a hospital floor. There, priorities matter far less that efficiency. If I go into a multi-bed room, I work more efficiently if I do all the tasks that room has irrespective of their priority. I can bring refill someone's glass faster than I can deal with than as an item on a smartphone to-do list. Making me deal with that list isn't a help. It is a hinderance.

    I worked as a tech, so I also know that work is also a lot more efficient if the nurse and I keep efficiency in mind in areas where our responsibilities overlap. Apps that specifically delegate a task to an RN or to a Tech neglect the fact that she or I could take it up when it's quicker for her or I. And often, if the RN was overloaded, I deliberately took up some of her load. Communication was an area where there was overlap. Most nurses like to manage patient transport, but if a nurse was really busy, I'd arrange transport and simply tell her. Similarly, when I had to help a resident with some exam room procedure, for perhaps 15 minutes, she had to take up all my work. Doing that sort of shared dance isn't easy to put into a set of apps.

    In addition, a priority-based scheme doesn't take into account the real complexities of nursing care. Virtually all the tasks that pop up not only have to be done but done quickly. A patient that needs a glass of water at 9 am isn't going to be happy if it finally gets taken care of at 11 a.m. simply because that doesn't rank as important. There are low priority tasks that need to be done quickly. There are high priority tasks that can wait, particularly if they're so time consuming they're disrupt a lot of other care. Punishing staff for not playing a priority game would be stupid.

    Working in a hospital, most staff quickly learn to adapt their work for efficiency and constantly changing conditions that can't be covered by a simple priority ranking. Forgetting tasks occurred far less common than these apps seemed to assume. On the rare occasions when I forgot, my patients were happy to remind me. For the few tasks whose complexity and seriousness created a strain, primarily closely monitoring patients getting blood products or risky drugs, I found a pocket timer more than adequate and far easier to program than any app.

    I could go on, but I think my point is made. This app is probably better suited for the hospital administrators who're likely to be the ones implementing it than it is for the actual work of giving nursing care. There's simply too much juggling of various factors in floor nursing to fit well with a priority-based scheme.

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    We'll see if this scheme takes off. My fear is that hospitals with overworked nurses will assume this can substitute for hiring more staff and the resulting clash may not be pretty, particularly if the system's rating scheme is used to harass as failures nurses who're actually giving quite good care.

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    What would I like if I were back doing hospital care? A one-ear headset with a communicator and buttons at pocket level. One button would let me talk with the other side of my RN/Tech team. One button would talk to the unit's front desk assistant. A third button would connect me with the hospital's operator, who could connect me anyone on the hospital's staff.

    A still better system would allow me or my fellow team member, to see who just tripped a call light and talk via the communicator with them. One of my least efficient tasks was going to a patient, only to discover that, when I left to answer their call light, I was standing next to what they wanted.

    On other occasions, a patient I had walked to see would need the other of my RN/Tech team and I'd need to go hunt up them. Far better this sort of conversation.

    Bobbie's call light goes on.

    Tech to Bobbie: What can I do for you Bobbie?

    Bobbie to Tech: My IV arm is hurting.

    Tech to Bobbie: I'll be right there. [Goes to Bobbie and inspects arm.)]

    Tech to RN: Bobbie in 302 is complaining that his IV arm is hurting. I can't see any swelling, but you might want to look at it.

    RN to Tech: OK, tell him I'll be there in about five minutes.

    Tech directly to Bobbie: The nurse will be here to look at your arm in five minutes.

    Visualize that situation and you'll see that what happened took less than a 1/3 the time it would have taken without that communicator. When the Tech went to Bobbie, he knew it was a task he could handle. When he called the RN, he'd didn't have to walk about the unit searching for her. The walking was minimum. The talking was instantaneous. That is as it should be.

    Like I said, technology should be used to improve efficiency rather than overly regiment and rationalize tasks. And there's almost nothing that improves efficiency like quick communication.

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    Oh, and there should be a Call All button on that communicator that'd reach all the staff on the unit in case of an emergency. "This is Ann, the alarm you hear is me coding the patient in 407. I need someone to bring the code cart to the room."

    The communicator could also be used hospital-wide to recall staff back to a critically ill patient. Residents and specialists typically carry such devices. Why not everyone in nursing?

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