Nurses spend lots of time doing what seems like busywork—logging into computers, pulling up patient files, entering details of what they did, and coordinating their duties with others. Researchers at Xerox are developing what they call the Digital Nurse Assistant to automate and simplify some of this work. The project is part of a broader trend to adapt information technology to the health-care system to make it more efficient and cost-effective.
“Its craziness, because the technology solutions are out there. We just haven’t integrated them into our systems. We are running on old technology,” says Carol Bickford, a health IT expert and senior policy fellow at the American Nurses Association.
Patients do better in and out of hospitals when they receive more hours of care from nurses (see, for example, this New England Journal of Medicine study). And yet the United States and many other countries face nursing shortages. One solution could be to give nurses tools that make their workdays more efficient. A study published in The Permanente Journal in 2008 found that more than half of their time was spent documenting and coördinating their work with other team members. Documentation took the majority of their time—more than a third.
“It becomes burdensome for the nurse to walk to the computer, push buttons or mouse, log in, choose the right patient, then sort through the material that might be there to find what’s needed,” says Bickford.
Xerox’s PARC division, a research unit of the company, worked with ethnographers to see exactly what nurses do each day to better understand how to help them. The PARC ethnographers helped uncover some of the details of the Permanente study, such as why it took so long to document things and how difficult electronic medical records are to use. Every time a nurse logged into a workstation, he or she might have to go down six menus before arriving at the necessary information. The challenge of coördination also became clear—a nurse may repeatedly order medication that never seems to arrive. The reality may be that another nurse did deliver the medicine, but did not document the task immediately, perhaps waiting until the end of his shift to go through all of his documentation tasks at once.
“Imagine you are a nurse going into a patient’s room,” says Markus Fromherz, chief innovation officer of health care at Xerox. Instead of going straight to a computer workstation to log in, a badge you are wearing detects your presence and automatically logs you into a system that knows which patient is in the room and which tasks need immediate attention and the information required to complete those tasks. You can then quickly document your work with the patient into a handheld device or mobile computer.
Fromherz says that nurses were involved in the design process to shape the system and ask for additional features. A pilot system has been tested at an undisclosed location.