These are the headlines seen by healthcare executives everywhere, but how do the promises of cloud and mobile translate to improved service and care for the individuals we serve? How do we separate the hype from reality to go beyond the sound bites? These questions are not just rhetorical—the answers make the difference in how our institutions can improve the lives of individuals for which we are responsible. Several years ago, The MENTOR Network had to answer these questions as we faced the challenge of bringing electronic systems to a company and an industry not familiar with technology. Our industry of home and community-based health and human services has been ineligible by law for meaningful use funding and therefore was still primarily paper-based. Furthermore, our company had the additional challenge of a distributed work environment across 36 states and thousands of facilities as well as a diverse set of services ranging from residential supports to hosthome therapeutic programs. Most importantly as we implemented new technology we wanted to maintain the focus on our mission to improve the lives of the individuals we serve. Simple answers of going to the cloud and using mobile devices was not sufficient to meet this mission-based objective.
Given the unique nature of our environment, our first challenge was to choose a platform that we could implement, support, and use. We explored the traditional path of purchasing an EHR package, but quickly realized that our operating model did not easily fit into a package solution. Our company’s mission is very focused on providing services in homes and communities serving populations across a broad spectrum of needs. The textbook approach of centralizing, standardizing, and consolidating processes to accommodate a consistent package solution was counter to that mission - it simply would not work without fundamentally changing who we were. Certainly, there were commonalities at a base level that could be levered, but we needed flavors of functionality to meet the specific local need and state-based regulatory requirements. We would have been forced to implement significant customizations making this traditional route too expensive up-front with too few degrees of freedom to be successful.
“Two years into our implementation, the cloud has indeed been easier to implement, allows us to deliver new capabilities faster, and is exceeding our security and HIPAA requirements”
With the package solution looking less feasible—or just too costly—we started to explore a cloud-based platform approach. The cloud architecture was appealing because it allowed the team to focus on the specific capabilities needed in the field rather than the necessary “plumbing” such as two-factor authentication, database performance, security, etc. However buzzword compliant a cloud solution might be, not all clouds are created equal. Choosing a cloud solution that was also a platform allowed us to build a solution that kept the focus on the individuals we served; yet, it was not as burdensome as a purely custom cloud approach. Ultimately we selected the Force.com platform from Salesforce, but not without some push-back. Ironically, the biggest detractors of using the cloud were from within IT. Reasons ranged from security and HIPAA compliance to being too accessible in the “wild west” Internet. However, these seemingly valid concerns didn’t stand up to simple logic. How can our security team of 3 be better than a cloud-provider’s security team of 20? Isn’t ease of access a benefit—maybe even a requirement—for adoption? And while we have high incentives to be compliant and protect the data of those we serve, the cloud providers have even greater incentive with their entire existence hinging on security. We conducted the risk assessment and found the opposite of these concerns was true—the cloud can be appropriately accessed, more secure and more compliant.
With a cloud provider selected, we needed a device strategy to access the solution. This was a non-trivial challenge with only 20 percent of the workforce having access to a device. Whatever we chose had to be effective in all of our environments and cost efficient at scale. Since the majority of the services and support that we provide are in non-stationary settings, a mobile solution was a logical starting point. Vendors quickly came to promote their mobile products and our users were all asking for iPads. However, we quickly realized several problems with this mobile vision. First, an adult with behavior challenges may throw the iPad across the room. Second, we have many rural locations that lack wireless or mobile connectivity making a mobile device useless. Lastly, despite the adoption of mobile for consumers, it is still an electronic screen that can get in the way of the interaction between the persons we serve and the Direct Service Professionals (DSPs) providing the service. After multiple group feedback sessions using multiple form factors, we established a hybrid approach of Chrome Books for residential settings and pen on paper for more mobile environments. The pen isn’t just any pen; rather, it is an electronic pen from Anoto that we’ve integrated with our cloudbased health record. This allows the DSPs to use pen and paper while still capturing discrete data elements for the capture and tracking of services. Technically, it’s mobile, but it’s probably not what one would initially consider when thinking about mobile. This solution is also less intrusive to the delivery service process and is just easier to use.
Two years into our implementation, the cloud has indeed been easier to implement, allows us to deliver new capabilities faster, and is exceeding our security and HIPAA requirements. The mobile solution looks promising although not a certainty and not in the form one would expect. Chrome Books have been well received and work. Most importantly, we’ve been able to proceed with a focus on the service and care that will improve the lives of those we serve. The deeper we deploy, the more challenging this focus will be to maintain, but with the right tools and approach we have the framework to be successful.