A hospital patient recovering from surgery turns on his television and is prompted to watch a video on home care. After viewing the video, he completes a quiz and the results are sent directly to the patient educator. The video viewing and quiz results are automatically documented and incorporated into the patient's medical record.

The patient has a few questions, so he sends a note to the patient educator requesting clarification. He then sends a request to hospital maintenance asking that the temperature in his room be adjusted. Next the patient accesses the Internet and sends email to friends and relatives, letting them know how he's doing. Finally he orders the latest Hollywood blockbuster movie and settles in to watch.

Sound far-fetched? Like something that could only happen in the distant future? Well, think again. All these things and more are possible with the currently available on-demand video technology.

Empowering Patients

Screen provided courtesy of Skylight Healthcare Systems

On-demand is a broad term describing technology that ranges from basic interactive television used for delivering education to advanced computer-like systems that serve as an informational hub for the hospital and a gateway to outside services such as the Internet.

While on-demand systems vary widely, they all share a key feature: interactivity. Patients are able to interact directly with the system using a remote control, a pillow speaker, a touch screen, a keyboard or a telephone in order to access information they need, when they need it. And interactivity - the ability for the patient to control the flow of information - is extremely empowering in the hospital environment where traditionally the opposite has been true.

“We really have disempowered people,” says Kathy Levine Vice-President of Hospital Operations at Allen Technologies. “If you took a well person and put them into a strange setting, took all their clothes, put them in a little shirt with their backside hanging out, took away their money and their identification and put them into a passive position like a bed, and usually an uncomfortable bed because it's not their own bed, and then have people giving them orders, this is not exactly going to empower someone to take control. So we're trying to turn all that around and draw them back into the process.”

On-demand technology is helping hospitals meet their new mandate of empowering patients and their families to participate more actively in their care. An on-demand system can allow patients to view educational videos at their own pace, ask questions or make requests of the hospital staff, and access everything they need to know during their stay, from the patient rights handbook to the cafeteria's hours of operation.

Screen provided courtesy of Skylight Healthcare Systems

But on-demand systems go beyond putting everything patients need at their fingertips to also providing access to information and services that patients want. Entertainment, email, Internet, spiritual and relaxation programming - health care consumers are demanding these and more. In fact, patients are starting to expect some of the same amenities from a hospital that they do from a hotel. Baby boomers in particular have high expectations when it comes to information and technology access. As a result, hospitals are finding it in their best interest to meet the demands for hotelesque services. On-demand technology allows them to do just that.

“I think it will become a competitive tool when it comes to satisfying that population," says Joe Nora, Vice President of Corporate Sales for SVI Systems. “The pyramid is going to flip here soon, the majority of the population is going to be in the older bracket and when that happens, hospitals will need to be geared to whatever type of competitive advantages they may have and this is just one of them."

Revolutionizing Patient Education

Patient education is one of the key areas in which patients are benefiting from on-demand technology. Gone are the days of pushing a VCR cart from room to room, or planning educational activities around an inflexible CCTV schedule. With an on-demand video system, patients can view educational videos when it's advantageous for them.

“Not enough consideration is given to a patient's time and availability," says Chris Simonsen, Video Services Coordinator for the Hospital of the University of Pennsylvania in Philadelphia. They have used an on-demand system for nine years. “You have doctor visits, X-rays, cleaning of their room, rehab and many other things going on. With on-demand, the patient can access a video when the time is right for them."

Having control over when videos are viewed also allows families to participate fully. In the typical model - where nurses fit education in whenever they can - family members are not always present. Yet often it's the relatives and even friends of the patient who need the most information because they're going to be taking care of the person. With on-demand, family members can view the same educational information as the patient, which is especially crucial when the patient is too sick to absorb it.

On-demand systems offer additional flexibility by providing VCR-like controls that enable patients to pause, stop or rewind a video, and watch it as many times as needed. Some systems even prompt patients to follow an instructional path designed specifically for them.

“A message will pop up on the screen that says 'Your caregiver would like you to watch such and such videos'. Then they are prompted through the system, like 'Would you like to watch this video now?' explains Lea Hackman, Director of Product Management at GetWellNetwork®. “What that does is allow the hospital to customize the process for the patient based on their own requirements . . . It really pulls the patient into the experience."

In fact, utilization of the educational features of an on-demand system is significantly increased when the patient is prompted, either automatically by the system itself or by the nursing staff. If patients are given a system to browse on their own, about 70-75% of them will actually watch a video. However, if patients are directed by their nurse to watch a video, the utilization rate rises to 97%.

Although any type of patient education can be presented via on-demand technology, the most popular topics are cardiology, diabetes, and maternal child health. Most systems provide reporting features that enable hospitals to track exactly which videos are viewed and how frequently.

Supporting Hospital Staff

While patients and their families benefit from individualized instruction that they can control, patient educators also reap rewards.

“The staff just loves it!" says Stephanie Mabe, an Education/Communication Specialist at The Heart Center of Indiana in Indianapolis, which installed an on-demand system in 2004. “When I talk to nurses at other hospitals, they say that they have to track down a TV and roll it into a patient's room to show them a video. Here it's right on the TV whenever they want it."

As a result, patient educators save time - time they no longer have to spend checking out equipment or searching for lost videos. Multiply the time spent on such activities by multiple nurses in different hospital departments several times per day, and the savings in staff time can be tremendous.

Documentation is another advantage of on-demand systems that lightens the workload of nurse educators. On-demand systems can automatically record what videos a particular patient has viewed and in some cases insert that information directly into the patient's electronic medical record. That helps relieve the administrative burden placed on nurses to verify that patients are receiving the information they require - not only condition-specific education, but also information on generic hospital topics such as advance directives. Such documentation is no longer a luxury, but a necessity in order to comply with JCAHO standards.

“Certainly JCAHO has driven tremendously the need toward education, the need toward informing patients regarding their rights and responsibilities and advance directives," notes Levine of Allen Technologies.

Another feature of on-demand systems that frees up time for the nursing staff is their communication capabilities. Many systems permit patients to send requests for non-clinical assistance directly to the responsible staff member rather than having to use the nurse as a go-between. For example, a patient could send a message about a plumbing problem straight to the maintenance department.

At the same time on-demand systems are relieving the pressure placed on nurses, they are improving the quality of the patient education provided. Because nurses save time on mechanical tasks like cart-pushing and administrative duties such as documentation, they have more time to spend answering a patient's questions or providing specialized training. Also, since on-demand systems are interactive, they can be used to administer quizzes, allowing educators to verify patients understood the information presented and pinpointing any content that needs reinforcement. Quiz results can also be - you guessed it - automatically documented and placed in the patient's record.

Keep in mind, too, that all the features of on-demand systems can be applied to staff education as well. Staff members can access the system to view continuing education or in-service training programs whenever it fits into their work schedule. For example, if a hospital starts using a new syringe and every staff member needs to learn about it, what often happens is that the vendor provides training but not everyone gets to participate. Or a training video is left behind and it's up to staff members to find it and then track down a VCR to watch it. With an on-demand system, staff training videos can simply be digitized and added to the menu so employees can watch them at their leisure.

Not just vendor training, but any type of internal training can be delivered via on-demand technology. A hospital could videotape its employee orientation and add it to the system, guaranteeing that a consistent message is being conveyed to all staff. Hospitals can also contract with continuing education providers to display their programming, enabling staff to earn the credits necessary to maintain their licenses and certifications at their convenience.

Note that staff training is typically made available in locations accessible only to hospital personnel, such as a nurses' lounge or conference room. Employees might even be required to log in to access the staff-specific menu. In this case, the system can also document exactly who has completed each training program and when, helping to ensure compliance. Either way, patients wouldn't have access to staff training, nor would staff necessarily have access to certain patient options such as movies.

Transforming the Patient Experience

As already noted, on-demand systems aren't just for education. They have the potential to transform the entire patient experience.

Nora from SVI Systems describes the range of features that an on-demand system can provide. “It can help deliver patient education, staff education, post test quizzes to measure retention, surveys of satisfaction levels, relaxation to help reduce anxiety and help with sleeplessness, entertainment via movies to help pass the time . . . And it can help deliver general information such as the daily menu, daily activities within the hospital, gift shop hours, a CEO message to the patient welcoming them, discharge and admittance procedures, assessment procedures. It's really a tool that has a number of applications."

Indeed, an on-demand system can function as a one-stop information resource for patients and their families. Many systems even allow patients to interact directly with hospital staff, enabling them to ask questions, make requests or rate services. Furthermore, the system can serve as an entryway to the world beyond the hospital. As a result, patients feel less isolated and more in control. Some may even - dare we say it? -- enjoy their hospital stay.

“They love the free movies," says Mabe. “They say, 'This is just like a hotel.' Family members and kids love surfing the Net. This makes their experience almost like being at home by watching movies, getting e-mail, staying in contact with the office. It makes them more comfortable and gives them something to do instead of thinking about their illness."

One patient at Thomas Jefferson University Hospital in Philadelphia was able to do all her Christmas shopping via the Internet during a hospital stay. “It just made her life a little easier," says John Plunkett, Director of Marketing at GetWellNetwork®. “It shows them that the hospital remembers that they have a life outside of the hospital, that they are not just there as a patient."

While entertainment and Internet access keep many patients happy, others seek spiritual solace especially during stressful times such as a hospital stay. On-demand systems are ideal for providing a range of spiritual programming, and in hospitals that offer it, its popularity rivals that of high demand patient education titles. Spiritual content ranges from relaxation videos, such as the images and sounds of a waterfall or yoga that can be performed in bed, to guided imagery for healing enhancement, to actual religious services of various kinds.

And applications of on-demand technology continue to expand. Virtual classrooms can be created in which hospitalized children attend school with their classmates. In hospitals where an on-demand system is tightly integrated with the existing information technology infrastructure, it can even assist with clinical care and help to ensure patient safety. For example, an advanced system might allow staff to enter data into clinical applications at the bedside as well as pull up x-rays, doctors' orders and charts. There might also be a patient identification system which permits the nurse to scan the patient's armband and the bar code on the medications she's about to administer in order to confirm she has both the correct patient and the correct medication. Furthermore, a patient who is receiving pain medication might be prompted to complete a pain assessment at specific intervals. Based on the response, the on-call nurse could automatically be paged to follow up with the patient.

“Pain management, pharmaceutical management, clinical information systems, all those kinds of systems are becoming convergent at points of care, at critical areas where nurses and physicians can more effectively utilize the information and input the information," explains Levine of Allen Technologies. “That means the patient, the hospital and the caregivers can share the information and systems necessary to most effectively educate and heal the patient."

So far only about 10% of hospitals are taking advantage of on-demand technology. But with so many benefits for patients, staff and hospitals alike, the use of these systems is growing.