Kathy Levine, Vice-President of Professional Development and Organization at Allen Technologies, recently talked to Patient Education Update about how on-demand technology is impacting hospital care. Kathy spent twenty years in critical care nursing and ten years in TV technology-based education before coming to Allen Technologies.

PEU: Why is on-demand technology an important development in healthcare?

Levine: Through the years, we in the medical community have taken away a lot of the options from patients. We're now trying to empower patients and families to participate in their care, make good informed decisions, and participate in the healing process.

PEU: How has the delivery of patient education evolved to this point?

Levine: What has happened in the past was the education went from VCRs being pushed from room to room on carts and then transitioned to scheduled education with CCTV. But CCTV really didn't interface well with patient care because you were running your care around the programming as opposed to the care, programming and the education working around the patient and the staff. Now it has progressed to on-demand delivery.

PEU: So what makes on-demand different and better?

Levine: Unfortunately because of the demands of nursing and the reduced number of nurses, we've had less time to actually deal with the patient. Admitting functions, advanced directives, those things that were previously done by the admitting department are now being done by nurses on the floor. And unfortunately, some of that one-on-one patient time, talking time, and education has suffered as a result. So it's a team approach and the system allows for the nurse now to come back and say, “Okay, did you have questions about this?" Our system can also afford the patient the opportunity to use the technology to ask for someone to come and talk to them in more detail about advance directives. Thereby it loosens up the nurse's time so that they can deal with those areas most critical to each patient.

PEU: Technically how does on-demand work?

Levine: Basically the television set at the patient's bedside becomes the focus of the communication. When the patient turns on the TV they're prompted to a main menu, a screen that offers them a variety of functions. You could watch entertainment, access patient education, access hospital information, take a survey, or do a quiz associated with a health condition. For example for new moms going home, a unit may utilize a quiz format to establish newborn care knowledge. That's tied to the nurse's station so that the staff is notified concerning wrong answers.

PEU: Does the family and other caregivers use the system as much as the patient?

Levine: Absolutely. Half the time, you're actually dealing with them more often. Often the person that we need to work with the most may not be the patient in the bed because they may be too ill. So it's the family and those people that are going to be taking care of that patient on an on-going basis.

PEU: Tell us about the spiritual content on your system.

Levine: A mass, a rosary, Jewish services, Buddhist sutras, the Koran - are all on video. In locations where hospitals offer the pastoral care content, it actually is ranked foremost, right up there with cardiac topics, maternal/child health, and diabetes. You're never going to find god anywhere like you will in a hospital sitting all by yourself at 3AM.

PEU: How can the nursing staff direct patient viewings?

Levine: The staff can go in and either individualize a patients viewing or set up a number of videos linked to a specific diagnosis. The patient gets a message, kind of like e-mail on their TV screen. We call it Education RX. From an education standpoint and from a nurse functionality standpoint, it's a thing of beauty. It takes the onus off the nurse and allows them to utilize an automated system to deliver the education specific to that patient. What I find very appealing is that finally the nurses, who for years have been beaten up by technology, now have the technology that actually works for them and can help ease their work load and enhance the patient care process.

PEU: How does the post-test or documentation of the viewing work?

Levine: There's full documentation of the patient viewing. All of these reporting features are HIPAA compliant. The beauty of it is that it automatically dovetails in so that it's actively there in the electronic patient record. Depending on what the hospital's structure is for reporting, we can interface with that. You can also look at the report and say, “Ok, this is a 15 minute video but patients are only watching 3 minutes. Something is wrong here with the content."

PEU: What are other possibilities?

Levine: You can attach a quiz or a request for additional information. For a diabetes program, you could send an electronic message to the diabetes specialist that says, “I've got questions about insulin injection. Would you come speak with me?" It lends itself to the dialogue and mutual goal setting between caregiver and patient which is more important than just a passive display of information.

PEU: How does this help with Joint Commission's standards?

Levine: Well, the Joint Commission's goal is the education of patients and family so it accomplishes both. It gives you your baseline of knowledge; the assessment as to what the patient's comprehension is by utilizing the use of the videos and quizzes, etc. and then builds on that knowledge base.

PEU: With great things like entertainment available to patients, can't that be a distraction?

Levine: It's not a problem. If you've got patient care priorities at the moment and someone is watching a movie, you can pause the video, prompt and talk to the patient, finish a procedure, and start the move back up again when you're done.

PEU: Most important question, what can you do about the food in a hospital?

Levine: Not much but we do have hospitals that utilize the system to make people aware of what the options are for food services on a daily basis. 'I don't want the salmon, I do want the chicken.' Also there are some patient populations that have specific dietary requirements.

PEU: What can educators do to push their hospital toward on-demand?

Levine: It's not just a matter of education and it's not just a matter of videos. You're now coming into a scenario of patient satisfaction, meeting patient and family needs, meeting the staff needs, and enhancing staff functionality. This really is a holistic system and that's what nursing is about. That's where our roots come from, that the patient is the foremost reason in the hospital for our being and this is helpful to the healing process.

PEU: So what keeps hospitals from moving forward? Is it a money issue or something else?

Levine: I think it's an awareness of the services, an awareness of the benefits of the system. A change of any sort is always an adjustment.

PEU: It seems like you're really asking hospitals to radically change the way they do things so this becomes the heartbeat of the hospital?

Levine: The heartbeat of the hospital is already there. What we're trying to do is meet their needs before that so they're not changing their functionality around the system. You've got a medium, the TV, that people are very comfortable with. Now some people may be intimidated by computers, but they feel very comfortable with television. The TV technology is tremendous.

PEU: What is the nurse's role in making this kind of change?

Levine: When the decisions are made about technology, it's really important for the nurses to be there and say, “Okay, this is how it's going to impact the patient." They're really the rooting and the grounding for the hospital. Technology's great, but if it's not going to meet the needs of the patient, it's for naught and it won't be utilized and it will be a waste of money.

PEU: What are some of the more visionary benefits?

Levine: You can link sick children or people who are in immune restricted areas where they can't have outside contact. As we do more transplants and immune suppressive situations come up, you can utilize the system to really link people. So you're not getting that isolation and you're not getting that sense, “I'm alone, I'm the guy in the bed nobody knows I'm here." You can hook kids up with virtual classrooms and involve them. In pediatric hospitals it's being utilized more, absolutely. Burn units, transplant units, they're all starting to utilize the system. We're going to eliminate the barriers, we're going to eliminate the walls and the healing process is going to be enhanced.

If you'd like to contact Kathy Levine, she can be reached at (203) 866-7703 or by e-mail at klevine@allentek.com.