An App for the Charge Nurse

Doctor assignments, room status, and doctor location

With the Patient is in app for the charge nurse, you can perform the following:

  • Patient assignments
  • Organize doctors and patients into teams for remote patient monitoring and to coordinate surgery teams
  • View doctor availability
  • Visualize the status of each doctor assignment
  • Visualize the status of rooms
  • Locate off-site doctors on a live map
  • Locate on-site doctors using iBeacon micro-location technology
  • Initiate a FaceTime audio or video call with colleagues and patients
  • Receive a FaceTime audio or video call from colleagues
  • Announce a patient assignment on any AirPlay-compatible speaker such as an Apple HomePod wireless speaker in a doctor’s office
  • Broadcast a general announcement to any AirPlay-compatible speaker such as an Apple HomePod wireless speaker in the waiting room
  • Receive remote cardiac data include ECG from authorized patients

Installation

The first step in managing your doctors or patients is to setup this app with the correct iOS permissions. You will need to allow the app to receive Notifications and Critical Alerts from doctors and other charge nurses:

You will also need to allow the app to determine your iPad’s location so that it can group doctors into teams and become an iBeacon which will streamline patient check-ins:

Make sure that Bluetooth and WiFi are enabled in the Settings app.

Doctors and other charge nurses will need to be able to identify that this iPad is from their organization so you need to setup this iPad when its connected to your organization’s WiFi.

Rename this device so that its role and location are identifiable to doctors during assignments, team alerts, and FaceTime conference calls:

Validating Your Organization’s WiFi Network

If this is the first time that your organization is installing the app at this location and WiFi network, you will need to validate the WiFi network by simultaneously running the Patient is in iPhone app for doctors on this WiFi network. You only need to do this once for this WiFi network at this location. As soon as the iPhone app is running on this WiFi network at this location, you will see the name of the WiFi network will appear in the “Facilities” section:

Rename the facility to something more descriptive:

Authorizing a Doctor’s Device

This section corresponds to the doctor’s section named  “Authorizing Your Device”.

Enable the toggle at the top named “New User Authorization”:

and in the iPhone app, have the doctor tap “Ask to Join a Facility”:

It is important to disable the toggle “New Staff Authorization” on your iPad as soon as you have authorized your staff.

Enabling FaceTime For One Touch Connections

Further down in the settings you can provide the FaceTime contact information used by this iPad. By providing the FaceTime contact information, doctors can easily clarify their assignments directly from the assignment notes screen or staff directory without having to dig through their contacts:

In fact, every staff member including doctors and other charge nurses can be reached with a single tap… if they choose:

Supporting Multiple Administrators and Charge Nurses using Multiple iPads

To enable access to your teams by multiple administrators or charge nurses from multiple iPads, simply download and install the charge nurse app while on the same WiFi network. Subsequently, each iPad can use a cellular connection or other WiFi networks. All administrators and charge nurses will share the same global view of your patients, doctors, assignments, rooms, and teams. And depending on network and cloud congestion and latency, that global view will be updated in real-time.

Administrators of regional or national chains of clinics or hospitals may configure their iPads to manage multiple facilities which will provide them with insight into patient wait times. An upcoming release will provide reports and analytics.

Creating Teams

Teams allow you to group and segment your staff.  Department charge nurses should use teams to constrain their view to the staff working in their department and not be distracted by the comings and goings of doctors not associated with their specific department.

Whenever a doctor is assigned to or removed from a team, he immediately receives a notification updating him. This is particularly helpful for surgeons and the surgery staff so that they have more time to plan out their upcoming day rather than have to call in and ask about their surgery schedule.

Here is how to create teams:

  • Tap the “Teams, Rooms, and Beacons” icon:
  • Select the “Teams” tab and then tap the “+” icon. Create some teams:

You can manual refresh the list if needed:

Changes to a team– such as when you create, rename, or delete a team– will be automatically synchronized across your facility providing charge nurses and administrators with a real-time global view of a facility’s resources.

Adding Staff to a Team

  • Tap a team’s name to view team details:
  • At the bottom of the view, select “Add and Remove Members”
  • Select the type of team member from the “Doctors”, “Charge Nurses”, and “Patients” tab and then select the team member:

The team member as well as all other charge nurses will instantly receive a notification or critical alert when added or removed will from a team:

To exclude the display of doctors from other teams, tap the “Display team members” toggle.

The teams which are being displayed are identified with the detail disclosure icon and the team names are identified in the “Available Staff” title

A charge nurse may view the location of members of a team by selecting the location icon in the team details. From this view, the location and the check-in/check-out details of a doctor which are displayed as a doctor passes by the iBeacon associated with a charge nurse’s iPad. As we see in the next screenshots, about six minutes ago Dr. Quinn began working near Nurse Station 2:

How to Create a Remote Cardiac Monitoring Service

The Patient is in app suite supports the secure transmission of a patient’s ECG, streaming the patient’s current pulse, and his historic heart data. To create a remote cardiac monitoring service requires 3 components:

  1. Designate a team as a cardiac team by enabling the “Receives Heart Data” toggle in the team details view.
  2. Add the appropriate medical staff to the team.
  3. Add the cardiac patients to the team. These patients must use HealthKit-compatible cardiac devices such as the Apple Watch or other medical-grade cardiac devices.

After setting up the cardiac team:

Each member of the cardiac team will receive notifications and critical alerts from the monitored cardiac patients:

Rather than mirroring their iPhone to an external monitor, any member of the cardiac team can use AirPlay to display a focused list of a team’s cardiac patients and their current pulse:

by selecting the “AirPlay” button from the team view in the doctor’s app:

As a reminder, please abide by your medical facility rules related to the display of patient information as well as any laws related to patient privacy.

If a charge nurse is added to a cardiac team, her iPad will periodically receive the patient’s ECG and other files containing the patient’s heart data. These will be downloaded into the Files app and then added to the patient’s medical record:

Defining Rooms and Other Places

A charge nurse must define the locations to which a doctor will be sent. This includes the rooms at the medical facility as well as the outdoor places during an emergency as seen in the screen shot above. Here is how to define a room:

Tap the “Teams, Rooms, and Beacons” icon:

Select the “Rooms” tab and then tap the “+” icon. Create some rooms.

Charge nurses will want to focus on the specific room which they are managing. To display some rooms and exclude others, navigate to the room details and toggle on the setting “Display Room on This iPad” and you will see the detail disclosure icon adjacent to its name.

Sending an assignment to the doctor

You send a notification to the doctor’s iPhone or Apple Watch containing

  • The name of the room in which the patient is waiting
  • Important notes about the patient such as if he has elevated vital signs

and the doctor app will notify the doctor with:

  • A discrete vibration felt on the doctor’s wrist if using the Apple Watch app for doctors
  • An optional, audible sound on the iPhone

If an AirPlay compatible speaker such as Apple’s HomePod wireless speaker is set up in a doctor’s office and authorized to be used by the charge nurse’s iPad, then the doctor can hear a wireless announcement similar to “The charge nurse says that Dr. Quinn has an assignment in Exam Room 2”. Here is a link to learn more about using multi-user Siri support and HomePod: HomePod and Multi-User Siri in Health Care: It’s how to reduce patient wait times

Additionally, this assignment is synchronized with the Patient is in iPad app managed by other charge nurses and administrators. This provides large clinics and hospitals with a global, real-time view of doctor availability, patient assignments, and room status.

In this video, we see how the charge nurse is able to quickly send a patient assignment to the doctor, visualizing doctor availability and see which doctor is onsite and connected to the real time peer-to-peer network or through iCloud, if the doctor is receiving patient assignments on her Apple Watch or iPhone, if the doctor is available for a FaceTime conference call, the status of assignments (accepted with an estimated time of arrival, decline, or completed), and the status of each room.

Locating an on-site doctor with iBeacon technology

In large hospitals, it is sometimes critical to locate a doctor who may be busy attending to another patient. The Patient is in app allows you to locate an onsite doctor. First tap the icon representing the doctor and then tap the magnifying glass icon as seen in the following video:

You will then be presented with a map view displaying the general location of the doctor as seen here:

beacon-sibley

The Patient is in app suite implements Apple’s iBeacon technology to automatically register each time a doctor’s iPhone passes near a charge nurse’s iPad running the app. In the above screen shot, a map pin shows that at 9:21 PM, the doctor was “Near Nurse Station 6”. And likewise, a few minutes after the doctor leaves the area of the iPad named “Nurse Station 6”, the map pin will be updated to show that the doctor has “Left Nurse Station 6”.

iBeacon uses Bluetooth, so for this feature to work both the iPad and the iPhone must enable Bluetooth.

If you are a fan of TV science fiction and specifically Star Trek, you may recognize this feature as a real world example of the Enterprise computer knowing the location of a crew member by passively tracking the location of the communicator badge as seen in following snippet from the first episode of Star Trek: The Next Generation

iBeacon technology and your privacy

It is important to note that the Patient is in iPhone app for doctors is only able to report on the last time the iPhone was in the Bluetooth proximity of a charge nurse’s iPad which was at the time both running the app and had Bluetooth enabled. The Patient is in iPhone app is unable to determine its proximity to other iPhones.

Locating an off-site doctor

If the doctor allows, the charge nurse may see the doctor’s off-site location on a live map. This map will also display current traffic conditions and is similar to apps such as Uber, Lyft, and Glympse. This feature helps the charge nurse estimate the doctor’s time of arrival for emergency surgery and other time sensitive activities.

Off-site location data and your privacy

It is important to note that only the doctor can decide if her off-site location should be disclosed to the charge nurse. The doctor can at anytime enable or disable the setting “Off-site Location” in the section “UPDATE YOUR LOCATION” as seen in the following screen shot:

If this setting is enabled and due to the imprecise nature of mobile location technologies, the app may update the charge nurse with the doctor’s location up to 1 mile or more from the location of the charge nurse’s iPad. Consequently, if the doctor is using her personal iPhone and not a hospital issued device, the doctor may choose to manually disable this feature when leaving work.

This setting is disabled by default.