Mobile Learning Toolkit For NNSDO Participants 2010 From Hospital U Eric Kugler: 713-256-1472

1. Mobile Learning Toolkit For NNSDO Participants 2010 From Hospital U Eric Kugler: 713-256-1472 eric@hospitalu.net

2. Table of Contents • The following tools/concepts werereferenced in Eric Kugler’s presentation at NNSDO, “Want better patient care at the bedside, there’s an App for that.” For more information on any of these feel free to e-mail or call Eric at eric@hospitalu.net or (713) 256-1472. • Step-by-step mobile learning project plan for an effective pilot……………………………..p. 3 • Chart to select the appropriate mobile device for different types of content……………….p. 6 • Tool to select the right mobile device for the right audience…………………………………p. 7 • Tool to convert DVD or online content into mobile format…………………………………...p. 8 • Where your employees can purchase mobile devices at discounted cost…………………p. 10 • Grant information and application process for mobile technology…..................................p. 11 • Access to Hospital U Generic Mobile Content Portal…………………………………………p. 15

3. 1. Step-by-Step Mobile Learning Project Plan • Project Methodology-Major Milestones. • This Pilot has been designed based on input from the following major health systems including: The Cleveland Clinic, Beaumont Hospitals, Covenant Health, Sentara, the Methodist Hospital System, among others. Milestones include: • Decide on pilot population: • There are many different potential pilot audiences for this technology. For nursing, you may choose to select nursing units such as med-surge, critical care, pediatrics, etc…Another good audience may be new nursing orientation. In our experience, since the technology contains content and apps for various user populations, there is little downside on selecting one group over another. • Decide on pilot locations. • If you have more that one hospital, you may want to consider a locations comprising of a main campus as well as one or more smaller community hospitals. This would not only give you data on some of your different demographic populations, but may also engender “buy-in” from community hospitals/clinics when you move to a wider roll-out. • Decide on scale of pilot: • With as few as 4 mobile devices, an effective pilot can easily be conducted. Of course for a larger health system, additional devices would increase your scope. However, by tightly monitoring the usage of devices, 4 devices could provide you with a fair amount of data in a short period of time. With fewer devices, the time period that a nurse has access to the device should be of a shorter duration, for example from one shift to one week. • 4. Decide on devices and peripherals: • Hospital U has tested a variety of mobile devices. The standard Hospital U device “hospital ready” device is currently an Apple iPod Touch, 8 gig. It is equipped with infection control features such as hard acrylic case, clear screen coating, identifying graphic with help desk number, non alcohol wipes, stand-alone chargers, and 1-page quick start guide. In addition a barcode or numerical sticker may also be placed on each device to indentify each unit. Other devices may also be considered (such as iPad) depending on project scope and audience (see following tools p.6-8).

4. Step-by-Step Mobile Learning Project Plan (cont’d) • 5. Distribute content catalog, application, and podcast catalog to clinical education team-Decide on content “Playlists”. • If you do not readily have you own mobile content, we would gladly share our content and apps that we have aggregated as part of an NIH grant. Clinical education team would decide which playlists of content to image on each device. E.g., for new nurses, a comprehensive skills based nursing catalog, for ICU, critical care and or/med surge playlists. • Pre-load each device with large number of Apps/Content • Since apps take up little storage space, our experience for a pilot is that more apps are better than less, so that different populations can find tools that apply to their practice. A typical device that we image will usually contain 80-100 clinical decision support applications, and more than 300 just-in-time-video modules (loaded depending on specialty), as well as an in depth selection of medical podcasts from a variety of specialties. Our experience is when you invest in one of these multi-purpose devices with the power and features of an iPod Touch, you want to enough quality software on it to ensure a high return on investment. • Consider including some health care system specific video/audio based content. • You may consider including some strategic hospital specific type content such as how to use a new medical device, customer service, etc…As a rule any video or audio based content is very easy to convert and image (see following conversion tool). • Distribute devices to participants. • Devices can be distributed for as little time as 1 shift, to as long as several weeks, and after that period participants would turn in the device and then hand out to the next group. In this way, a single device can capture the input of several individuals. To incentivize participants, they should be made aware why this pilot is being conducted, and how their input may help to justify broader use of this technology throughout the system. In addition, we may want to consider a drawing for 1 or more study participant. A best practice we found for executive sponsorship is to ensure that executives have an opportunity to use these powerful devices as well. Note: Be prepared to order an extra device or two as sometimes after an executive has tried this technology, the device disappears. • Sign out for loss prevention • Make sure that if individuals sign out the device, they are responsible for its safe return. Devices are quite sturdy, along with peripherals. Users can sign out these devices as they would a house phone.

5. Step-by-Step Mobile Learning Project Plan (cont’d) • Device Training Sessions. • Even thought these devices are quite easy to use and they may not take you up on it, it is a good customer service practice to schedule weekly short training sessions (15-20 minutes) in person, or via tele/web conference to those who would like additional assistance and guided tours to the device. Each device should also have a help line number on it so any user can call for immediate assistance. • Collect user feedback. • We recommend requiring each pilot participant to fill out a brief 5-minute survey collecting data regarding demographic data, user experience, content and applications most frequently used for patient care, as well as noted clinical outcomes. We have developed an online survey that can be customized, and all feedback will be more easily collected than paper-based. • 12. Summarize data. • Another advantage of a good online survey is to summarize user and project feedback in an executive summary. Length of initial pilot could range from 3-6 months. • Plan for success • Because of the popularity of the technology, the depth and breadth of content, the simplicity of the pilot, and the feedback we have collected from other hospitals-be prepared for many users to gravitate to this technology rather quickly. In this eventuality it is a good idea to prepare for success with the initial pilot, and be prepared for a follow-up plan. • Make necessary adjustments for wider rollout • Even though this is a pilot, all devices, content and infrastructure are production ready-meaning that project can be rolled out to the health system in as little as 2-4 weeks at the end of the initial study. • Set up Mobile Content Portal for users with their own existing devices • To allow other user populations the same benefits of your pilot group participants , this is a good practice, as they will be able to download new apps and content through your own branded hospital mobile portal and they can leverage their existing mobile devices.

6. 2. Chart to select the right mobile device for different types of content Mobile U Portal 1000 clin videos 100 medical apps 50 med podcasts 900 leadership Blackberry-3,4 iPad-1-4 + EMR Touch/iPhone-1-4 Nano-1,3,4 Online Portal Shuffle-3,4 6 Access from any computer-1,3,4

7. 3. Tool to select which mobile device for the appropriate audience Training Performance Support Clinical Workflow Decision support at bedside EMR Leadership content Clinical Skills Nursing/Physician/Educator Management Nursing/Resident 7

8. 4. Tool to convert video files to mobile • Summary: • We use a variety of software tools for mobile design, such as converting Flash to mobile, mobile to Flash, un-encrypting video files, copying video to DVD format, recording podcasts via the phone, and a powerful tool that we are sharing with you here, converting video to mobile format. Where some tools cost, we have tested several in our lab and found that some of the best tools to use are actually free. The one we are going to recommend, and summarize how to use, is called Handbrake. • Here is the website to download the program (either for PC or Mac) http://handbrake.fr/downloads.php • This tool provides many different ways and settings to configure and save mobile content • On the following page are some standard settings that we have tested that work well. Just copy these settings, follow the instructions and if need more help, call us.

9. 7. Click Start-This is the last step. Encoding will begin and will take some time to finish. 1.Open Handbrake and click Source: choose your video file that should be stored in your computer 2. Destination: is where you save the converted file 3. Picture tab: There are many options, though 640 X 480 is good for iPod, iPhone and iPad 4. Video tab: Video Codec H.264 5. Check 2-pass encoding 6. Select AvgBitrate: Once again, many options. The higher the number, the better quality . But too high will take up too much space. For mobile devices, we find 500-550 provides quality clinical video.

10. 5. Where your employees can purchase discounted mobile devices http://hospitalu.com/podcast On left hand side of page, under “What’s New” click on link Discounted Apple/iPods. Then click on the text and you will come here. Note: These refurbished products are exactly like new, with the same warranty, and prices will usually be between 20-30% less. While Apple will not let a company order refurbished products in volume, individual employees will have no problem buying these products through this link. A good benefit.

11. 6. Grant Information and Application Process for Mobile Technology • Hospital U Grant Project Name: iPac (iPod/iPad Applications and Content ) Clinical Performance Support at the Bedside) • Project Description.  Hospital U is accepting applications from 15 not -for-profit health systems/hospitals geographically dispersed throughout the U.S as it has secured funding through a partnership of the NIH and a private foundation. As a byproduct of this project each health system will be able to  offer its key clinical stakeholders (e.g nurses, physicians and leaders) a robust mobile learning and performance support architecture- leading  to improved clinical performance at the bedside. • What the grant covers.   The grant covers a turn key solution including  a branded content management distribution portal, user generated  quality video and audio content in the form of distinct nursing and  leadership modules, and podcast and CME content for physicians. In  addition, a series of premium clinical decision support applications  will be imaged to each Hospital U device.  Hospital U will also use grant funds for implementation services as well as ongoing support. The project is built upon a wireless cloud computing platform so that NO internal information technology resources will be required at any time. • Contribution.  A minimal voluntary contribution of each health system will be requested to cover 10% of the project costs. This ensures:  • The project will be self-sustaining after the initial 1-year grant period  is completed. • The partner health system commits some energy to  realize measurable outcomes. • Costs of the mobile devices themselves are also subsidized, ranging from 22-33% savings for each device that the  institution purchases. Individuals can also leverage their own mobile devices and download content from our mobile portal. Even without devices, much of our content is also viewable directly through a computer, • Next Steps: • Identify a Project Sponsor and a Project Owner • Identify participating departments and target populations • List areas of interest, ie: nursing orientation, nurse refresher, performance support for residents, nursing decision support at the bedside, leadership development, etc…) • Fill out Letter of Interest Form and send email confirmation signifying interest • Set up Project Planning Meeting with Hospital U Project Coordinator

12. Your Own Health System’s Custom Content Portal: Project Deliverables: • Custom Hospital U Content Portal • 1000 video nursing modules (by specialty) • 100 Premium Medical Apps • 900 leadership modules (by competency) • Uploading of your own Content • Modules available online or mobile • NO IT support needed for Project Your Hospital’s Portal • Users have unlimited access to their own branded mobile portal to use with their own devices, or… • “Lending Library” devices are imaged and lent out as part of our unit based kits Nurse Education &Training/ Decision Support

13. Project Description • To Pilot Mobile Devices to support healthcare applications, training and education in a collaborative of hospitals (maximum of 15). • Focus Areas: • Nursing Orientation • Resident/physician tools • Policy and procedures • Reduction of med errors • Rapid content creation/distribution (e.g., grand rounds) • Bedside decision support • Mobile electronic medical records • Leadership development • Patient Education • Medical device • Add your own content

14. Participating Institution Information: National Institutes of Health iPac (iPod/iPad Applications and Content Distribution) System for Healthcare Funding Opportunity Number: RFA-EB-09-001 CFDA Number(s): 93.286 Discovery and Applied Research for Technological Innovations to Improve Human Health Creation Date: January 16, 2010 Closing Date: Sept 15, 2010 Contact: Eric Kugler 713-256-1472, eric@hospitalu.net

15. 7. How to access Hospital U Content Portal 1. Clinical Videos on PC-Click on any of these categories to see a complete list of the hundreds of just-in-time nursing videos in Clinical Content for PC. These are Online versions of these modules. They are in Flash and will run on ALL computers. Ask your site coordinator for the single Password to access all this content on our portal. 1a. Clinical Content for Mobile are the mobile versions of our clinical content that can be added to your iPod Touch/iPhone/iPad the exact same way that you add music or videos to your iPod-take your content on the go. 2. Medical Apps. If you have ever tried finding a medical App through the Apple App store, you will have seen how difficult it is to find the right App among the thousands available. Not any more…We have done the hard work for you in our Medical Apps Index. Our reviewers have categorized a select group of medical apps into 20 categories using the following criteria: Highest peer review and best value. Many are even free. 3. Medical Podcasts. There are thousands and thousands of free podcasts in iTunes, but almost impossible to find the best medical podcasts. Not any more-We have reviewed and organized the 50+ best Medical Podcasts that you can access-and new content is added regularly. 4. Leadership Content. Want to listen to hundreds of short audio leadership modules from the best sources, Leadership Content is the place. ALL modules are organized by Leadership Competency. Just click on a skill you would like to improve, and you can either listen on your computer-or download to your mp3 player. Instructions are on the site. 15

16. 7. How to access Hospital U Content-Click Link Below http://hospitalu.com/podcast Each hospital/system has their own content portal with their own branded interface. When you click on the above link you will have access to our generic Hospital U content portal. The previous page walks you through the key features of the portal. In this example, any time you click on a content area you will be asked a password. Please call us at 1-888-534-1212 x 202 to obtain your password for these sample links. Remember, with your site we will be able to add additional playlists, or customize any of the content in these playlists, or any other text on the site. We hope you find this Mobile Learning Toolkit useful. Please do not hesitate to call me directly at 713-256-1472 or email me at eric@hospitalu.net if you would like any additional information on any of this content. If you would like us to conduct a webmeeting for team members that did not attend our presentation just let us know.