Thursday, March 21, 2013

Aone Day 2 Time Saving Medical Device Interoperability

I moved to the country....farther into the country than I already lived in my small rural town….I moved to “county”.  Outside the city limits, on acreage with a pond full of fish, land full of trees, and plenty of space to attempt to grow something larger than marble sized tomatoes.    We have learned about several things since we moved – most of which will turn into blog posts (bet you all are really excited for me to compare something to living on septic….and how much I miss the Pizza Hut delivery guy).   The biggest change for us has been time – it’s a drive to the nearest grocery, a couple acres to the next neighbor, etc.    I have started thinking – well that will take me an extra 30 minutes so I need to make this trip to “town” count.  I get very frusterated when I execute my shopping list incorrectly…I actually tried to make shrimp cocktail the other night because I forgot to pick it up – which didn’t work so I made a remoulade.     Time is our most valuable asset and we start to make decisions on what we will or won’t do based on how much time we have.
Yesterday, I posted about acuity management based on the diagnosis of the patient, and how it could be augmented by adding more information about the need that the patient is generating.   The time that you would save only happens if you balance the need index and the task list associated with caring for a patient.   Then clinicians can spend more time doing patient care and less time being interrupted. 
Today, I am posting about ways to use technology to save time.    There was a study released yesterday by West Wireless on the value of interoperability.  (if you go to this website you can download the full report in a PDF)  
Here is what I like about the report – it’s not written by a vendor…… West has nothing to gain by telling hospitals to invest in technology that makes medical devices interoperable with the EMR.  Second, it speaks to nursing workflow and the value of the nurses.  Did you know that nurses salaries account for $173 billion of heath care spending per year?   The report cites the 36 hospital time and motion study (It’s amazing how prolific that study has been in defining how nurses spend their time.) that indicates 35% of time is spent on documentation. (They uses a lower figure for their findings)   If I am making the correct assumption – 20% of a 10 hour work day is 2 hours per day per shift….that’s real savings.  It’s not 2 minutes or 10 minutes (always question when vendors give you savings of 10 minutes or less for a value add) The 20% they are referencing would allow for better patient care – more time at the bedside however they link it to a potential savings of  $12.3 billion dollars…..that’s where I have a slight issue.
Here is what I don’t like about the report – if I run a company that has people that I can save 2 hours per day doing a task that can be automated….the only way to “save” those dollars is to eliminate staff.  If you shift the tasks (remember yesterday’s blog – tasks associated with timeframes) then you can potentially have fewer people do the same “care.”  So, for example, to save money we would need to reduce staff by 1 which would equate to 8 hours of work tasks that need to be distributed throughout the workforce in some way.   Maybe I am looking at this wrong….but dollars and sense would say I have to reduce staff to gain the savings.
Reducing workload by 2 hours per day not only saves time but it also allows for a more time to engage with patients, do rounding, and patient centric care.   It allows nurses to engage in better patient care, more time at the bedside, and (as the study goes on to site) improve quality and safety.    The study sites a $36 billion dollar savings - $12 billion is nursing salaries.
Since it’s AONE and a number of nurse leaders have the ability to seek out new technologies that can aide in the automation of work flow of their nurses.   There are two that come to mind as industry leaders in the medical device interoperability (namely documentation)  Isirona ( and Capsule ( . 
Isirona is three spots down from Sphere3 (we are in booth 727) stop by and chat with them.
We hope to see you today at AONE we are at Booth 727 and would like to introduce you to Aperum a mobile dashboard that allows you to identify not only the need generated by the patient but their current perception of their care.

Wednesday, March 20, 2013

AONE 2013 Patient Need Based Acuity

My husband ran a distribution center  for 13 years.  When we met had around 150+ employees and through automation, software, and workflow modification was able to reduce the employee count to less than 10% of that number.  His guiding principal was to break tasks down and manage the individuals according to the time it took an average person to accomplish the task.   He and his team could watch a process and identify skills sets and aptitudes that allowed them to manage the team to accomplish the goal in a timely way with a low error rate.

As I have researched acuity it seems to be a similar structure.  The DRG defines a grouping of tasks and the tasks have an associated average time of completion (geeks call this a weight) and the assignment is made based on how many “tasks” can be completed within a shift.  Then the patients are assigned to the caregivers based on the workload associated.  That’s when I started to ask questions….are we treating nurses like assembly line workers?   How does this affect how we assign them to a patient – does our technology really support the mindset?
I have watched this process at a number of hospitals, interviewed a number of managers and I do believe that it’s much more of an art than a science.    In the last few years I have also observed several production facilities - from a Milk Farm to a Coffee Roasterie to Electronics manufacture.  The thing that jumped out at me……the product or coffee bean or electronic doesn’t drive any additional demand or strain on an assembly workers day.  There are outliers where a piece of material is bad but for the most part it’s pick up the widget, put it in a box, etc.   The point is – the widget doesn’t ask for ice chips when you are trying to complete other assigned tasks....the widget dosen't code.   

I get it – there has to be a way to balance the workload of the caregiver and acuity (aka task management) seems to be the best method.  I am not trying to disregard the years of research and work done in creating the tasks associated with diagnosis, etc  but there is more here than just a task list.  We at Sphere3 believe there is a way to capture additional information to make assignment of patients easier and managing the workload more effective.  Stop by and check it out.
I am eager to see at AONE this week how many vendors try to tout their technology as a way to reduce staff….be careful with those statements… should be an enabling tool the data should give the ability to manage the workload more effectively.  Patients aren't Widgets – Caregivers aren’t assembly line workers.   

If you would like to see how Aperum® can help your facility better manage workload of your caregivers stop by BOOTH 727 this week at AONE.

Wednesday, March 6, 2013

HIMSS Day 3... Day???

I have been on the road for a solid week now as most of us in the industry know kind of forgetting what my house looks like and hopeful that my boys remember my name when they see me.

Yesterday – I was able to enjoy the Cedars Sinai & Voalte presentation.  Most of you know I have an affinity towards Voalte..yes, yes, I am vendor agnostic but there are products that are disruptive, innovative, and extremely functional for nursing that shift the paradigm.  Or maybe it’s just the pink pants…..
The presentation was great – I tweeted it out and saw lots of people liking the thoughts.  Darren Dworkin is a real thought leader – I have had the pleasure of working with him and his phenomenal staff and have experienced firsthand their ability to grasp a concept and mobilize it (no pun intended).    Dworkin was humble in the revelation that Cedars has tried a number of different technologies to really find the right fits for their organization that also fit the fast changing IT infrastructure.  For communications devices they have landed on a more “consumer” type product – the iphone.    They have deployed more than 1000 devices.  I was most impressed with the statement that nursing came to him and said “we don’t want a batman belt” and IT listened to the end users and sought out a product that would not only be forward thinking but serve the nurses well.  He said that nurses don’t come up and tell you how much they love EMR but they do come up and tell you what a difference this device has made. 

My biggest disappointment yesterday was on the statements made by Epic.  I have debated whether or not to post anything (when you are a startup it’s better not to ruffle too many feathers…which I tend to do with Cerner on occasion.... ) but for the few of you who read my blog you know it’s my opinion. 
I didn’t like their statement.  I understand they got bad press because they weren’t sitting there on stage from the beginning.  I also understand that it appears that they are being strong armed into the party – twitter and speakers are brutal and love a good bit of drama and gossip..we are all grown ups and can see it.  I also understand how they could take this as a competitive movement…. 


Why not say – we weren’t invited to the party but we think this is an idea worth exploring because we believe in patient care.   Then take a look and if it’s not a great idea – make a statement then.  The point is can't they just sit down and talk about it.....somehow they got Neal to sit next to Jonathan Bush (which was visually awkward) but they were there willing to talk. 

I don’t know Neal personally – I don’t know the other men on the stage (I met Jonathan Bush…and wow still not sure what to think of him)   I have to believe – that somewhere each of these men have some part of them is good intentioned enough to believe that CommonWell is really what it says for the Common wellness of patients…….
I am weary – weary – of going to events and seeing so little about the patient – seeing the vendors latch on to analytics because it’s the next hot topic and it will “save money” and it will “improve your efficiency” – they need something new to sell.  I just want them to know you won’t be able to really love analytics  and serve the hospital well until you step back and see the people in the numbers. 
Ok, soap box complete for Day whatever it is....

Tuesday, March 5, 2013

HIMSS Day 2 & Histalkapalooza

My goal with HIMSS is generally to have meetings, see the vendors, and get inspired and rejuvenated for the next 11 months – being with 33K other geeks really helps me get refocused on what is really “innovative”.    However, as John Moore (@John_Chilmark) tweeted there are a lot of “Me toos” and at HIMSS.  It’s true you can see the wide  red ocean of nothing new being under the sun.  Or people thinking they are disrupters but really they are noise makers in an already disrupted space.

The booth that I was able to spend the most time in (ironically since I live less than 15 minutes from their Innovation Campus and pass it on my way to work every day – I hoped on two airplanes and a taxi to see them here) was Cerner.    Their Care Connect area was very impressive.  I am still a huge fan of  Mystation (even though it’s still not on an IPad where is should be).  I like the concept of driving more patient understanding and engagement throughout their care process.  This is something that could follow them home and be part of the home health model....not sure if she said that but that’s where my mind went.   Ashleigh showed me the Care Connect mobile device area.  It’s not easy to give a concise presentation that shows how really powerful a tool is and she did a great job.  If you have time stop by and ask for her.   The tool lets you see not only your patients but their status it’s a really nice blend of EMR with alarm notification information.  

I popped into the Hil-Rom booth – and got the standard – “who are you and why are you here”  after saying who I was I told them about the blog and one replied “yes only if you write nice things about us….”  (that should be the number one thing not to say to a blogger – it just makes it tempting to write less than flattering things….) I will do my best.  The challenge with nurse call is since it’s hardware and we live in a software world – it looks the same for a number of years before a new system comes out….same is true for Hil-Rom – it looks the same as it did the last couple of HIMSS.   However, they did make a statement which perked my interest – that “we don’t need middleware” – I think I am going to work on a post called “the death of middleware”.    It’s true – most nurse call light systems don’t need middleware but the implication from Hil-Rom is that they were middleware with the ability to automate information from their bed, their fetal link alert system, and their nurse call… that’s where you get the ding…’s not about “your” anything in middleware it’s about “their” everything.  So long as you have a single vendor ecosystem you can achieve what they described – kind of like how EMR sells their interoperability.  

I stopped briefly by Rauland - same as Hil-Rom the hardware just is what it has been for the last few years.  However, their newest software addition is Responder SYNC.  I have heard people call this single sign on...which I say kind of.  Sync claims to deliver on the promise that the alarm notification world has been talking about for years – Single Assignment.  Middleware claims this service by allowing a single point of assignment for multiple devices but as everyone knows that doesn’t really “sign you in” to nurse call – the lights and the tones do not follow the middleware assignment.   From what I saw - the greatest benefit to SYNC is the ability to sign on using EMR.  You are still limited in who can do this (Connexall and Cerner have made the interface) but evidently it's "open".     Stop by and ask about it - it's worth the converstation.
In general the floor seemed very steady but not busy – not the shoulder to shoulder crowd we sometime experience at HIMSS – but it was steady.  I did hear several vendors say there were fewer people….

My evening ended at the HISTalkapalooza event – I was not fashionably late.  I saw some amazing shoes (especially @TIMURDC which were my favorites) and was able to chat with lots of interesting people including the folks from Dr. First – I am going to see their booth today because it sounds amazing.   I chatted with Jonathan Bush about his lack of ability to score soccer tickets while sitting next to Neal Patterson….  I ended up on the front row of the prizes and was able to snap some fun photos....  the one of @Farzad_ONC has been retweeted a lot.  As I left, once again ran I into Judy from Epic.  Thanks for the invite Mr. H.

 If you have time today - I am speaking at the Burwood Booth 5019 @ 3:15p  come check it out.



Monday, March 4, 2013

HIMSS Day 1 Clinical & Business Intelligence Symposium

Well, HIMSS13 has started off…..interesting in both good and bad ways.  After having some hiccups getting my morning caffeine fix (thank you to the HIMSS staff that helped me find the Starbucks at the Marriott) I headed to the Clinical & Business Intelligence Symposium.  Then at some point twitter began to show signs of a problem....water....the symposium leaders announced that we could not  drink the water.  This wasn't too bothersome until they announced that they were manually going to be flushing toilets with buckets of water ....I suddenly wished I wasn’t so hydrated……some tweets made me laugh (especially @SteveHuffmanCIO) but I must admit the people running everything didn't miss a beat and handled everything very well.
For me the water issue - while concerning - didn't deter from the Symposium - more gave a room full of geeks something to talk about other than the weather.   The Clinical & Business Intelligence Symposium was a not focused on a specific “type” of data – it was a well-built process that took us from defining to analyzing to improvement.
Each presenter took a different segment of the process of defining, analyzing, and improving using data in a meaningful way.  They gave applicable advice that any hospital could use if they were planning to head down the business intelligence route. Brian Jacobs, Children's National, (and others used the same definition) gave the following definition.

 Workflow‐integrated information which enables healthcare providers to drill from reports into detailed analyses of quality, safety, efficiency, effectiveness, regulatory and financial aspects of care practice to identify poor quality, waste, non‐standard practices, under or over‐utilized services, & opportunitiesfor improvement.

The most surprising thing for me - all of the presenters recommended that the BI group of the hospital NOT be under IT.   That while there are governance's and processes that are IT enabled it should be reporting directly to the Executive Team.  (Namely the COO)  Also that the area seemed so nebulous and undefined - I appreciated John Glasers statement that we had a lot to learn and will continue to learn and adjust the field because it's just that new.

The room was pretty mild - except for one woman who decided to soap box about how far behind the US was from other developed nations.  The presenters handled it well and while I am not ethnocentric and understand we have a long way to go - it struck me wrong that someone would sign up for a course that was to introduce hospitals to the "how to's" of doing business intelligence.  The presenters handled it well and we were able to move on after her dissertation.

Like usual I met some great people –  and even have a devoted KC Chiefs fan talked into joining me for a Sporting KC game.  (BTW – SKC won on Saturday!) 

 Today, I am going to meet with some good friends and check out several vendors and give some thoughts on the blog – if you want me to pop by send me a Twitter message @Sphere3CEO

Also will be at the Histalkapalooza tonight!  So excited.