Clinical Transformation

The Art of Location

2012-01-23T14:27:00.000-08:00

Please turn left.....Please turn left.... The GPS lady repeated herself as I basically made a circle..... "When possible please make a legal U turn...." at this point I decided that my car was lost. How was this possible? She is supposed to know where I am at any point in time and direct me to go.... I think we have grown so accustomed to location accuracy that the idea of Lack of accuracy in hospital RTLS seems really strange.

The lawsuit that Centrak has filed against Ekahau is at the heart of location accuracy in a hospital. Products like Awarepoint and Ekahau are at a significant disadvantage to products like Centrak and Sonitor based on their ability to get bedside accuracy. Let's face it, if of you are including a RTLS system in your hospital you want to be able to do more than locate a pump in a room or cancel a call light. In the very least you want the ability to build into bedside location and accuracy. This enables the RTLS system to integrate to the EMR and provide meaningful integration of data associated with

The challenge is to identify where the ultimate accuracy needs to be - or what technology needs to hold it. Products like Capsuletech encapsulate it in their bedside interface. The neuron can easily forward it to the medical record. Products like Centrak are more independent and interface with multiple systems.

RTLS has been somewhat of a novelty "nice to have" product for healthcare. However, the increased need to be Lean and it's ability to support the legal processes has caused a real interest among hospitals. I will caution hospitals that the flash you see in a demonstration - moving dots on a page are really worthless without a quality reporting mechanism.

Leveraging the investment for real value comes from the ability to interpret the data associated with the movement, and utilize the information for meaningful automation of processes.

Let's just say mistakes were made......

2011-12-27T06:31:00.000-08:00

It was a great Christmas holiday with my family this year. There in front of me were all of the things I love – my kids, my husband, my parents, and mom’s famous hand decorated sugar cookies…..to say I “indulged” may be a bit of an understatement. Sugar cookies are like a gateway drug. They lead to fudge which leads to chocolate chip pecan pie and so on until I am like a desperate junkie looking for an IV drip of sugar. So, when I hoped on the scale (for the first time in 2 weeks) I realized the inevitable……Let’s just say mistakes were made this holiday season.

No worries, I know what it takes to lose – I have gone through the process before. It’s simple and only sort of about the ”what and how” – it’s mostly about the focus. Paying attention and being aware of what goes in my mouth then monitoring with a scale.

Isn’t that the truth with all improvement projects. Haven’t most hospitals been through a number of processes improvements that have gotten them back on the straight and narrow. Which makes me always wonder – do they really need a consultants? I was recently in a hospital that had a “No Pass Zone” which simply means if the call light above the door is on – go in. I have seen others like “KISS” and “Hello My name is “ the list could go on. These aren’t bad things – it’s always good to look at things differently. And don’t get me wrong consultants often know a very niche technology or methodology or have walked through programs so many times that their value is they are a lot like weight watchers – tell you what you already know but encouraging you to implement and holding you accountable for the implementation.

I know this is funny coming from a consultant, but I am a business owner who is always evaluating what is needed in the market. What the market has told me – don’t tell me what to do – give me the tools so I can do what I already know how to do. So, in 2012 our goal is to remove the complexity of the “niche” for the hospital and put the tool in their hand that allows them to stay accountable (or to get back on the wagon).

Our latest addition which releases in January is On-Call Fall™ a new module for Aperum™. We are automating something that was once our service. On-Call Fall™ was born out of a manual process we would do for a hospital to clearly document the Root Cause Analysis for each incident at the hospital. It immediately draws a very clear picture of the activity on the unit, patient room, and caregivers assigned patients. In an easy to use and understand way. Our initial feedback from a Quality Director “This used to take me days and now can be done in minutes”

All of this to say – there are sugar cookies on everyone’s path. Most of the time we know how to fix it but it takes time and energy. If the scale is not readily available the morning after the holiday season then how will we know we have fallen off the wagon.

As for me and my 5 extra pounds – it’s time to get focused so I can be down to my end of KC Slimdown weight by HIMSS.

Leading....

2011-11-21T07:54:00.000-08:00

I really enjoy watching soccer – though I am a relative newbie to the sport, over the past year I have learned a lot about the rules and strategy from my boys. One of my favorite things to watch is when the players are driving the ball down the field towards the goal. It’s amazing how they kick it to a seemingly empty space and out of nowhere one of their teammates will appear. My oldest tells me this is called “leading”. He explained “If you kick the ball directly to your teammate – where they are – then you will never make it where you want to go.” What a powerful statement for everything we are doing…..

As I watched the MLS cup last night, and read through some information on a few middleware companies – I wondered – who is “leading” hospitals and who is merely kicking the ball directly to them.

I will submit that if I am truly honest with you all – I think most are trying to figure out where to kick the ball. Many of them know there is more that can be done than what they are doing currently, but can’t really seem to identify the open space so that their teammate can kick the ball into the goal.

There are two things in that statement if you are paying attention. The first is identifying the open space – the second is so their teammate can make the goal.

They cannot identify the open space because they are too busy worrying if they have a “trail” someone trying to come up and steal the ball from behind them. (If they are playing Chance Meyers – they should worry) This watch your back mentality has stifled their ability to take a really good concept – middleware – and leverage it into a really powerful platform. Old data models and proprietary mindsets are crippling that industry.

The open space is not in your hardware or even some of your proprietary software….it’s the data, and your ability to understand it and to model it is at the root of the future.

The second part of that statement is “so their teammate can make the goal”. Have you noticed how few real teammates there are in health IT? I think it would be interesting if Middleware could accept their role on the field. They are the midfielder – the person enabling the end point device to make the goal. The midfielder is an interesting position – probably the most interesting position on the team because they play both offense and defense. They run more than anyone else and frankly their ability can decide the game. The midfielder positions the ball – leads – to the open space so the forward can send it in. The forward may get the glory of the goal – just like the end point device that the clinician’s use or patients touch is visible. The midfielder enabled that goal.

Just some food for thought on a Monday morning - compliments to the LA Galaxy on the win - thank you for beating the Dynamo.

Cerner Health Conference

2011-10-13T09:01:00.000-07:00

Living here in Kansas City everyone “knows” or moreaccurately claims to know something about Neal Patterson. As the iconic entrepreneur walked by mysecond row seat and took the stage for his Keynote at the Cerner HealthConference, I wasn’t sure what toexpect.    I tried to brush aside all thegood and bad I’ve heard and just listen to see if I could connect to him andCerner.

I expected a politician – slick with perfectly constructedand managed content. A more accuratedescription is comfortable, confident and owning the content.   Dressed casually, he appeared moreapproachable than intimidating. His speech style was more conversational thanchoreographed. The “picture in his head”is much more detailed than what he could share in the time frame.   He was funny and entertaining – much morethan I expected. I take time to describehim because when you read about what he said I want you to see this picture ofhim.   These are sound bites with myinterpretation.

“We must separateHealth and Care”
Cerner, throughout the conference, delivered the nextfrontier of their ambitious goals: Managing health as opposed to maintaining asick society.   The Solutions GalleryFloor was split into three areas Foundation, Organizational Excellence, andCommunity. When you entered thesolutions gallery floor the first thing you see is Foundation. Many times when I have talked to people aboutbeing able to interpret data we have to step back and look at the way it’scollected and the model in which it is stored. The Foundation is representing the “Care”. How hospitals document and gather theinformation that improves the care of the patient. Thoughthe pods were a little fragmented and hard to see the vision of how they allplayed together the message was one foundational platform to collect data.

If you think about the future of care it’s built on thefoundation of data. Think of it this way– if you build your house on sand there is no way to maintain the stability of thestructure. If you build your house on asolid foundation then expansion and stability are givens.

Across from Foundation is the next frontier the “Health”what Cerner noted as Community. Ithought the visual was quite nice – the past was facing the future.   We MUST start managing the wellness thehealth of not only an individual but of entire populations.

“What Steve Jobs didin regards to music – Cerner is doing with health data”

I found this statement extremely bold, but accurate. The challenge withmost leaders is to be able to drive vision, growth and domination in an industry you areoften seen as prideful. While I agreewith some of the pundits – a self comparison to the actions of Apple, thebenchmark for transformational innovation, is not the most humble of statements– the only thing I would throw back – isn’t it pretty accurate? Cliff and Neal took the documentation ofprocesses and have systematically transformed it into a billable standard. Andamazingly have driven such change into the industry that the government has seen the benefits of this documentation and will now subsidize their growththrough mandates to their core customers.

The thing I wouldchallenge Cerner on is this – Apple has the unique ability to take a complexidea and make it simple to use, visually appealing, and extremely easy to understand. On the BI side - I didn’t quite see that in Cerner yet – notsaying they won’t get there.   They havebuilt a firm foundation – collection and storage of data. The hard part is the presentation of the datain a useable manageable format.

Thecenter of their Solutions Gallery was the Organizational Excellence.   I stopped in to see their dashboards andexamine their process.   My take away andI hope this isn’t too harsh – they are just not there yet….a little bland andcanned.   My encouragement to them – the people who will be successfulin the BI space are those who can take the data and do what Neal told theaudience Cerner will do “We will future proof your organization” he said thatin regards to how the government will change reimbursement based on thecollected data.   Somehow you have totake your incredibly complex data set and deliver it to leaders in the hospitalin useable fashion.   Most people are not data junkies.

I will say this as a note to the other EMR companies – my money is on Cerner todo this first and from being first they will build the standard. If you are not all ready in the space you areall ready behind and if you are looking at only the EMR data set – you won't catch them.

The final two statements hit home for me and if you listenedto what Neal Patterson was saying they were actually quite revealing to who heis as a person.

“We are all mortalwith a huge instinct to survive.”

There is an underlying ambition to extend life and improve the quality of life. While not the most personable way to put thisthought to the audience – it was a directive.  From a technical standpoint this is the push to build PHR and build itwell. Driving home the point that wemust manage health creating a foundational platform like Cerner has done in the“Care” space for the “health” space. FixingPHR.

“If we know something and we know how topredict it in the future why aren’t we doing it?”

I am not sure if the crowd heard it, but I heard frustrationin this statement.   When you hold greatpower, knowledge, data……when you can see the future and you are pulling thosearound you to understand it…..when your mind understands that all thepieces of the puzzle are there and all we have to do is put them together…..it’s almost excruciating. It’s ablessing and a curse to have a vision.

When that type of driving vision is mixed with a personal experience it intensifies in a way that many won’t understand. Neal’s top 4 things hewanted to accomplish in this decade – one was “Save Linda’s Life”.    Linda, his sister in law, died fromSepsis.    Can you imagine being one ofthe most powerful people in healthcare and losing a loved one to a preventablemedical error? Knowing that the data contained in yourservers holds a key to change possibly annihilate this and other preventable medical errors?   With great understanding, knowledge, and blessing comes great responsibility - great responsibility engages great pressure.

In closing - Cerner is not Disney World – not what I woulddescribe as “friendly” place but they are knowledgeable and they are incrediblycapable and powerful. They will findanswers and save lives. I amnot sold on them as an organization, but after this speech I do see that the leader has passion and purpose.

The Immersion Principle

2011-09-26T09:25:00.000-07:00

In college we were required to take a foreign language to graduate,and if you read through the information you figured out that with oneadditional class and a study aboard you could get a minor. This was a no brainer for me – I got to go toSpain all in the name of education.    The purpose of the study abroad was to immersestudent into the language and the culture. Unlike a class which trickled information into your glass slowly withfinite precision allowing you to drink at reasonable pace – a study abroadthrows you into the lake with a small life vest and expects you to learnquickly how to tread water.

Have you been immersed in the culture and the environmentsof the people you are developing products for? Technologist, if you are in the business of creating a “business” is itreally worth it? Can you truly attachpassion to it? As for me and my house –we don’t think it’s a long term answer. Passion comes from creating tools that reallyhelp people.

I met some really great folks at the Connexall User conferencein Toronto.   One was Craig Martin an “ITGuy” from University of Michigan Health System. Craig and his IT team have immersed themselves into the different units togain clear knowledge of clinical needs.    Craig described his goal of disintegratingsilos and creating more effectiveness in development and decision making idealsaround purchasing and creating healthcare products.   The formula is really quite simple from ahigh level view - it’s to become theforeign exchange student on the clinical unit – to immerse yourself in theculture and life of the people who will be most affected by the choices ontechnology - the end user. On a hospital level Craig’s “ImmersionPrinciple” takes a person from IT and attaches them to the hip of a nurse toexperience a day or week in the life of someone who is directly engaged inpatient care. Craig said “We in healthcare IT cannot hide from thesometimes overwhelming things that go on in our hospitals.”

I am impressed by this team they were focused on creating environmentsfor better care by utilizing technology as an enabling tool. I can’t say that of every hospital.

Technologist – when was the last time you stepped foot in ahospital for something other than a sales call? Where does your passion for product come from? Is itin a paycheck or is it in the realization that what you are doing is making adifference in the lives of the sick and helpless. This which we do for the least of ourbrothers…….

After being in the hospital with #4 for a week – I willnever look at a call light system the same again. My passion is in the eyes of that sick baby.

When you immerse yourself into a culture – your perspectiveis forever changed.   Do you need aninspiration? Spend a day on the floor ofa hospital with a nurse doing nothing but observing – not selling, notcreating, just observe. Let theirreality become your reality.

A Coloring Page for Root Cause Analysis

2011-09-07T07:59:00.000-07:00

The other day #2 boy brought home a coloring sheet fromchurch. I asked him to tell me about hispicture. He went into a wonderfuldescription of the story of David and Goliath.  Goliath was colored blue similar to a giant smurf and David was wearinga green skirt. He had added grass,bushes, and even some small animals.  His hands flew through the air describing his well colored picture andtelling me in detail that Golliath blue from him blueberry pancakes and whyDavid was “late to the party”. As hetalked, I began to focus in on the upper corner of his paper to the small grayairplane. “What is that?” I asked. Tucker’s eyes lit up and he replied “That’sthe fighter pilot backing up David in case he missed.”

It's interesting when we begin see the outline of apicture and think we have the whole story.

As I have been reviewing RCA’s fromdifferent hospitals and researching the rebuild of the incident – I find itinteresting that many hospitals do not build the picture from data that is veryrepresentative of what is occurring in the room. Manytimes this is simply that they do not know that the data is available or thatthey have systems in place that the data is locked inside and notaccessible.

I was working with ahospital on a fall analysis - extractingdata to begin to layout the outline of a picture of what happened surroundingthe patient fall.   The patient requestsand responses are a lot like a blank coloring sheet. The outline is your basic patient requestdata and based on the patterns it began to paint a picture. The physiological alarm data, the medicationdata, and other bits and pieces began to color in the outlines to give a fullview of what was occurring in that patient’s room. Didthe patient have a critical telemetry alarm? Who received it? What were they doing?

Another interesting piece of the puzzle is communicationsbetween caregivers. I was having aconversation with Voalte’s Trey Laudedale about the value of the TextMessage.   As I was thinking about thisblog it occurred to me – the text messages are the hand drawn fighter jet inthe picture. Sometimes the outlines andthe information we are looking for does not create the whole picture. Sometimesthe picture needs to have more data then what we would normally consider tocomplete it.

So here is my tip for an RCA

·        Review the Patient Requests from the Nurse Call andResponse of the Caregivers
·        Review the Physiological alarm data that wassent to the Caregivers
·        Review the text messages between clinicians

Remember data is always available if you are careful to setup your technology correctly.

The 3rd Annual Medical Device Conference

2011-08-02T08:37:00.000-07:00

I am really excited about the workshop S3 is presenting at the Medical Device Conference. The presentation will take a look at how different types of industries measure effectiveness. We are in process of touring, interviewing, observing, and documenting several interesting places to bring value to the MDC attendees. We will be looking at Shatto Milk Company, US Toy's 750,000 sq foot Distribution Center, a Call Center, a manufacturing facility, and more. During the workshop we will use the case studies to determine how efficiency and effectiveness metrics were used to improve productivity, customer satisfaction, and more. We will be applying the learning to developing useful metrics (IndicaresTM) for your hospital's patient communication platform.

I will be blogging about some of the experiences prior to the class so stay tuned to learn more.

Sign Up - this will be a lot of fun!

http://www.tcbi.org/files/agendas/MDC3_Agenda.pdf

The ER Visit Blog

2011-07-29T12:09:00.000-07:00

As some of you saw in a recent tweet, I had to journey to the Emergency Room for a brief visit. While it wasn’t intended to give me material for a blog post – it has provided me with some thoughts that are worth sharing to my fellow technologists.

During the visit one of the questions I was asked by my fabulous nurse was "Who is your primary care physician?" This should be an easy one, right? Well, it’s easy if you have been to a PCP more recently than your last year of college. Yes, a little known fact about me is I have a terrible phobia of Doctors (ironic right?) As part of my discharge process both the Nurse and the Doctor said I needed to followup with a PCP. I told them I understood and thanked them for their help – fully knowing in my mind that I had no intention of going to see a PCP….that’s where sick people go and I am not sick…I am healthy, OCD about eating right, I don’t need a doctor. My husband had other thoughts and soon I was scheduled to see a PCP.

As I bemoaned the coming doctors visit I had a call from my conscious the voice of reason since age 12 (her name is Carrie) and without belittling me she made mention that you can’t improve when you don’t know where you start. Then, in a way only she can, she reminded me that I preach to dozens of clients and businesses. "Kourtney, don't you tell people there is a need for “baseline” data before starting an improvement process. Yet there is not one ounce of data pertaining to your medical care over the past 10 years." (other than my calorie counting iphone ap)

Sometimes, even when we are healthy we need a doctor. Technologist, do you make products that make sick hospitals better or do you create products that enable the on-going health management of hospitals? At some point isn't the goal for the hospital to be well - doesn't that somehow work you out of a job if you are always focusing on sick?

Even if you are focused on fixing a pain - How do you know that your technology or service has improved their facility? Do you know specifically what processes you impact and what things within the processes you are measuring that link directly to patient satisfaction and improved care? Can you measure them? Will you measure them? Or are you satisfied with the status quo technology buying cycle where people by a feature and are not guaranteed a result.

Technology enables a process. A process is NOT worth changing or implementing if the steps are not measurable and the data derived is not linked to a meaningful goal.

Technologist, if you are not providing a baseline that is documented with data directly from an existing technology prior to implementing a new technology then you are doing the hospital, it’s clinicians, and it’s patients a huge disservice.

In case you were wondering - There is value in driving the wellness of organizations as well as fixing a pain.

In the end – I did go to see a Primary Care Physician. To all of you doctors out there, I chose him on a few factors - he was recommended by someone I trust, time spent with patient exceeded the norm, but my final decision point for choosing him..... what made the biggest portion of my decision? He was part of the network of the hospital that I visited and he had automatic access to my electronic patient record from my Emergency Room experience. No phone calls – no faxes just a few clicks and there I was in all of my single entry glory. I drive 35 minutes to his office.

I know my Data is important in decisions and that on-going my data available to my care providers for logical diagnosis decisions is critical.

Reflections of a Former Fat Girl

2011-07-18T06:17:00.000-07:00

A wise CEO I know said that “Trended Change is the only Change of Value.” In terms that most of us can relate to – if you lose 10lbs and can’t keep it off then you have failed. I have been on as many diets as Oprah Winfrey and failed as many times. At my largest I was well over 215lbs, my smallest around 140lbs. Now, I am somewhere in between.   Whether it was a pill or a plan I would move blindly towards the current fad diet searching for my magic bullet.   I call it experiential learning, after years of failure I have figured out that the magic bullet does not exist.

The only way to succeed in consistent long term weight loss and management is by lifestyle change.   Which is a lot different than saying “I am going on another diet” A diet may provide a specific goal but it also implies a designated time frame, at some point we reach the goal. How many of us look forward to reaching the goal so the diet is over and we can go back to “normal”?

A lifestyle change means that you not only have identified the functional causes, but you have established a starting point.   A lifestyle change involves education and understanding, which may require technology and data. Once you have identified the functional causes you can hone in on the decisions and behaviors that are creating the situation and begin to make a change.    I applaud my friends at Cerner for the KC Slimdown challenge and www.cernerhealth.com if you haven’t taken a look pop on and see. If you are competing with Team S3 – good luck - I like to win and I really like Sporting KC. (It's one of the prizes)

At this point you may be asking – why is this CEO of a patient experience & safety analytics company writing a blog about diets?   Improvement whether its weight or patient experience is all about making a lifestyle change, and managing yourself after the change.     One of the reasons weight watchers works is because you are consistently watching your weight. Hospitals need tools to consistently watch their weight. I get on a scale nearly every day which some may find excessive but seeing the number motivates me towards doing the right things during the day.

S3 Aperum is the like the scale I get on each morning. It’s providing patient experience and safety data in a "weight management" format to allow leadership to make adjustments and alignments as needed. I would love to tell you it is the magic bullet, but it’s only part of the puzzle.   Like any weight loss or management program technology is a tool that enables us to succeed it’s not the tool that makes us succeed.    We have developed 4 key areas called pickle points where hospitals have issues surrounding patient safety and satisfaction. 3 of the 4 are not technology based – they are identified using technology but the root is in people, policy, and behavior.

For fun – if you have a “Slimdown” story you would like to share – please post it as a comment. We would like to hear of your success, your process, and on-going management.

The Patitent as a Person - my lunch with Clay Patterson

2011-06-16T07:55:00.000-07:00

The patient’s position in the HIT marketplace is that of data….that is a really strong statement but if you look at the Medical Record you know it’s actually a fact. The focused push to enable EMR in hospitals IS critical and has to occur. The mindset around it, to me, is often concerning.

Somehow the “data” has to evolve back into a “patient” who has to evolve back into a “person”.

As most of you know – my professional passion is the patient, the one who must take up residence within the walls of a hospital for a period of time. However, if we limit ourselves to seeing the “patient” only within those walls then we limit our view of the health continuum.

On Monday I enjoyed a wonderful lunch with Cerner’s Clay Patterson. I wasn’t sure what to expect – Cerner is an enigma – when people ask me about it I say “It’s shiny” meaning it’s very exciting, cool new innovations, amazing technology, thriving business, and flashy interactive gadgets. However, nothing I had seen to date gave me the feeling of heart – innovation, yes – incredible business, absolutely – heart, not so much. The heart I was missing was the patient – the person. Then I met Clay. His passion is getting medical data in a useable format so that a person can better interact with their health. This incredibly engaging and friendly man painted a picture of Cerner unlike any I had seen before – he shared a vision of people not products.

As he spoke, the picture that formed in my head was a giant sphere and inside of it there were stations of a person’s health journey. They include Hospital, Family Doctor, Medications, Tests, and even Diet & Exercise. (which I call DEA - which is a blog for another day) all surrounding the ability to research within the platform. The components within the sphere are interconnected and the data can ride freely between them.

The Sphere is taking information that is generally spaghetti and putting it into waffle format. When it’s in waffle format it can be searched, analyzed, cross referenced, and made into useable information. Think of it like managing your finances. Many of us keep our receipts in a box – or a wallet – or the center console of our car (or for some of us all of those places). You may have to dig them out if you need to return something, but the data of what you bought and when generally goes nowhere. However, if you use an online banking service then it automatically can analyze your spending habits and you can toss your little pieces of dispirit papers. The evaluation can lead to better planning, better habits, and overall better financial wellness. WHY? Because Data itself is not valuable – Data analyzed and applied into information is valuable.

But will adoption of this medium really occur. My prediction is yes – if you look at the slow recovery of our economy, you notice that people are spending less with credit cards and more with cash. Why because when you lose your home due to over spending you must take drastic measures to get things under control. People have had to learn to live within their means. Currently, the US is one of the most unhealthy nations in the world. Out of necessity a time is coming when we are going to have to reclaim our health. Sooner than later change will occur – not because there is some cool gadget but because consumers will realize that managing their health is the same as managing their finances.

The challenge will be education, access, and funding. How are we going to teach masses of people how to engage with their health while using a computer based tool? Encouraging people to take control of their health is only part of the puzzle. How are people going to get access to this portal? This is a really layered portion of the equation including socioeconomic, locations, etc. Who is going to provide access to this cool portal and who will “own” the data? Remember the data isn’t the value, the value is in the analysis….. when the data becomes information. As with everything else, it all comes back to who is going to pay for it? In a time when socialized healthcare is looming are we going to drive consumers to pay (not likely), employers, payers, ACOs?

If you believe that the patient is the heart of all we do then you must believe that the patient’s ability to interact with their health is critical to our success.

Stay Tuned for an exciting announcement from Cerner in the coming months.

The Walking Gallery

2011-06-09T07:24:00.000-07:00

I always wanted to be one of those creative artsy people when I was younger – something about their free spirit draws you into their earthy lifestyle. As my friend Carrie can attest – I did attempt to be “cool like that” but I have settled for just enjoying art and music. So, when I started following @ReginaHolliday I was enamored with her artistic ability, and something about her draws you into her world of colors and words.

I will admit – I didn’t know what to expect traveling to the Walking Gallery. Let’s face it I met her on the internet….squares just don’t do this type of thing….I had no idea what I was in for, and let me say the experience was incredible.

When I arrived at the Kaiser Permanente Center for Total Health – I encountered fellow Walkers @MatthewBrowning and @FairCareMD we were all lost but soon we found our way to the “Gallery”. There were jackets all ready walking…I was challenged to find my own as I began to lose myself in the art. Soon I found myself standing at a table receiving my jacket, but strangely it wasn’t the jacket I sent – the jacket had become a window into my life for all to see. As I stared into the face of my sick baby it was incredible how she captured him – my Noah. I put on my jacket and found @ReginaHolliday. She recognized me immediately and threw her arms around me. It was like seeing an old friend.

As I wandered through the room I met @technicaljones and learned about his mothers fight for life. His jacket with a “SuperMom” who fought through illness to be there for her children. Across the room I spotted @epatientDave, he moved through the room like a rockstar with people reaching out and talking. David Hale incredible Matrix inspired jacket with a red pill representing all data and a blue pill representing us accepting what we are told to be truth from doctors. We marched together walked sharing the challenges of weeding through data with limited budgets. @MatthewBrownings jacket (one of my favorite paintings) showed the harrowing experience he had with his wife and their first child. @tmit beautiful jacket in support of the #caremom movement. The evening went on and my story repeated itself over and over sometimes without my mouth even opening – to people who understood. I didn’t have to prove myself as an expert in my field – I didn’t have to justify how I knew anything since I am not a clinician or doctor. I just got to be a mom with a story about healthcare.

My story – we were in the hospital and Noah vomited – I pressed my button and no one came….my company installed the button years ago – I thought it was broken……it wasn’t…..the difference between my story and most is when I went to the hospital they acted. They didn’t just act – they talked to me and made me part of the solution. I was able to meet other patients they call “frequent fliers” and their parents. I was able to work deeply with the technology team. I took my story and I created because that’s what I do. Talking only will get us so far – words are meaningless without action.

Look at Regina – she is a preschool teacher – she is an artist – who would listen to her? Most artist are seen by business people as creatives who can’t work so they paint….I laugh at the thought when I think of Regina. She uses her powerful medium as a tool to reach the masses – as a method to spread her gospel – as a leader to those of us who don’t know how to define our voice. Let me tell you, some of the most powerful people in healthcare listen to her. If you are in healthcare and you don’t – you are missing the boat.

I have shared with very few people recently how tired I am – fighting to build a startup, being challenged by healthcare to prove it, traveling every week, and night time kisses through video phone – after this event…..I am inspired…..I am energized…..and I know it’s all worth it.

If what I do impacts one life – it’s worth it. Let that be your thought today. Be inspired by the stories – not by your technology.

An Industry in Flux

2011-06-03T13:05:00.000-07:00

It strikes me that there are some fascinating industry changes occurring in the “middleware” space and more are on the horizon. Interestingly, its not aggressive competitive behavior - it’s shuffles, buyouts, ReOrgs, partnerships, major players leaving major organizations, and simply surprising business decisions.
Dramatic human capital changes as opposed to dramatic technology change.
But what does it all mean – is it that alarm notification tools are not doing the job they set out to do, is it that the alarm notification tools promised too much and delivered too little, or is it that creativity and design ability was not balanced with well researched deployment on the cause and effect of the disruptive technology.

My thought is well intentioned creative individuals saw an opportunity in the marketplace that allowed the perception of faster communications. (If you haven’t figured it out – I believe most people are well intentioned.) The crux is more than 10 years after Michael McNeals press to market with the game changing Emergin platform – the cluttered market space is starting to relax and mature into a “what’s next” mentality.

Major platform changes are needed to meet the demands of a healthcare ecosystem that has a broader expectation of what information needs to go to which person. The new mantra is not about “alarm notification” it is more about “information distribution” and “decision support”. “Notification” brings with it the thought of disruption while information distribution and decision support bring the picture of well balanced and focused approach to patient care.

The problem is alarm notification has not reached maturity before the next change. What I mean by that is we have started to move to a new thinking without truly looking at the data associated with the “old thinking”. We have no base line comparison to clearly identify how information distribution will affect the ability of the clinicians to serve better. The industry has no clear baseline of information to compare the emerging decision support capabilities of the patient communications platforms (aka Nurse Call) with the old way.

Technologists, ask yourself:

Are we making things more flashy, exciting, techy because we can or because it’s right?

I challenge Nurse Call providers – Middleware developers – and even you EMR players who get in the game to prove it.

Show us how a change to status quo solves….if it doesn’t make the patient’s and caregiver’s lives better in documentable, data backed ways – then don’t waste your development dollars.

My prediction – major change is coming – large players will be motivated to change their focus and new players will be motivated to create better platforms.

A Day with Nurse Sue....

2011-05-15T16:52:00.000-07:00

Learning about new products has always been a lot of fun for me, and whenever possible I like to go to the company and experience their product and meet their team in person. Just to be clear I am not a journalist, and everything I blog is my opinion. So, this is the story about my day with Nurse Sue.

As I entered the doors of Capsule Tech I was greeted by a friendly a woman and welcome sign displaying my name and company logo. In the corner was a larger than life cardboard cutout of the Nurse Sue Avatar, and down the hall came the real Susan Niemeier. She is an adorable red head with a bright midwest smile and matched warmth. There was no formality just a friendly hello and then off to get some coffee in the break room.

Our first order of business was a tour of the office. It’s not flashy – but nice – a large space with cubicles and a few conference rooms. Nurse Sue pointed out the large black and white pictures on the walls were their colleagues in Paris, and in Paris they have pictures of their colleagues in the US. Every person seemed busy but happy and frankly excited to be working on challenging projects. A few had Avatars which made me write *add S3 K Avatar to the development list. I internally sighed with relief. I have grown weary of the corporate stodginess and the competitiveness of HIT.

As we settled into the conference room, Nurse Sue delved into her passion for clinicians and how to drive more time at the Point of Care. She bubbled about the product she manages and how she believed it would – make life better. We dove in and vividly she relayed the story of “her” MVP. The Mobile Vitals Plus is really a simple product. It’s a box (isn’t everything ) that takes the vitals collected by almost any mobile vitals device (demonstrated with the GE device) – it automatically collects the data, allows the clinician to confirm, compiles it in a server, and then sends it to the medical record…any medical record.

MVP was created for Nurses by Nurses with influences from – not technologists – but Human Factors Engineers. The device is ergonomically designed to have the most beneficial colors for reduced eye strain to the most beneficial placement for the log on/off button. I was very pleased with the company’s commitment to not just make a product but make one that was easy to use. The presentation ebbed and flowed in and out of conversations of industry, family, business, and baseball (we were in Boston). I ended the day thinking – wow, these are good people trying to make a difference.

It is clear that Capsule is a darling in the industry. But Why?

It could be their Switzerland Status. They closely align with many EMR companies, but are married to none.
It could be their well thought out – well researched product. Nurse Sue’s commitment to research to make sure the product truly makes a difference is fed from her history of research on projects such as the Kaiser/ Ascension Time Motion Study and the ever famous Proclamation for Change. This woman gets data like few I have met.
It could be their people – many who I have termed “the good guys”
It could be a methodically planned approached to product, implementation, and test…continuously improve. Wash – Rinse – Repeat.
It could be their culture. Friendliness, Transparency, and a non-smearing attitude. They don’t spread FUD (my favorite new term from @VoalteTrey) Fear Uncertainty and Doubt – they just are who they are.
It could be that they are small and in small companies ideals and vision are easily disseminated amongst the team. There is no clawing to the top – you just walk down the hall way.

It “could” be anything – end of the day this will make life better.

This is my quest - if you have Healthcare IT products that "Make Life Better" I want to know about them. I am interested in learning and sharing. If you are a hospital with a process that will "Make Life Better" for other clinicians using HIT - I am intersted in learning and sharing.

Today.....

2011-05-09T09:24:00.000-07:00

If we are honest with ourselves there are times in our career where we grapple with the business verse human aspects of our products. We seek balance. We balance making money with helping people. We balance “marketing messages” and big picture vision with everyday life in the weeds. We balance heart and commitment to being the change with the work that must be done.

On the 3 year anniversary of Sphere3, I find myself evaluating the balance of building a start up and staying true to my commitment to Make Life Better for Patients AND Caregivers. Today – I focus on the Caregiver.

There were two blogs that caught my attention over the past few weeks. One blog was noted by Paul Levy called “Medical Margins” by Josephine Ensign. Josephine tells the story of a RN who had made a medical error – her blog blasts the hospital for the inequality of discipline levels between Docs and Nurses. Really what struck me was Kimberly Hiatt – a veteran RN with all in all good approval ratings – was dismissed for her error of administering a lethal dose of medication to a fragile NICU baby. After which she committed suicide. (Note there is no public information about linking her suicide to her dismissal)

I struggle with the balance – a bad day for me is I publish something on the blog that irritates someone or my team misses an internal development deadline. (which is really a bad day for them) A bad day for a RN is someone could be seriously harmed or die. Do we expect perfection? Are we being realistic to apply “lean six sigma” principles to a human based profession – patients are not cars and clinicians are not assembly line workers. The patient advocate side of me really wants to drive every ounce of error out of existence. What if that error was my child – what if that “bad day” affected my parent? Aperum™ was created to identify when workload balances are too great. Is it enough? Do we find that self reporting based EMR systems and other gadgets and gizmos really make a difference in the day of the RN?

When my brain went into over drive trying to grapple with it all another great blog was posted – this time by a Nursing Student named Jennifer-Clare Williams of my home state Missouri. Her heartfelt desire to be the super hero that “saves the world one patient at a time” brings back the sovereignty of unadulterated hope. The blog is beautiful – showing her true desire to be a help to those in need.

I replay my mistakes (“No wonder your patient was uncomfortable—you put the bedpan under her backwards!”), I cry more than I ever have in my life, and I continuously wonder how on earth I will ever learn everything I need to know.

But there is good news. I’m surviving. And I’m learning that perfection is unrealistic. That nursing really is a fluid profession: things are constantly changing, and that’s a good thing. That there are very few things that I’m going to master on the first try, or heck, even the 10th try . . . but that’s ok. I’m learning that the patients who are, let’s just say . . . unkind . . . are not launching a personal attack on me, but are facing a difficult set of circumstances and are unhappy with the situation.

The inspirational heart of this young woman pushes me forward that every nugget of information we can provide back in a visual meaningful way can make a difference to improve her ability to provide care. The S3 team has made linkages to reduce readmissions, show documented improvement to patient satisfaction scores, reduce fall rates and errors, and do all the big picture money saving things that we need to do to sell a product. That’s not what drives me – and technologist – EMR person – industry specialist – big picture lingo laden with catch phrases shouldn’t be what drives you either.

What drives me should be the thought that today – we made life better for Jennifer because we were able to identify that her workload was so great that she may make an unintended mistake. What drives me should be that today we were able to provide information to the charge nurse that over stimulation was increasing the propensity for medication error beyond capacity – so she can engage and make sure her clinicians are in an environment where they can care and not run. What is your “today” statement? What did your product, software, service do today to Make Life Better?

For a moment, stop and focus on how you can make life better. Stop thinking about selling the next big deal and start thinking about the people you are affecting.

Thanks to:

Josephine Ensign’s “Medical Margins” Blog
http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/#comments

Off the Charts AJN Notes of a Student Nurse: A Dose of Reality written by Jennifer-Clare Williams http://ajnoffthecharts.com/2011/05/04/notes-of-a-student-nurse-a-dose-of-reality/

Everytime......

2011-04-27T06:30:00.000-07:00

It’s funny when people know what you do how the conversation trends towards that topic. One of my dear friends mother has been in the hospital for over a month with kidney failure and infection. Tammy has been the epitome of advocacy. She called me one afternoon to share the trials she was going through. Pouring her heart out to release the pain of watching her mother suffer. Before she got off the phone she said “Make sure to tell your friend – the boss here – how great our experience has been – how great these nurses are in making sure we are taken care of every time we need something.” My friend, Damond Boatwright, the CEO of Lee’s Summit Medical Center has done a great job of cultivating a culture of caring staff.

I began to think about that statement “making sure we are taken care of every time we need something.” I know that hospital – I know the technology, the staff, the design, the process, and how they manage their care. Managing by metrics is only part of the equation – the other half is care.

I had a great post written for you all – about metrics and managing by numbers and pushing for results. It was insightful and interesting with recent data from a new hospital. Exploring Dynamic vs Intuitive responses based on the “need type” and weighting averages. Numbers and the quantification of expectations – it was brilliant……..but listening to Tammy reminds me - it's only part of the solution....have you been reminded today? If you haven't had a recent hospital encounter - technologist, you need one. Don't let the math cloud the reality of what we all do. Don't let the flashy exciting technology be the cetner of your universe. Don't let competition between bitter rivals reduce the ability for the patient to have the win. I want to win as bad as the next guy - but I don't want to win at the expense of the patient.

Maybe some of the best things I post have nothing to do with fancy math (or as Steve says "Algorithms") but have everything to do with the human condition – the patient as a person – the clinician as a giver.

Who would think a geek could feel?

Press Release on APERUM

2011-04-18T08:41:00.001-07:00

Kansas City, Missouri (April 18, 2011) -- Sphere3™ Releases Aperum™ targeting patient satisfaction Indicares™ within U.S. Hospitals. Sphere3™ is the first to reach the market in an emerging category of software targeting patient satisfaction and safety during a hospital stay. Since it’s inception in 2009, Sphere3™ has focused on nursing activities that indicate quality of care. Aperum™ uses data found within standard transactions of the hospital’s patient communication platform to provide performance and risk indications.

The Company’s proprietary algorithms dissect the data path and normalize basic elements for analysis related to patient requests and resulting caregiver responses. The resulting Indicares™ within Aperum™ reveal actual caregiver performance against hospital expectations for performance based on patient needs by category. Further analysis within Aperum™ reveals behavioral patterns for patients and peak times for certain patient needs, offering new insights in caregiving and staffing models.

“We are very excited about how Aperum™ can advance the suite of clinical management tools within the hospital,” says Kourtney Govro, Founder and CEO of Sphere3™. “Most CNOs and Directors of Nursing manage staffing and clinical care decisions based on subjective data. Few have access to the necessary technical expertise to evaluate the real and changing patterns of patient needs and caregiver response.”

Hospitals invest heavily in the nurse call systems and clinical alarms found in a patient’s room. These devices are the primary method in which patients can request assistance from hospital staff. In some cases, the systems have advanced to “sense” patient needs based on physiological movement or biometrics and automatically generate a request from the room. Although very technical and advanced in their design, the platform makers are more about devices and less about offering critical management information. Yet, the systems are rich in data and capable of revealing behavioral patterns in patient care.

Govro offers, “Our progress was initially challenged by the lack of understanding for the information available from resident systems. We are bridging the knowledge gap within the hospital by creating a common language for this data and the behavioral patterns revealed within it.”

Govro believes a number of drivers will aggressively move hospitals to using this new category of software. For example, Lean Principles for staffing target more flexible movement of staff as needed throughout the hospital without compromising the level and quality of care. Objective measures of patient needs, priority, wait times and associated risks should assist caregivers and managers in assigning the right staff at the right time to a floor.

“Patient safety is at the heart of this balance,” Govro says. “Patients are in the hospital because of acute needs. The simple act of getting out of a bed unsupervised creates the risk of a fall, which is a costly event for hospitals.”

Govro explains patient falls are closely measured by hospitals. Because the event is considered avoidable, Medicare and insurance companies deny the associated costs of care linked to the fall, including additional days of stay in the hospital. According to a study completed by the Washington University School of Medicine, St. Louis, MO with Barnes Jewish Hospital, St. Louis, MO in 2004, the typical patient fall occurred during activities unassisted by staff (79%) in the patient room (85%)1.

The makers of patient communication platforms place continue to investment heavily in more accurately categorizing and routing the patient needs to caregivers. Sphere3™ has filled the information void by developing the necessary enterprise level management software to manage the aggregate of needs with caregiver availability.

“Although Version 1.0 is a retrospective review of the data,” Govro says, “future versions will move data to real-time and allow for immediate care management decisions.”

1 Characteristics and Circumstances of Falls in a Hospital Setting: A Prospective Analysis. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/)

How to Define "Help"?

2011-04-05T08:05:00.000-07:00

When you order BBQ in Kansas City – you don’t just order burnt ends – you can order chopped burnt end sandwiches which can be sauced or dry – you can order a platter which can be sauced or dry – you can order it as a combo. Then there are the side dish selections…cheesy corn, beans, slaw, pickles….

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?”

The interesting thing about the next section of the question is its tie to “help”. What defines help? In most hospitals if you press the “call button” there is one “button” it’s big and it’s red. You can figure out it’s for “help” even when you are groggy or sick. The newest fad is to add more buttons – which is great for me would work. I am used to self selecting. I self-check at the airport, I order meals and movies on my Iphone, and think nothing of the lack of real “service” that is providing.

My mom (who is 62) would think the extra buttons were a novelty. She would laugh as she tried to find her glasses to read the small words on the extra buttons “water, pain, or toilet” then ask me if she pressed toilet does that mean she has to go or that she went. She would never press the pain button because she rarely admits when she is in pain. She would always press the red button. (Please no hate mail here, I am generalized a generation based on my experience with my parents)

My grandma would press no buttons….even with her glasses she probably couldn’t read those little words, and she would look at the crazy “paddle” and say why are there so many buttons. Then she would look at me and say “Bo, go get my nurse” I would either press her big red button or I would just walk out of the room to find the nurse.

The point is defining “help” is challenging in a healthcare environment especially in a patient self-directed self-selection process. Evaluating “help” is even more challenging. There are numerous options and building the paddle would be a challenge. Ironically, in an industry move to be more efficient and direct patients needs to a caregiver using a decentralized design method – we lost a great deal of the data modeling. There is no way to track the request specifics in an automated fashion in a decentralized design without additional manual steps (which frankly defeats the purpose). There is no way to get specifics but there are request patterns.

There are ways to collect this request data – get a good understanding – then design you call processes. Just to take it a step further – we can tell you how many of each type of request hit when, how many were answered in your desired time frame (or what your average time frame), and even how the caregiver interacted with the request. If there is a hospital interested in knowing how to create a real patient centric care model – call us – we are looking for partners in a study to make life better.

The current analysis structure (at least what we have found published) looks at qualitative information – how many focus groups does it take to get to water, pain, and toilet? What’s crazy is all the information you could want to design the paddle or better the process is locked inside the nurse call system….if the hospital has a reporting package because most nurse call systems are built like archaic life safety tools with proprietary databases.

What’s more – I am the patient – I want to know how quickly you responded to my need – I know the information is there and frankly I know how to get to it. Stop and think how valuable that could be though - if I am going to do a survey (qualitative) to evaluate my care would it be better if I knew on average you answered my call light within 30 seconds every time PRIOR to me filling out the survey. Sometimes it feels like longer – but when you KNOW what the time is aren’t you more patient….Do you think that would influence my decision on whether or not I had good care?

But what do I know…. I am just a mom who had a sick baby and instead of blasting a hospital for a bad experience – I dug down to figure out how to solve for a pain I felt during a hospital stay. It really is that simple….by the way so is the data.

"The Immediacy Conundrum"

2011-03-26T06:56:00.000-07:00

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button.

“after you pressed the call button”

Patience is not in abundant supply at Gate’s BBQ. When you walk in the door they shout at you - “Hi May I help you?” you must know to yell back very quickly – there is no patience for Umm or questions – by either the counter staff or the patrons behind you. You must shout back – quickly with full confidence - “Yes, I want a burnt end sandwich, fries, and a Ice Tea.” The food arrives to the counter very quickly – you can watch the man through the cook window constantly chopping and slicing meat to serve – you know it will be good, hot, and fresh.

The Gates atmosphere creates an expectation for an immediate response to questions, there must be no hesitation. I have reviewed reams of data from nurse call systems and 4 years ago when we started – the average wait time before exit of the bed for a patient was about 1:13. Now we see a majority falling under the 30 second threshold. Are people getting more impatient? Maybe…

We live in a world where as soon as I want to be connected my expectation is to have connection. The problem with “after you pressed the call button” is many patients expectation is immediate. Geeky techy stuff – if you have a nurse call system older than 2 years and you are functioning in decentralized – there is a lag time. Depending on the specific system – it can be an “eternity” in terms of immediacy. This is not a reflection on caregivers, it may actually be a reflection on the implementation of technology. Yet, caregivers are under pressure. Just like Gates, the health system and government is creating an atmosphere around hospitals that require immediacy. By its ever- more acute care criteria for entry, there is an equal expectation for immediate response?

Let’s talk solutions to the immediacy conundrum. The Decentralized Nurse Call craze of a few years ago is beginning to subside as hospitals realize the limitations of moving the patient call to an individual who is mobile and has variable task responsibilities on the unit. Decentralizing or sending the “Normal” patient call to a wireless device does not solve for immediacy – it’s actually the most difficult methodology for nursing to utilize because there is no immediate feedback on volume of requests or the “queue”. Immediacy requires the “queue” to be low and the person answering the call to interact and disconnect quickly. Think Economics - Basic Supply and Demand Theory – if you have too many nurses and not enough calls then you are fine. However, what is generally the case at documentable specific periods of shifts, if you have too many calls and not enough staff then you are going to get low scores on question 4.

The trick is the patient has a need and since they are not in their home environment and have very little control of their surroundings – many “wants” become needs. Not to mention the variation in expectation. The patient requires an immediate interaction – not an immediate solution. This is a really important point – so don’t miss it – the patient needs an immediate interaction and a sense that their need has been identified and help is on the way. The second key to this is you must deliver on the promise. So, if you have pushed your button and someone has quickly told you “help is on the way” then help must really be on the way. The only way to manage that is to develop a methodology to alert the needed caregiver with a specific request – data rich. Then Mobilize AND Monitor their action towards delivery. What does this mean – the person interacting with the patients request should be air traffic control – they should be able to monitor the total quantity of requests and estimate a delivery time. If there is a change in delivery time – maybe the patient should even be notified…..

BBQ and Nurse Call

2011-03-22T07:23:00.000-07:00

I have noticed that several of my blog posts involve food…diets…etc It’s a true statement that one of my vices is really good food – not pretentiously good food – just plain good food. My pallet is not well refined, but I know when something tastes good and when I am served well.

One of my favorite restaurants is Jack Stack BBQ. Disclaimer: I live in Kansas City and talking BBQ is similar to talking about religion. There are alliances to BBQ that span generations of families. So, to be fair let me list the other greats in the Kansas City: 1)Gates – where “HI MAY I HELP YOU” is shouted at you when you walk in the door, 2) Arthur Bryants - where sweat is integral to experiencing the meal, and 3) Oklahoma Joes - only loses points because of the name.

According to the Kansas City BBQ Society (http://www.kcbs.us/ ), Carolyn Wells Ph. B, tells me it is measured on Appearance, Taste, and Tenderness. To achieve success in competition you must have quality in 5 areas: cooking unit, meat, seasoning, fuel, and most elusive, expertise of the chef.

For those of us with the untrained tongue, the challenge with BBQ is all data to assess are qualitative judgment’s – meaning, based on how I feel at that very moment I have made a judgment call on its goodness. Don’t get me wrong - when you taste a crispy chopped burnt end sandwich with just the right amount of salt, spicy sauce, and for me Cole Slaw on top, you will know what heaven will be like and I challenge anyone to say it’s not good.

So, what does BBQ have to do with Nurse Call? I look at Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button. I think would I ever answer "Always"?

One of the most concerning aspects of healthcare is measuring qualitative – questions based on “feelings” without creating a reasonable expectation for delivery. For example, asking “Did Jack Stack taste good?” to a random selection of people. (I have heard you East Coast folks think you know BBQ.) My perception of good BBQ is different than a person who prefers Memphis “Dry” BBQ , a North Carolina Vinegar based BBQ, and Texas hunk of meat they call BBQ.

In the next few blog posts I plan to break down question #4 and dig through how we can really expect to build continuous improvement and value from a “feelings” based survey question. How hospitals can use data that is existing in their facility to create quantitative Inidications of Care or what we call IndiCares™.

Just to get you started:

“During your hospital stay” this is a variable length of time. A metric based on an inconsistent variable is not easily understood and does not lend itself to being fixed. The time frame “your hospital stay” could be 1 day, 2 days, 1 week, or in a rare situation 1 month. The variable also could be a “frequent flier” as my favorite Children’s hospital calls their recurrent patients vs a one time in five years visitor. Their time may be short and consistent or random and long.

We have evaluated data from over 30,000 patient days and the interesting thing about the data it is until you break it down by specific consistent measures there are very few patterns. You have to stop looking at the data as Spaghetti and create a waffle structure.

A parting thought - If the data is barcoded according to which patient submitted it – why not just look at their nurse call statistics after their stay in comparison to their responses? If you are a hospital and don't know how to do that - call me or email me - I will tell you how to get to your data.

Be the Change

2011-03-15T06:53:00.000-07:00

I know you were all expecting a blog post about Patient Communications – I will post it soon. Many of you have seen the tweets about Joella’s blog. For those of you who haven’t she was a beautiful little two year old girl who was suddenly diagnosed with Leukemia, and passed away on Sunday. I read the inspiring blog posted by her family, and prayed for them. The “Doer” in me kept saying what more can I do to help? I was talking to my tree hugging hippie little brother about her and he said “Bo, why don’t you join the Bone Marrow registry?” The brilliant scientist that I am – I replied “Grant, I am all ready an organ donor on my driver’s license” After he quit laughing he said “Dude, Bone Marrow is like a renewable resource in your body.” Since he used to work for the Red Cross – I thought he could be correct. So, two weeks ago – I started my research. Like every good geek I started with Wikipedia – which is never wrong – and it confirmed Grant’s statement. Then I found www.marrow.org if you haven’t been to this site I encourage a visit. I registered on the website – they sent me a 4 pack of swabs – I swabbed my mouth at my Kitchen table – then sent it back in their postage provided envelope. Let me assure you – I don’t like needles, blood, or IV bags – I am a soccer mom with 4 very active little boys and in my spare time I run two companies. Time is not in grand supply, and I am not a big fan of pain. However, if one life is saved – it’s all worth it.

Be the Change is a movement that transcends financial ability, race/ethnicity, and even religion. Though I do believe in my faith it’s a directive not a recommendation.

I was inspired recently by the move of KC Sporting – our local soccer team. Soccer, unlike many sports, has few borders and internationally reaches into all socioeconomic levels. KC Sporting recently named their new stadium LIVESTRONG field, the first time in history a professional sports team has taken a not for profit as their field namesake and not the sponsorship of a major company. For those of you who don’t know – two of the team’s owners are men who started Cerner. If prideful ambition had been their desire, they could’ve paid homage to their achievement and we could’ve had Cerner Field. Instead they chose to be leaders of change and part of a larger social awareness movement.

So, how do you plan to live your life in a way that demonstrates the change to society you want to see. You can tell a bucket of water to overflow – you can point your finger and speak beautiful words to the bucket and it will never overflow. You can actively pour water into the bucket and watch the results occur. Teaching, Preaching, and Telling will not inspire movement – Acting, Living, and Being create movement.

Being the Change does not require you to give masses of money, it does not require you to give hours of time, but it does require you to stop and make a conscious decision to make an impact on the lives of others.

Sometimes all it takes is a cheek swab…..
http://www.marrow.org/ click the link get the swab

A Confession....

2011-03-12T06:57:00.000-08:00

A confession – focusing has never been my strong point. Some call it ADD others call it visionary, but mostly it’s just when I figure the puzzle out I am done. Since HIMMS my mind has been focused on ACOs, PCMH, and other items and different ways we can apply technology to those models to revolutionize healthcare. As I presented this long term vision to my team and watched the color drain out of their faces as my hands flew through the air – I realized in all fairness – the future is not today.

Today we have a set of technologies that must be leveraged to migrate today’s abilities with tomorrows vision. A more powerful vision then creating something new is to create a path that shows how to get from old to new. Reinventing the wheel in the healthcare environment is not necessarily the most effective or safe process.

So, the next few blog posts will be about today’s technology but with a twist. In the spirit of collaboration - I hope to drive a conversation (whether on my blog or in your hospital) about what the technology today can do above and beyond it's basic "job".

The first blog post series will be about Nurse Call - it can tell us immeasurably more about the patient then previously determined. Nurse Call - if applied correctly - can be an effective tool in mitigating risk associated with HACs. Nurse Call is a workflow enabling tool....And locked inside that box is data that will change the way you manage capacity and the patient stay.

Stay Tuned....here we go – hope you enjoy……

The Recipe Matters

2011-03-07T09:51:00.000-08:00

I love a challenge, and recently I have taken to making cakes. I am not Duff or Carlos, but I am determined to conquer the cake. My weakness is I don’t like recipes – ok, so I don’t like being told what to do, and I feel a recipe is just Betty Crocker’s way of bossing me around. When cooking, her recipes are general suggestions, but unfortunately in baking, it’s an order.

The thing with a recipe in Betty’s book is someone experienced has documented it – it has been verified – and it has made it to the general public. A recipe is successful because the common language used in each step. We are taught in grade school the standard terms of measure – cup, teaspoon, tablespoon, etc. We are also taught time – minutes, seconds, or hours. We are taught by our moms how to “preheat”, and we are taught by the Food Network how to “fold” in an ingredient.

Documentation of anything requires standard terms and common language. In a recent revelation in speaking with others about my professional passion for clinical alarm data and the picture of patient needs hidden within it, I found that there is not a current standard terminology in the arena of clinical alarm design. Therefore, I am proposing one. Just to set the minds of my readers at ease – Patient Communications Platforms are in my blood. You could say my youth encoded a understanding of clinical alarms into my DNA. I went to my first “nurse call” training before I could drive a car, and had a doll house with RTLS. I am not a novice, however, I am not so proud to think that what I’m proposing can’t be improved upon. Actually, I’d be thrilled if this proposal sparked a debate. So,I challenge all of my readers (all 700 of you) to comment. Collaboration can only occur if we are not so prideful to think we are perfect – if we can agree that little companies have as good of ideas as big companies – if we can solidly stand by saying we must create things for the betterment of healthcare because it’s really about patients – not all about profits.

This is Sphere3’s proposal for common language for documentation of Clinical Alarms. Below is a cascade of action – reaction that can either be generated by a person or the configuration of the clinical alarm system.

Initiating Action:

This is the beginning of the call. It can be manual, such as a patient pressing a button or physiological, such as a telemetry alert. The initiating action can also be a system trigger such as an occlusion or a system creating an alert based on a malfunction or necessary service request. The easy way to remember an Initiating Action is “it’s gotta start somewhere”.

Example:

Patient Press a “Normal Call” button on their Nurse Call System

Patient’s heart beat indicates a “V-Tach”
Notification Action:

How do people know that a clinical alarm has occurred? A Notification Action is the ring, ding, buzz, text, etc. This is the way in which a caregiver knows that an initiating action has occurred – they way they know the patient is in need. There are generally multiple Notification Actions for every Initiating Action. Every Notification Action is an invitation for the Caregiver to interact with the patient or their device.
Example:

Initiating Action = Patient Presses the “Normal Call Button”

Notification Action 1 = The Dome Light is White

Notification Action 2 = The PCT’s Wireless Device buzzes

Notification Action 3 = The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance OR Rejection Actions:
If the Notification Action is the caregivers invitation to interact with the patients need it forces an acceptance of that request or a rejection. Accepting the alert requires an interaction with the patient or their technology. A rejection is a “delay of response” while it could indicate that the call is being ignored, mostly it indicates that the capacity of the caregiver to interact with the workload is challenged.
Example:

Notification Action3: The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance Action 1: The PCT presses “Accept” it “dials back” into the patient’s room, they communicate with the patient.

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action:

A Patient Communication Platform (aka Nurse Call) has a feature called “always an answer” where it will bounce a call if it’s not handled within a set time frame. Anytime a call is rejected, it bounces either automatically based on timeframe or physically based on a button push. That being said anytime a call is “rejected” technology should be programmed to create an automatic escalation action. Similar to an Initiating Action the escalation action is the technologies methodology of moving the call to the next person or place in line.

Example:

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action1: Since the call has been “ignored” the technologies internal timer has allowed for a wait time of 2 minutes after which the call is sent to the RN’s wireless device with a message “Normal Call Rm 320”.
Escalations drives additional Acceptance and Rejection Actions, based on time frame. Again, a Rejection Action will create an additional Escalation. The hospital has to decide when the patient request (physiological or physical) has gone on too long, and at what point a failure to respond will generate the final Mandatory Action.
Mandatory Action:

The hospital’s determination of the final phase of the escalation process is the mandatory action. This designation is generally linked to Overtime calls. When a mandatory action occurs, the technology should force a physical face-to-face interaction with the patient. Mandatory Action is a new Initiating Action with a required interaction from staff.

Example:
Normal Call has not been answered in 4 minutes.

Mandatory Action: Due to escalation past allotted time frame the technology changes the alert verbiage to “Overtime Room 320” and tones at the main console and duty stations in all caregiver work areas on the unit. Additionally, the PCT and RN’s wireless phone receives a text message “Overtime Room 320” with no capability to call into the patient’s room. The call can only be cancelled at the patient’s bedside.

Now, let’s get back to baking cakes. Here is what I’ve learned in my most recent experience. There is a certain amount of discipline that comes with baking. To try to get creative on the basics is the best way to really ruin a dessert. Getting the basics of a cake right makes for a great foundation. But, the real fun and creativity begins once you have solid knowledge of the basic fundamentals of a cake. You see, I’ve now learned how to take a basic recipe and make an exciting dessert for my family—its about the secret additives, the substitutes that have just a little more interest in flavor, the interesting style of presentation, and complimentary chemistries of toppings, sides and coffees.

Clinical Alarms is the same thing. You have to know the basics and assure the foundational strategies in clinical alarm design were applied. BUT, once that is accomplished, there is so much more that can be done to enrich the patient and caregiver experience with request and response.

The documentation above associated with each phase is laid out similar to a process chart used in lean, however Sphere3 has created a methodology that is easy to understand and see at a glance. I will create a blog series on each phase of the process if there is feedback on this, but if there is not then we will just leave it as one persons attempt to create some normalcy to the market.

Comment Back – Ask Question - Email me kgovro@sphere3consulting.com if you don't want to post a comment – join this conversation.

It’s not “IP” it’s about creating something we can all use. This shouldn’t be an uneven playing field - this is Sphere3 stepping up and saying it's about the patient - not about the technology. If alerts are designed incorrectly in the extreme case someone could die – in the most likely case a patient is dissatisfied with their care.

The New Economy

2011-02-25T11:44:00.000-08:00

During my visit to San Diego for the NSCA leadership conference Economist Lee McPheters spoke about the economic changes and challenges facing our nation. While the economy seems a daunting – I think that the needed productivity changes are also a huge opportunities for those of us in process redesign and we just need to find ways monetize the work associated. The American worker has been asked to increase their productivity – put in the extra hours – in hopes to help their company make it through the rough waters. The challenge is we can only work so many hours – we can only work at high capacity for so long before it requires an innovation change.

The interesting change is that while businesses have pushed their employees to be “lean” and move faster and do more with less – the American consumer has become more demanding. They expect more, because they are spending less. The American consumer is adopting the Ramsean principals of if you don’t need it don’t buy it - if you don't have the cash then don't buy it. They are also spending their capital in a more focused manner with a thought process of you should be treated like a customer instead of a consumer and the idea of disposable society should go by the wayside.

So what does all of this mean for healthcare? It means that the patients – who are customers – should be treated as such and that their demands will become more and more extensive.

Let’s Dream Weave?

If my grandma eats breakfast every morning at 6:30am when she is at home, then when she is in the hospital for hip replacement shouldn’t the hospital know when Grandma would like to eat breakfast? Tools like A-Frame Digital and Parental Health’s Misty can feed into her “record” and begin to create a model of how she chooses to be cared for when she is not in her home. The more data we can drive from the home to the health record the more we can allow our parents to age in place.
The scenarios of how we function in the home should model how we are cared for in the hospital. The concept of a Patient Communications Platform should encompass more than just request from point A to point B – it should encompass consumer data modeling that preemptively leads to care.

If I document my life in Facebook and am comfortable sharing it with 400+ of my closest friends wouldn’t I be comfortable with sharing my comfort models with the hospital? If I document my food and exercise in My Fitness Pal (ap on the iphone) then why wouldn’t I share my nureotic eating habits with the place that is supposed to heal my ailments? (What if my ailments are caused by my addiction to Latte’s?)

These models allow us to improve patient care. At Sphere3 we use Performance IndiCares™ which are items relating to the behavior and performance of Caregivers and Patient IndiCares™ which are items relating to the behaviors of the patient. We tie the information together to create Risk Models or Risk IndiCares™ clearly finding paths to reduce risk and improve performance. All of these things lead to our three core values Patient Satisfaction, Caregiver Satisfaction, and Safety.

Health IT companies should feel challenged. If the farthest horizon you are looking at is within the walls of the hospital, then you are going to miss the boat.

Patient As a Consumer

2011-02-22T15:20:00.000-08:00

Coca-Cola is test marketing a product called the “Free Style”. It’s a box (isn’t everything) that allows the customer to select their Coke product, and even Mix n Match the flavors. If it were just a pop dispenser it wouldn’t be so interesting – what IS interesting is that the box is daily providing information back to head quarters about which products were selected, how specialty blends were selected, etc…in essence a direct information feedback loop of what people want.

Every Hospital has a “Free Style”- it’s required by code and it’s providing multitudes of data that reveal how a patient wants to be cared for on a daily, hourly, even minute by minute basis. The Nurse Call System is alive with information that indicates how a patient’s stay is going. Interestingly, this immediate patient feedback tool is often dismissed as something required by code. It is more about safety then about information. While many nurse call systems are reaching beyond the safety realm and designing abilities for requests – the data is inefficiently and ineffectively managed by the hospital. HP made a great point in their focus group the Patient must be viewed as a consumer and we must cater to their needs. The way to do this is to understand their communicated requests.

It’s got to be seen as more than just a safety tool – it’s got to be seen as a tool that lets the patient tell their story.

Let me dream weave with you for a while…… If a patient is consistently asking for a blanket could we automate the heating system to kick on and raise the temperature? Yes, if we knew they were asking specifically for a blanket.
If a patient is consistently asking for water or ice chips, could a model be created to preemptively provide them with a glass of water before they ask? OR is that indication of something occurring physically that needs to be checked by a doctor? OR for you safety nuts – what do you do a little while after you drink 6 glasses of water that could cause a fall? OR could the information automatically be cross referenced with the EMR data and could IBM’s Watson decide a lab needs to be ordered?

I know that sounds space age but the information is all there – it just takes looking at it, creating a model, and well…the hard part getting everyone to talk together in a common language.

Just to get you thinking – why isn’t the nurse call system called a nurse call system – are they stewardesses or are they clinicians? It needs to be labeled the patient communication platform and IF it is a patient communication platform……why does it only reside within the hospital?

The EMR Limitation

2011-02-11T19:56:00.000-08:00

Have you ever done weight watchers? I have and it was fun for a while, but then you start to figure out ways around the rules, the math associated witht he "points", and the limiting factors associated with losing weight – it becomes not fun. For example, why is it motivating to lose my daily points allotment if I lose weight? Isn’t that a punishment? Think about it last week I could have a cookie because I was heavier, but this week after having lost 3 lbs I changed categories (which means your allotted points decrease) means I lost the extra points needed to partake of my favorite treat.

The other limitation of weight watchers (and frankly any diet) is it’s based on self-reporting. Similar to an EMR if you report incorrectly and cause an error there are consequences – in my case think Bridget Jones – in the second movie.

Yes, Yes, there is an analogy here to Health IT – EMR is dependent on the physical documentation of a clinician, doctor, or other caregiver. There are advances being made to reduce errors such as the automated physiological data capture. There are methodologies by use of Pixis (the Kleenex of the medication world) and other like systems to assist with managing the medication transfer to the unit and barcodes to assist with reducing medication error. There are even RTLS tools that can be used to identify caregiver entry and exit and time frames. All good things.
There are all sorts of devices, software systems, and technology being created to make things bigger better faster cheaper, but where is the patient in all of this? EMR is a self-reporting tool that allows clinical individuals to document their interactions with patients. But, how are we documenting the Patients interactions with Caregivers.

Why are we painting a picture of the patients stay based on the hospital’s perspective?

What do the patients movements, actions, and requests say about their stay?

Why are we judging a fall risk based on a questionnaire and physical observations?

We are judging caregiver satisfaction by surveys and turnover rate?

Why are we using a survey that’s provided after the patients stay to assess their satisfaction?

What if there is more……what if there were a way to see answers looking at data that is readily available? There is so much information available that provides a clear picture.

The next frontier is not the EMR – the EMR is the current frontier – the next frontier is the patient – the next frontier is the information that the patient is providing to the hospital - physiologically and physically.

Hospital Value-Based Purchasing Program (VBP)

2011-02-04T14:02:00.000-08:00

I am pleased to welcome my first guest blogger. Rebecca Mackinnon has been working with Sphere3 for several months. She successfully built a HIT company called Beyond Now Technologies which is now part of Cerner's portfolio. A brilliant woman who offers great insight and perspective.

Hospital Value-Based Purchasing Programs

We've been told for years that hospitals would be judged and paid upon performance, and now it looks like the time has arrived!

The Hospital Value-Based Purchasing Program is the first concrete step with defined timelines of performance measure for the purposes of calculating premium to the DRG. The interesting detail in the labyrinth of language: there will be a baseline reduction in the DRG and then VBP calculation will be applied on the new DRG base.

Unwind and interpret...you will be penalized if you can’t prove minimum quality performance.

The CMS proposal: 17 clinical processes of care and 8 measures (from HCAHPS) with a currently proposed ticking clock beginning from 7/1/2011 through 3/31/2012 to adjust the FY 2013 DRG payments. If I do the counting on my left hand correctly, five months before the clock begins ticking.

So here is what I know. Regardless of what any hospital wants to purport, some of the very expensive and very avoidable clinical measures are not being managed.

Here are the basic questions every hospital CEO should be using to challenge the CMO and CNO:

What is our Falls Ratio (falls/1000 patient days)? How are we assessing the Root Cause? Is the information being used in and educational and reforming way to improve for the future?

What is our rounding procedure and how often is it adhered to on the Unit level?

What is the actual response time to a patient request? Response time to pain? Response time to toileting?

What is our hospital noise coefficient?

What are our alarm frequency measures and response times?

Each of these is the most basic unit level measure of performance and ties directly to the ability to improve performance in the FY 2013

A very insightful CEO of an inner city health system spoke to a small group in the recent weeks. His best advice to his audience, “you have to get into the bowels of your organization, you have to know what’s happening and be able to create a clear line of sight from staff activities to mission critical performance”

Sphere3 has been expecting this for two years. This month, we will debut of a comprehensive option for managing quality.

Sphere 3’s business intelligence software endeavor combined with our consulting team who are experienced in clinical process, Nurse Call and other alarming technology design is now more important than ever.

When the Beep is a Heart......

2011-02-02T05:53:00.000-08:00

Last week a dear friend fell on the ice, hit his head, and had a stroke. He was taken from the rural critical access facility to a larger facility in the “city”. The family (most of who were from the city) had so many trials gaining information necessary to help care for their father, and I was struck by something – we have gallons of information available about patients now and the only people who get to see it are the “educated” ones. One day he was doing better and the next he was in ICU and the family was told to “prepare”.

It’s always hard for me to go to a hospital – it’s kind of like eating at a restaurant when you have been in food service. When I walked into ICU and looked at his monitors it was so striking – We have been in heavy R&D lately developing new metrics, and producing our new software program. I stood in that ICU, stroking the beard of my friend, and thinking it’s not just math. It wasn’t just a number that needed to be processed for automation or documentation – it was his heart, it was his life. This man, who the night before his fall had called to sing happy birthday to my son, was hooked up to all of these machines.

Do you ever feel like you are just looking at a page full of numbers when you are analyzing the work your do? “Alert quantities” take on such a different meaning when you are staring into the face of friend.

How do we make it all about him – the patient? How do we make it meaningful to this man and his family? They were so scared. They didn’t understand and by the time I arrived at the hospital – they didn’t trust the staff because they weren’t being communicated with clearly. As I talked with them there were a few things that stood out to me that every family should know going into a hospital.

Have an advocate with the patient, and keep track of “vital” information. When the nursing staff is collecting information, ask what they are doing and be engaged in the answer. It may not make sense on day one but it will by day 2 or 3 it will start to make sense. If it still doesn’t make sense ask more questions, or see if the hospital has a Patient Advocate.

For example, if your family member has a fever – ask why – ask what tests are being done to figure out why – ask what his temperature should be.

Use the internet to understand the condition – but remember the internet is not always right, and it can’t see your family member.
Know your caregivers by name – the Nurse is the one who gives medicine – the Care Tech is the one that brings ice chips, helps the patient to the bathroom, and does the leg work. The Nurse is probably tending to 5-6 people during her shift and the Care Tech may have as many as 12. If you have a problem the person in charge of the Nurses is the Charge Nurse. Get to know the Unit Secretary too – the person at the center desk that answers the phone - they are often air traffic control for the unit.
Use a life line - Phone a friend. When you are in the thick of it, and emotions are high you may not be thinking clearly. Call someone you are close to and download – they may have different perspective and be able to help you refocus.
Take a break. If you are the only person from your family available to sit with the patient – know that the care staff will be there when you are not. Just let them know you are going to the cafeteria or getting some dinner. When BFB was in the hospital the hardest thing I had to do was leave for an hour – but my Nurse (who was wonderful) insisted so that I could relax and refocus.
Pray Continually – this one is my personal advice, but it works. Even if you don’t believe -sometimes you just need a release and no person around.

As we move into an era of “Smart Phones” let’s not create a Soulless environment where we have so much data and we forget that the man in ICU is someone’s Dad, Grandpa, and friend. Technology must be an enabling medium – it must be something that allows a caregiver to care – not limit their ability to engage. Every click is a moment they aren’t engaged with a family – every alarm is a moment they aren’t focused on a patient.
How do we create less “technology drain” and create more “patient engagement”? We all need to make sure that our focus is creating an environment that is conducive to healing, or if the family is saying good bye create an environment of peace.

The Twinkie Factor

2011-01-24T05:58:00.000-08:00

Around Christmas time, ironically, I began looking in the phenomenon of the “Twinkie Diet”. For those of you unfamiliar with this unorthodox methodology of losing weight, it was the thought up by Mark Haub, a professor at K-State (there’s your sign) who wanted to prove a point that calories are important. Basically, for a condensed period of time he ate a strictly monitored caloric intake which included only Twinkies and protein. The result was he lost weight and improved his cholesterol.

What struck me about the diet was the intense focus on one factor – calories. It basically ignored every other health “rule” known to man. In the professor’s defense – he was not advocating for eating junk food consistently he was proving a point that calories are important. However, calories are just one factor in overall health. No, I am not a nutritionist but I, like Oprah and 90% of the US population, have had my battle share of weight gain/loss. The one major lesson I have learned is Calories/Weight Gain are just one factor in overall health.

Heart health, for example, is made up of multiple factors with different inidcations of whether you have good or bad heart health. Weight is one indicator, but it can be ultimately deceiving. You could be in good weight range, but you may have high blood pressure. Healthcare providers have learned to evaluate a number of Key Risk Indicators that look at multiple factors and lead to a decision.

The point is – make sure you are looking at multiple factors before assuming you are doing a “good” job based on one.

In a hospital – Response Time is like Calories. Response time alone can indicate efficiency to the taking care of the patient need but you really have to look at several factors to determine if the staff is being effective in responding to the request. I can eat 10 Twinkies a day and get enough calories to meet my 1500 calorie per day quota. Does that really meet the nutrition needs of a 29 year old woman? (Ok 31 year old but who’s counting) The patient may have their need noted in a prompt manner, but the need may not be met for a longer period of time. I would argue that the latter is actually just as important as the first, especially when it comes to the core measure of pain management. Specific design applications are needed to ensure that Caregivers are able to manage the flow of communications and responses to patients needs. Then the technology must be programmed appropriately to gain the information to provide accountability. Sphere3 has done this and collected the benchmarks.

I thought about renaming our Key Risk Indicator for Efficiency and Effectiveness the “Twinkie Factor” but my team thought that Efficiency and Effectiveness Indicator (EEI) may be a better name. Let me know what you think.

Compassion - a Measurable item?

2011-01-08T08:03:00.000-08:00

Several hospitals have the word “Compassion” as part of their core values, mission statement, or vision statement. If something is important enough to be in the mission or vision or values is it something that should be measured? Wait I know what you are thinking - seriously are you going to put parameters or compartmentalize something as important as compassion. Won’t that diminish the "feelings" associated with it? My creative free spirit side would agree - compassion should be organic, voluntary, and come from a passionate desire to care. It is locked within a smile, a touch, a tone of voice, and an attitude. My square side would argue if it's worth putting in a mission or vision or anything related to the strategy of the hospital than there must be a way to determine whether or not we are producing “compassionate care”. That while patient surveys are effective in obtaining the information of feeling of the patient, they are retroactive and the results are not generally correctable during the stay of the patient. So, how do we determine measureable factors associated with compassion, how do we identify measurable items that can be dynamically adjusted during the patients stay to move the patient experience from good to great.

Compassion is a reflection of empathetic feeling. What makes up the actions or behaviours associated with it? While, at this point, we can’t capture “emotion” I think that determining actions that can be measured is really doable. Think about the 5 Languages of Love by Gary Chapman (www.5lovelanguages.com) Chapman contends that all feelings associated with love are made up by 5 core categories: Words of Encouragement, Physical Touch, Words of Affirmation, Quality Time, and Gifts. These core categories can then be broken down in specific actionable items such as telling your spouse how nice he looks, that you love him, spending time together, and giving heartfelt items. If you have actionable items then you can have measurement associated with success or failure. No, I don’t think you should keep a spreadsheet of your actions associated with demonstrating your love for your spouse. However, if your Spouses love language is Quality Time and you are never home because you travel for work, go out to networking events, and when you are home are preoccupied with your iPhone to show him love you clean their car or give them a gift. THEN your actions do not speak the words “I Love You” in their core language – it’s like speaking in Gernan to someone who only speaks Chinese.

So step one in defining the measurable aspects of Compassion is to identify the core categories associated with it and actionable items that can be captured by technology. There is technology available that can capture some of the actions that Sphere3 has identified. Think about what you currently have in your hospital – could you capture anything – are you capturing anything that you are not documenting?

This has everything to do with how the receiver identifies understands and recognizes that actionable items The key is - like Love - the deliverable actions may flex on those pesky hard to categorize people called patients. The hospitals other challenge will be to drive action as well as innate desire to care. Is it possible? I am not sure - am I going to figure it out - you betcha.

Falls and HIT Polic Committee Measure Concepts

2010-12-15T07:42:00.000-08:00

Yes, the title gives it away this is a serious one. I read recently on a blog that the HIT Policy Committee is creating “measure concepts” that will be applied into meaningful use standards. At the very bottom – in fact the last one listed – is "Measures of fall events and screening". While we each are passionate about one item or another on that list, I believe there is some low hanging fruit that could easily be picked off and taken care of quickly AND provide the hospital with real “meaningful” savings.

The tricky thing about falls is that you are dealing with a patient. Patient’s actions, movements, attitudes, and even behaviors are a challenge to categorize into the neat and tidy little boxes that EMR vendors need to have strong governance in documentation standards. That’s a mouthful that says patients don’t follow the rules. The key is to look at the patterns of patient behaviors, staff behaviors, and other key dynamic factors then balance them with some static information. That is where you will find the answer to identifying Key Performance Indicators that link to predictive modeling for falls.

I know, I know you have never heard me use so many $20 words in one sentence. The answer is all ready there in the data. Think of it like seeing a Picasso – some people look at a Picasso and see random shapes, meaningless strange pictures and some people look at it and can interpret a story. I see the story in regards to the data surrounding falls. I had a great experience the other day with a hospital that “got it”. While I presented the data and our assumptions on the patient behaviors and indicators the staff filled in their specifics surrounding the staff’s behaviors. We see the same thing in the data – over and over again. We see the story.

This data should be in the Medical Record, it should be part of meaningful use standards, and it is part of the patient experience in the hospital. This is low hanging fruit – as my dad would say “easy pickins” – a real problem that is solvable.

I believe the key to reducing falls in a hospital lies in the ability to categorize, capture, and document the behaviors and actions. Believe me there are consistencies that we can currently identify. You just have to know where to look.

Symphony of Information

2010-11-23T14:26:00.000-08:00

Have you ever heard a 9th grade band on their first few days of rehearsal? I lived it – well a much heavier, awkward, glasses wearing, hair out of control, version of myself. The interesting thing about 9th grade band is everyone has had their instruments for a while so most can make a noise that resembles music, but “musicality” is really lacking. What they teach you in that critical year is how to be “Symphonic” which means taking something that is very complex and diverse and pull it together harmoniously. For a percussionist (like myself) that means - just because you can play the loudest doesn’t mean you should and that following the conductor is not an optional activity.

As I was reviewing data this week (reams and reams of data) I began to notice a series of new patterns. Patterns, within themselves, are fascinating but they get interesting when variations occur. So in musical terms if you have 4 measures of quarter notes and then a measure of 8th notes and then a measure of 16th notes the original pattern varied to a pattern that builds intensity. Intensity builds excitement and excitement builds to the climax of the song. As geeky as this may sound the workflow data we review is often like a musical score to me – sometimes just out of sync.

I don’t know about you but when my mind gets stuck on patterns I have a hard time breaking free. My solution has always been to get in my car and turn the radio up to blaring sound to let my mind focus on the patterns in the music. After a few minutes identifying them, and figuring out the layering it is easier to refocus on something new. This week was especially overwhelming as we discovered patterns outside of alarms that affect our data points AND that the information is readily available.

That’s when it hit me – the problem with the patterns that I was seeing for this particular hospitals report were that they are simply out of sync with the other dimensions of the unit. (Clear as Mud?) Think of it like a musical score – if the woodwinds are playing 3 measures behind the brass who is playing two measures ahead of the percussion it sounds like noise. However, if the conductor is able to see how the patterns line up and is able to pull everyone into sync then it’s an amazing symphony.

Music at it's base is a complex math equation - music at it's core is art and soul. The key to making beautiful music is to be able to define where the math ends and the soul begins. The same is true in clinical workflow design the numbers may speak the "truth" but the answer may lie in the "soul" of the work. That's what we do - we help the hospital define the math so that the clinicians can better create the soul.

I know this is two months in a row of shameless plugs but we are creating a new dashboard that is unlike anything in the market today. We have welcomed several new team members in to help us mold the product into something that can quickly help a hospital reduce falls, increase patient satisfaction, and increase safety.

Defining What "Matters"

2010-11-09T07:21:00.000-08:00

Creating focus can be challenging. I am a firm believer in goals (lots of Zig Ziglar growing up) but sometimes defining those goals is just as hard as achieving them. We may create a visionary goal, but not understand the detail to make it achievable. Many times our inability to identify what “matters” leads to failure, and our lack of understanding of the information produced creates a foggy understanding of success. That’s why it’s critical to be able to break things down into digestible chunks so we can quantify the achievement (or failure) towards our goals.

My six-year old struggles with spelling – if you have read my blog long, you know it’s genetic. In September his third spelling test score was a D. As soon as I saw that paper, I emailed the teacher to request a conference. The teacher explained that they had 20 words and 10 phonics per week, and the importance of good penmanship. (All I heard was 20+10= 30 items per week to learn!)

That information in hand, I devised a plan of action for home study. The plan was simple break down the materials into daily digestible goals. The next week we hit the ground running. We practiced daily, and he got a D+. To me, this indicated failure of the plan, not the child. We reviewed the goals, made an adjustment to the plan, and the following week he got a C+ then a B. Last week, I am pleased to announce, he had his first A, missing only 1 word!

The reason I am reviewing 1st grade spelling tests is because had I waited for the grade card, my baby would have had a D or F on his grade card. (The C he got broke my heart.) Using indicators, in this case the spelling test, to shine light on a potential problem we were able to thwart a hard to recover disaster of a bad grade card.

Hospitals are faced with a number of challenges – one of which is alarm fatigue. Alarm fatigue is a multi-faceted problem that encompasses everything from noise, to acuity mix, staffing and so much more. If you try to tackle the problem by saying "REDUCE ALARM FATIGUE" that solution is foggy at best. However, if you look at the issue pragmatically then you can identify the multiple layers each with a “spelling test" indicator. Just like the spelling test above the solution lies in breaking down the problem into digestible chunks and refining those goals based on the outcome of the result.

Shamelss Plug - Our Scorecard is a tool – something that can be used like a spelling test – that along with daily goals and observation could solve the problem. The quarterly trend is much like a grade card. If you wait for the grade card to correct course – then you may be too late.
My advice for today – look at everything as a solvable problem. When the problem is too big – break it down as many times as it takes to become understandable and digestible.

Changing Lanes

2010-10-07T08:26:00.000-07:00

I was driving to work yesterday in the Tahoe (aka Mommy Mobile) since my car (aka Princess) has a flat. As I sped down the road with Cruise Control set – I couldn’t figure out why the Tahoe wasn’t slowing down as I approached a much slower moving vehicle. All of the sudden, I remembered that the Tahoe does not have the cruise control distance feature that Princess has built in to ebb and flow with traffic. I slammed on the break as to not hit the vehicle in front of me. You see, the Princess car can practically drive itself. You set cruise control and it slows down as it approaches a vehicle and once that vehicle moves out of your lane it resumes its constant speed.

This change in vehicles has caused a number of issues for me this week. I have no hands free calling if I push a button on my steering wheel and say “Call Dad on Cell” it only changes the radio. When I go to change lanes there is no light telling me there is someone in my blind spot. When I go to back up, I actually have to look over my shoulder because the radio does not change into a back up camera picture. All fun and joking aside - This experience really relates to what we are seeing with devices and workflow design in healthcare. (Bet you didn’t see that coming.)

There are really two paradigm shifts. First, there is an expectation that a technology will provide more and require us to “do” less. This does not discount the fact that we still need human interaction. Princess really can’t drive herself, but Ford has developed ways to reduce the amount of action I need to take while driving. They looked at the driving requirements and removed steps out of the process that could be replaced with technology. They also provided technology that could enhance the driver’s ability to make decision. Isn’t that what all technology is supposed to do?

There is a warning that should be going off in your head at this point. All of this high tech stuff is great but what do you do if the technology is different from unit to unit? What if Med-Surge is driving a Tahoe and Med-Oncology is driving a Princess? Caregivers float between units. They are asked to shift from one process to another without missing a beat. This is the second paradigm shift, technology must be flexible but the flexibility must be tempered by continuity. We ask a caregiver to go from driving a full featured princess car to driving a low featured school bus then we wonder why there are mistakes.

Workflow design should be based in finding commonalities and working to drive similarities between the units. Every car is different but every car has a turn signal, break lights, head lights, and there are requirements to use them within the standard confines of the law. Then that has to be monitored to drive the similarities to be consistencies.

Please heed my warning to all of you in Kansas City – especially those at Cerner because I pass your facility daily - If you are driving home and see a large Tahoe barreling up behind you – I recommend you just change lanes. I am not an aggressive driver but sometimes I forget what technology I have (or don’t have) at my finger tips.

Alarm Fatigue

2010-09-15T06:55:00.000-07:00

I was cooking a BIG meal – one with several burners going, the oven on, and even the microwave. It was one of those “Martha Stewart has nothing on me moments.” (Ok, I was really more like a I'm a tall version of Rachel Ray) There were 4 boys running in and out asking questions and trying to “help” - other kitchen noises like the garbage disposal, can opener, food processor plus of course the TV was on in the other room. It was loud - like the Chiefs Stadium when we beat the Chargers on Monday night – LOUD! The point is I had a lot going on and neglected to set the egg timer for one of my pans and ignored the beeping on the oven……all of this to say we ended up eating at Culvers that night.

My kitchen scenario is much LESS intense than a nursing floor. No one was critically ill, there were no emotionally distraught family members, there was no Code Blue – it was a kitchen. (Well, the food was critically ill by the end of it – I digress) The point is think about your most intense - loud - busy moments and then think of how much more intense - loud - and busy the nurse is and you will begin to understand “Alarm Fatigue”.

On a floor with 30 patients with IV pumps, nurse call, telemetry, other physiological alarms, etc there is bound to be some noise. The current methodology of listening for an alarm can really hinder productivity – but leave productivity out of it – it is a major safety concern.

Let’s take an easy one - Do you know the most common way we document a response to an IV pump alarm? The patient has pressed their call button and the nurse is notified that the IV Pump was dinging in their room. Think about how scary that is for a patient and their family – who has no idea what the dining means. Do you know the most inexpensive way to fix that problem? Automate an IV pump alarm to the caregivers wireless and explain to the patient and their family what will happen if the alarm goes off. (BTW – repeat that information every time you enter the room for rounding.)

Here’s a freebie - Depending on your nurse call system there is generally a quarter inch jack that can take a contact closure alarm – old school – this is the way my Dad did it when he sold nurse call in the early 1980’s. Order the cord you can use it tomorrow in your hospital. IF you have a question (hospital) – call or email me I will walk you through it. There are much more expensive ways to automate these as well.

The challenge is at some point in alarm automation and “management” you simply begin to displace the problem. If a clinical alarm device is trigger happy then your wireless device will be as well. Too many alarms is still TOO MANY ALARMS – just because it’s quieter on the unit does not mean its better. At some point it’s time to really review the technology that is making the alarm happen, AND review the process of who is getting what alarm when and why. The event in Boston was not due to the alarm noise, really it wasn’t even due to accountability because no one “heard” the alarm. The Critical alarm was turned off and the Warning alarms were ignored. Some automation would’ve helped the issue but it may not have solved.

Patient safety officials across the country have said the heart patient’s death at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because of alarm fatigue, as beeps are ignored or go unheard, or because monitors are accidentally turned off or purposely disabled by staff who find the noise aggravating. ()http://www.boston.com/news/local/massachusetts/articles/2010/04/03/alarm_fatigue_linked_to_heart_patients_death_at_mass_general/?page=1

It’s tragic that a death occurred due to an alarm issue, and no family should have to go through that. That death should be a rally point for all of us in the device industry.

See - Hear - Paint by Numbers

2010-08-25T06:24:00.000-07:00

Those of us who work in automation of process often are asked to take a “look” and “see” what could be done better. Which is really the basics of what we do – visually obtain information and document it so that it can be assessed. However, you may not want to judge a book by its cover.

Several years ago my Dad went to buy a Cadillac. He showed up to the dealership on a Saturday in his old blue jeans, flannel shirt, and his post card which said if he test drove a Cadillac he could get a free pull over. The dealership was empty – not a customer in sight. He entered – found a sales person – and was promptly told that he would need to make an appointment to test drive a Cadillac. Dad persisted showing the card he had received in the mail for a free pull over with a test drive but the sales person made an assumption that he was not someone who would buy a Cadillac and turned him away. Ironically, two weeks later Dad found the model he wanted online with every feature available at a dealership in Minnesota, went there, purchased the car, and drove it home. Based on what the sales person saw he made an assumption and lost the sale. In the same way we may be looking at a process and seeing each interaction but not make the connection on what is occurring.

In the story above the sales person was focused on how Dad was dressed. Sometimes consultants are focused on what they see and don’t balance it out with what they hear. The verbal interaction with staff – explaining why an observed process had a specific method is critical. The trick is asking the right questions – in the right sequence – to elicit the honest response. Questioning people on how and why they do specific workflows is really an art blended with a science. (Anyone who tells you different is selling you something) The science is the sequence and the information needed to be gathered that provides patterns. The art is the phrasing and interaction. It’s the way you respect their environment and their specific personality.

The final point in workflow modeling is being able to develop a picture of what is occurring without looking or hearing anything. I heard a story on the radio of a woman who had lost her sight. She described how she could see objects with her hands. The form, the texture, the edges all became data points in her mind and she was able to create a picture of what she was holding. In the same way that you can look at the data that comes out of devices, integration software, systems, etc and begin to build a pretty extensive picture of what is occurring on the unit. It’s basically paint by numbers for geeks – a series of “If and Then” statements that when you put them together in the right order create a very in depth picture. Just like when a doctor looks at a patients chart – the data creates a picture.

We have had a pretty busy month at Sphere3 - which means the blog has taken last place. Topics are always welcome please send them through to kgovro@sphere3consulting.com

When Our Use becomes "Meaningless"

2010-08-02T06:21:00.000-07:00

I recently read a blog post by Regina Holiday that was both incredibly moving and really thought provoking. Regina lost her husband to cancer and has recounted the experience throguh art and speaking. She has gained national attention because of her patient’s rights movement her voice emphasized through murals. Sometimes words are not enough.
She along with other noted leaders like E-patient Dave are paving the way for more information - better information- to let patients make informed decisions. The point that stuck out to me was the concept that the medical information could be presented to the family in a format as easy to read as the Nutrition Facts label. While I don't want to discount the difficulties to do this nationwide with consistent standards - it just makes sense. People didn't understand what everything on the nutrition label meant initially, but now most of us know sodium # high = bad. (I could soap box for days on the unhealthiness of the US and our unwillingness to read the label and make good choices but that's a different post for a different blog)
All of the “bring it to basics” mentality brought me to reflect on the creation of Sphere3. It came out of frusteration that all the creatvivity in the world associated with integration was thwarted due to the difficulties associated with trying to communicate the functional process. (that was a mouthful) In other words most geeks want to tell people "how" it's done instead of "what" will occur.

The "what" to me is like writing a book or a movie - there are characters, there are scenes, ther are props, and if all is done correctly there are great reviews. It makes what we do in integration design look really simple, which is good. My theory (which is shared by many) is a Nurse needs to be concerned with the patient and things that cannot be replaced by technology. There is nothing more frustrating then being handed additional technology to “make life better” which just complicates life more. Nurses should spend a majority of their time helping people – not fiddling with unnecessary technology.
This is a scene from my own life – and I encourage you to remember a scene from yours that will help you focus on the clinician and the patient. Remembering that the technology should be complimentary – the people should be the main focus.

One night, when BFB (Big Fat Baby - see our story) was in the hospital, he was having difficulty breathing. The Oxygen reader (aka 02 Sat) began it ring. I was "sleeping" in the chair next to his bed, my head propped against the side of the crib my hand holding the fat fingers. I turned my head to see the machine (which I had learned to read a few days prior) and the numbers where dropping. At first, I thought his toe thing is loose, so I unwrapped him to find it firmly attached. I began to follow the cable to the machine to make sure it wasn't unattached. As I did the door opened and in came the RN, followed by the Respiratory Therapist. "Please step back Kourtney" she said stepping between me and my bundle.

In my head all I could hear was a warning announcement saying "Warning! This is not a drill...".My heart stopped and everything around me seemed to be in slow-motion as the night nurse and Respiratory Therapist (among others) began poking ,prodding , and suctioning (to this day I can hardly look at that suction when I walk into a patient room for work). His skin looked gray, his fat arms barely fought the team as they suctioned, and worst of all - he wasn't crying. So, I took on the role for him. Crying dosen't really describe what I was doing - sobbing unconctrollably - the kind of experience where you know at the end of it you will look like a prize fighter. David had emerged from the bed in the back of the room and tried to comfort me. We didn’t want to watch but it was like a train wreck that we couldn't help but watch. As it ended and it seemed as though someone gave the "all clear" signal - the nurse turned to me and I said "is he going to make it through this?” She was experienced, had as many gray hairs as my mom, and had kept her cool the entire time. The kind of person you want in a foxhole with you - bullets wouldn't faze her. "The worst is almost over" she said as she touched my arm and smiled. Though she didn't say it I knew she was saying "he's going to be fine". After the group left the room - I returned to my watch post at the side of the bed, reached in, and my fingers were met by the firm grip of BFB.

A Nurse’s primary role is to care for the patient - do things that we can't do ourselves. Her secondary role is to assure you - in a way that few can - that all will be ok. Neither of those things can be replaced by technology.

Our job as "technologists" - "integrators" - "geeks" is to enable these people to do what they do best - help with people. If what we do gets in the way of those roles our use is meaningless.

Intuitive Caller ID

2010-07-22T09:06:00.000-07:00

During many of my phone interviews with CEO’s “Please excuse the noise” is often referring to airport pages, bustling people, or highway traffic. This particular late Friday afternoon, Todd Plesko, CEO of Extension, was referring to his family – namely a gaggle of children preparing to head to the lake. Making family a priority is a challenging thing to do when you are running a start up (from the voice of experience) but he has chosen to set priorities according to his values. He sneaked in an hour of time to talk with me about his company's rise from concept to actual.

As we chatted about industry changes and his appliance style “Red Box” (which makes me think of movie rentals.....) I kept thinking how is this software different from any other Integration Software on the market – or is it just another “Me Too” application to ride the wave of Cisco’s movement (did I say movment - oh I meant potential Tsunami) into the market. Then almost in passing he said something about “Caller ID” and I thought "Did he really just call Integration Software Caller ID?" To reduce the solution to that seems is to reduce value and make it appear like something that a call manager could do.

However, as I listened the story became really clear. What Todd and the team are claiming is not "Caller ID" like you would get from a simple SIP interface, it's multiple pieces of data compiled into one. Think about it - here is a team that started as a ReSeller of GE Centricity, created a hosted solution, and has a strong foundational knowledge of HL-7 and medical records. This is not a integration software company focused on alerts - this is a healthcare company focusednon information - or to use Todd's words Aggregate Data.

I think that better terminology is "Intuitive Caller ID." Intuitive because of the ability to garner information from the medical record and build a messaging structure that includes not only an alert but decision enhancing data. Their strength appears to be more data rich message need such as Lab. The challenge will be communicating that to the marketplace and delivering on the workflow design. The product has a lot of flexibility to the "what" it can become challenging to determine how much is needed when and how.

I think it sounds interesting, but I haven't seen it in action therefore it wouldn't be fair for me to note it as a solid solition. However, Todd claims 25 installs in the United States and he claims all as raving fans so if you are looking at the product ask for the list and call. (A little word to the wise make sure you talk to a Clinician and an IT person and if possible BioMed)

All of these incredible points about the platform weaves a great outlook for their product, however it has two very notable weaknesses. Integration software companies are easily assessed by their ability to integrate to telemetry and the quantity of available output points. Extension is really limited in both areas - they have no current telemetry integrations. A strong Telemetry relationship is important as that information point can be critical to a hospital’s mobility plan. Though there are many work around design models, at some point it needs to become a cog in the workflow communications plan. Second, current state they only integrate to Cisco VOIP wireless phones. Though Ciscos presence in the marketplace can't be ignored - they are the Golliath of every industry. Nor can you think little of any company hitching their wagon to them - it is Cisco. The handset has a lot of challenges with durability and the integrations I have seen the user interface for alarm messaging can take several button pushes to get to the information. The biggest benefit Cisco VOIP phones have - brand and recognition by everyone as a leader in every aspect of IT.

Todd and the team at Extension do have a strategy to begin to expand their output device capability as they plan to launch an intuitive message platform for the Iphone, Droid, and Blackberry in September. They are targeting Doctors with the ability to use their personal phones to obtain data about their patients and interact with it in a meaningful way. While I see it as a response to the Voalte, Amcom, and Connexall solutions their plan is to raise the bar by offering a FDA Class 3 certified solution. I look forward to seeing it.

Thanks again to Todd for the great conversation.

Workflow and Growth

2010-07-13T14:57:00.000-07:00

I have found with a start up there are several rules – I think of them like the If / Then statements we use in developing our software.

The three that I have found to be critical are:

1. IF you don’t have enough Capital THEN you are hosed.

2. IF you don’t make the right relationships THEN you are hosed.

3. IF you don’t create replicatable processes where every move isn’t hinged on you THEN you are hosed.

The third item I noted is one of my favorites – hence the reason for writing the Sphere3 Workflow Tool aka our software program. I don’t like to do the same thing twice, and it kind of drives me nuts to watch someone else do repetitive processes. (Once I have figured out the puzzle you might as well garage sale it because it’s not like revisiting an old friend for me, it’s just dull.) I think that’s why I like to look at workflow – while there are patterns there are also variables around those patterns keep things interesting.

I recently found a kindred spirit in this vein, Tony Marsico, CEO of PCTS. Tony stopped by our office on a recent trip to Kansas City to get the “Grand” tour. Tony has a graduate degree in documentation of complex processes and corporate training. (No, I didn’t make that up, and yes I did laugh when he told me.) Which makes him perfectly suited to run PCTS, a analytic software firm that provides business intelligence for hospitals via an RTLS system. He is an investors dream with his ability to clearly document and communicate process back out to his team.

PCTS provides real time business intelligence for Operating Rooms and Emergency Departments with “air traffic control” like screens, mobile buttons, and integration to systems and medical records. The really interesting thing about their product is its ability to run workflow rules and associate them with other rules. (That’s an over simplified way of describing that) Breaking down processes to physical movements, allowing for interaction levels and not only the “time association stand point” such as “IF the RN is in the room for X period of Time THEN do XYZ” obtaining information from other systems to validate the entry and interaction with patient specific information. All of which I have seen in “Demo” mode.

As I have said before I usually don’t believe it until I see it and PCTS was gracious enough to take me on a site visit and let me watch their team in action at Cook’s Children’s Hospital. This was an asset tracking project, so not nearly as complex as the workflow in an Emergency Department or OR, but interesting and exciting. The team was incredible, and the processes appeared to provide real time value to staff. Including the ability to better locate, identify, and collect recalled pumps and modules.

It’s important to note – while PCTS is dependent on RTLS they are NOT an RTLS company. However, they do provide RTLS products. Tony’s explanation made a lot of sense. Analytics based on workflow using RTLS is not simple and the validity of the information is a direct correlation to the installation of the RTLS product. His challenges, similar to many companies I have talked to, is who to hitch his wagon to. He is in need of companies who understand analytics, understand workflow, and understand the relationship to hardware. (That last point may sound “easy” but take it from the voice of experience it’s not)

My assessment – Tony Marsico is an Investors dream - he could "McDonalize" processes within a company. He has also surrounded himself with good people - which I have found to be the key to building a successful people. (Yes, that's my secret - I hire people smarter than me.) He is driven, intelligent, and has an eye for creating better workflow inside his firm and outside.

Tony’s Most Recent Read: Inside the Tornado – which I read the following week and it was a really interesting read. (Note to audience: Just read the first couple of chapters and you will get the gist of the entire book)

Sphere3 celebrated our first birthday in May. Though there was no noted celebration there was a strange, we have arrived moment – meaning that the phone has been ringing a lot and business is definitely starting to move. That momentum has really increased my travel - which has noteably decreased the blog posts. Stay tuned there are good posts to come later this month: Chad West, CEO of Ascom Wireless and Todd Plesko, CEO of Extension

Who put the "I" in Innovation....

2010-06-25T17:29:00.000-07:00

It seems anytime you put an "I" in front of a product it can represent a number of different things. In healthcare it means innovation, interaction, intelligence, and integral. The goal however is to make sure that it does not become irrelevant, inferior, or illogical.

The I-phone has spurned a number of discussions because of it's innovative nature. The product has been built on a platform that allows everyone to create their own "Aps" - in my world that means design their workflow in a way that works for their unit not generically designed to work in all applications. (just a quick warning that can be bad also)

The flexibility of the platform that is open to large and small organizations (and individuals) is the best way to drive new ways to solve problems. Let's face it - it's not always the big guys with all the ideas. It's also not always those of us who break out and build a business - more times than not it's the people who live in the situations everyday. Therefore, the intelligence in the product is built by the users, and the flexibility allows it to become an integral part of the workflow and daily life. So integral often times we overlook product "issues" such as durability and compatibility with infrastructure.

The challenge will be how do we make sure a strong "I" shaped platform does not become irrelevant and illogical. The best way to approach this is to make sure that it's the workflow that drives the innovation and not the innovation. Cool - for Cool sake - is not so Cool. This is not meaning you need to run out and hire a Sphere3esque firm to document and help design your wireless device workflow - it just means if you are not currently doing it - why not? What innovative value are you missing?

The I-Phone is driving people to design applications that can be used in the healthcare space - in my world that's for automation of alerts to a wireless device. Amcom releasing software that will automate information to the Iphone is interesting, but as you saw in my previous post about Voalte that application for clinical alarms to the Iphone is still hard for me to accept. Durability has to be in the decision process for a clinical device not just innovation. Also as we drive more information to a single device are we really making the best decision? It sounds logical - don't get me wrong - one device that can get alerts, call the on-call doc, use decision making software, access facebook, see information on a med record, etc sounds great but is it really the best choice? (I am throwing that out there for interaction sake because honestly I am not sure - I see benefits but I also see a lot of limitations due to the critical nature of alarm automation)

The device has more application to those who work outside the hospital, like a doctor but then the question becomes what information does he need that requires integration to the hospital.....this I know, but I will let you ask me to find out.

From a market perspective - it's only good news to have multiple competitors in the on coming tornado that will occur with smart phones.

Command Centers

2010-06-21T06:01:00.000-07:00

In a strange turn my blog has lead me to interviewing – ok so not really interviewing more having conversations with really interesting leaders in the healthcare medical device community. I want to be transparent – probably don’t need to say this because it’s apparent – I am not a journalist and 100% of what you read is my opinion.

Since the blog started last May, I have encountered all sorts of people. Some I like- Some I didn’t like so much. One that I have really enjoyed getting to know, during my contracted work with his organization which is now complete, has been Chris Heim, CEO of AmCom Software.

Chris is a genuine nice guy which permeates the corporate culture of his organization. He is genuine because he has never forgotten his roots. He started in a garage - not in a band but building a shipping software platform that grew and grew and was eventually sold for multi-million dollars. A lot of people would be pretentious after achieving that, not him. He is down to earth and even willing to talk shop and understand the journey of little start up software company like mine. Just because he’s a nice guy doesn’t mean he isn’t competitive – think of the way that Magic Johnson and Larry Bird competed – tactically, well practiced, engaged, and with a team spirit. That’s the competitive attitude of Amcom.

In 2007, Am Com Software, an operator/ call center company, saw an opportunity to enter a market space purchased a middleware company called Com-Tech. From the view of most middleware players Com-Tech was a simple “point to point” solution, one that wouldn’t rival the depth of Emergin, the flexibility of Connexall, and the integration to wireless power of Ascom. While the perception of the product is a challenge, the team behind it is building a well researched powerful offering.

Even at a high level view AmCom has a unique market opportunity. Their core product is operator or call center software, with a unique application that provides doctor on-call contact information. Since I have only seen in it a lab – the view is appears well organized and easily attainable. If you were to create a central call command center, then the operator software and middleware for alarms this could be a valuable pairing.

Communication from a patient perspective is any interaction dealing with their care, whether it is a with a licensed care provider, a volunteer bringing an extra pillow for their spouse, or even with the dietary group to order lunch. Communication from a caregivers perspective is any interaction from a patient, other caregivers, doctors or services provided that enable them to provide better care or services within the hospital. The faster triaged information can be provided the faster care can be administered.

Notice that I said triaged information. Information overload can hinder the effectiveness of the hospital’s performance. Sometimes I hear caregivers say, “we had pagers and/ or phones but we quit using them because they didn’t help”. Most of the time they “didn’t help” because the information was not provided in a usable fashion – in a central command center portions of the communications can be triaged and managed more efficiently than by pure automation. I’m a geek – I would like to say let the computer make all the decisions, but I have also been a patient, a patient advocate, and a parent –human interaction is more than just obtaining and triaging information. It's about connecting - not just systems, people.

If you look at a central call command center from the view point of one communication point, it is really just a fancy phone booth. (not discounting it's importance, but couldn't we do more?) The value of that command center is exponentially increased by leveraging it for additional abilities. Even non-clinical - Think about the value of this application from a Mass Notification Emergency Communication standpoint! (see previous post on Seattle Grace)

It appears to me that the AmCom suite coupled with the Com-Tech software could be the “Killer App” in a command center design. Granted, I have only seen this application and their middleware piece in a lab environment. You all know my stance, I have to see it live to believe it would really work. (I do live in the Show Me State)

AmCom has a lot of "futures" planned and they have an impressive team of individuals who are working to build a really powerful very well integrated platform. I look forward to watching them grow.

To Wash or Not to Wash....

2010-06-08T08:55:00.000-07:00

Recently, I enjoyed a spirited conversation with Hill-Rom’s GM and Vice President, Mike Gallup. Mike is a former IBM consultant who has been tasked with creating an unstoppable force in the Hill-Rom HITS (Healthcare Information Technology Systems) Group. His goal is to systematically coordinate the design of applications, creation of partnerships, and integration of collaborative initiatives that will strategically confront the marketplace status quo. He was gracious to share his thoughts and a new project that they are going to be launching soon.

Hill-Rom as written and developed a patent on hand washing that should cause the industry to sit up and take notice. Hospital infections are costly and many are preventable. Those two items are ear perking to people who focus on providing value to a hospital. Not to mention the pain and discomfort that they cause a patient, and potential additional infections throughout the hospital. The ability to decrease infection by a simple hand washing or sanitization is crucial. To put dollars to the thought, according to Hill-Rom MRSA infections can cost in excess of $200,000.

Hill-Rom approached the marketplace trying to identify a strategic partnership with an RTLS provider that could meet the system and software requirements developed in the patent. After much research they decided on Centrak. Centrak’s ability to get granular in the patient room allows for the proximity of the caregiver to the dispenser to be identified. It also detects the actual motion and interaction with the cleaner.

Sound a little like Star Trek? It’s not.

The concept is actually quite simple, but software and application is really brilliant. The motion sensor within the Centrak tag notices movement of the dispenser when it is touhed and the badges correlate the proximity of the caregiver. To “fool” it you would actually have to have a caregiver bump the dispenser on purpose and not clean their hands. This would seem to be a farfetched idea. I am not an expert on hand washing, by any means, but I would assume that a majority of the time that a caregiver didn’t wash their hands prior to interacting with a patient would be more out of forgetting, and not intentionally avoiding.

I see this as a brilliant tool. Since it’s a standalone system it could be tied into a number of different integration points to track the effectiveness, but also offer some proactive notifications to the caregiver or manager. While the application is not prime time at a facility today the system has made it through all of the Hill-Rom and Centrak’s internal testing. Mike’s projection is to have it live within the next three month.

Thanks again to Mike Gallup – www.hillrom.com I look forward to more spirited interactions about healthcare in the future.

The Trauma at Seattle Grace

2010-06-01T09:47:00.000-07:00

Normally, I would not blog about a television show, especially Grey’s Anatomy. Personal views aside, I was drawn in to the finale this year. A disturbed man entered the hospital with a gun and the facility went on lockdown. Doctors, Nurses, Visitors, and Patients were held in terror for 2 hours as he made his way throughout Seattle Grace. No one permitted in or out as the local police department determined the proper course of action. No one inside knew where the shootings were occurring, or what to do to protect themselves. The shooter made his way through the building killing and terrorizing all.

Hospitals will be receiving increasing pressure from AHJ (Authorities Having Jurisdiction) to be prepared for these types of events. Seattle Grace (as depicted in the show) was horribly ill prepared and it resulted in a number of dramatic losses and over dramatic saves. It was as if the building had no internal security system. (They should partner up with the hospital on the tv show 24 – they were able to view cameras in the hospitals on a tablet PC - by the way that's not as difficult as it may sound)

Here are just a few thoughts on “acts of terror” on a hospital. The security office should have access to view both internally and remotely all security cameras. They should have a cooperative program with the local police department. Providing access to the local police is not as challenging or space age as it may sound. Digital and IP based cameras can be network based or the Video Server can be leveraged. The security plan and threat assessment should determine how to notify staff of the location of the shooter. The Mass Notification should identify the following: What is occurring and what should the people do to be safe? Imagine if there were a series of cameras in the hospital that could identify where the shooter was and begin to strategically lock down areas within the hospital to keep him out. You can’t necessarily evacuate a hospital but you could minimize casualties by limiting the shooters movements within the building.

Additionally, there was no internal communications occurring. The doctors had pagers, but there were no internal wireless phones. The saddest scene in the show was when Dr. Bailey dragged the dying young doctor to the elevators only to find they had been shut down. She has no ability to call for help - she had to sit and hold him as he died. She had a pager. If she has wireless phones in this situation she could have called a central command post. To take it a step further, if there was a central command post they could have been able to see the entire situation unfold on a camera and have dispatched a help team.

This TV show depicted what Mass Notification Emergency Communication (MNEC) is all about. It’s sad that we live in an age where people find release in killing others, but casualty counts can be reduced if proper security people, process and technology are applied.

MNEC is really about choreographing movement based on the threat that is occurring. It’s about knowing who needs to get what information and how are we going to get it to them.

Power to the Pager....

2010-05-24T05:29:00.000-07:00

Buzz Buzz the PCT’s pager sounded as he was taking my mother's vitals. He stopped – looked at the pager – then smiled and said “I never seem to be in the right place at the right time.” He silenced the pager and went back to checking her vitals. Before he could finish the pager sounded again – frustrated this time he smiled wearily at my groggy mother and said “I am popular today”.

The trouble with pagers when used in a decentralized methodology is their limitations on actively interacting with patients and the call while mobile. The message is received and its plain simple information about the patient such as the room number, the call type, and whether or not this is the initial notification. In a straight nurse call to pager design – even though they are cost effective they are not very effective. That’s not to say this is a useless piece of technology, because if applied correctly it can be very effective.

The reason that pagers are purchased in mass quantities for hospitals is primarily the price. They offer low initial cost and low total cost of ownership. While I am all for creating low cost options for alert designs and see pagers as very applicable in specific situations there are limitations to these power packed little boxes. For those of you who talk with the CFO – “if designed correctly – pagers used in a workflow application can see a payback potential”

Designing workflow in a way that properly leverages the power of the pager is critical. The power of the pager is it can be non-intrusive if used correctly. The Caregiver needs to know that there is information attached to the page that is specifically for them. They need to know that the patient need has all ready been triaged and that they can quickly and efficiently answer that need. For example, a pager should be used on Normal Calls only if triaged through a central point (whether through the PBX or Unit Secretary or Others) However, pagers can be leveraged with other emergency call types – such as Code Blue.

One final tip on pagers – this is a freebie – NEVER use an external pager system to automate a Code Blue. A Code Blue should only be automated to an internal paging system such as WaveWare. The latency and delays are a patient safety issue and should be seen and addressed that way. If your hospital is currently using an external paging system your delays can be in excess of 10 minutes during peak times. If your hospital is using an external paging system then the CFO will be pleased to know that by replacing 90% of the pagers with an internal system there are HUGE potential savings.

So the moral of the story – use a pager if you would like but design it properly.

A Personal Note: Spending time with my mother in the hospital brought back a lot of the initial reasons I started Sphere3. Ironically, it was 1 year ago this month that we launched. Designing alarm automation often times we get caught up in the geek side. It’s cool that through the air we can make something ring or buzz – it’s interesting to examine process maps and charts, apply lean principles that help us assess the efficiency of the process.

However, when you sit with your mother in a patient room – watching her recover - helplessly knowing that the red button is the only methodology we have to engage the outside world – your eyes are opened to the other side of the map – the human side. The human side is where lean and process don’t always compute. As much as we would like to make the processes as straightforward as building a cheeseburger at McDonalds the fact is my mom wasn’t a cheese burger.

I want to thank the team at Columbia Regional Hospital in Columbia, Missouri. My mother received excellent care. It wasn’t just the care that she received – it was the non-clinical emotional care that we all received while in that hospital. It was the true demonstration of team work that I saw between team RN and her Care Assistant. The friendly and helpful volunteers, and overly helpful support staff. Thank you from the bottom of my heart.

There's an Ap for that....

2010-05-10T19:29:00.000-07:00

Some of you that know me well – know that growing up some people had pictures of Rock Stars on their walls – not me I had a file cabinet and books by Jack Welch. (I am serious, I asked for a file cabinet when I was 12 so I would have some place to store my budgets and letters). In other words – my rock stars were CEOs, movie producers, innovative genius, and other leaders. So, being able to talk with a great CEO is always high on my list.

I had a great conversation with Rob Campbell the CEO of Voalte. Rob, as you might know, has worked with the likes of Steve Jobs and Bill Gates on a little program – not well known at all – PowerPoint among others. Just talking to him was incredible. He has an amazing business mind and a keen understanding of the healthcare marketplace – which is surprising since he didn’t come from the file and ranks of an EMR vendor, medical device manufacture, etc. He is really an outsider who has stepped in to help launch the first Healthcare iPhone “App” for medical device connectivity.

What do you really think about that – an iPhone in the healthcare environment? Since I have been through 4 (yes, really) in the last two years I am a bit skeptical. The device, while loaded with features, is fragile. Dropping at the right angle can shatter a screen (been there) – not to mention that scratching a screen can render the device useless (done that). In addition the battery life can be – let’s say challenging (got the t-shirt). I have worked with wireless internal communication devices in hospitals for more than 10 years. They are as abused as a rental car in a third world country. That’s why Cisco rushed to replace earlier models that weren’t suited for being crushed by a Stryker bed, Ascom has made their phone survive the swim that often occurs when a Caregiver helps a patient off the toilet, and Spectralink’s case can be dropped and kicked down the hall.

Now, before you throw your hands up and run screaming from the device think about the flexibilities of what they have just developed. The Apple iPhone is one of the most user friendly devices on the market. If you are using the wireless device to receive patient calls and the average patient call per hour is 1.5 then making the “answer” function easy is essential. I challenge you to try answering a Cisco phone. (Hint: there are more than 3 button pushes to answer and speak with a patient) I don't claim to have experienced the Volate Answer process, but from what I have seen it appears very straightfoward.

Stop for a moment and think about the flexibility of this concept. How many Nurses currently have a “Smart Phone”? How many are using the facebook, twitter, yelp, urban spoon, or other crazy ap? The device is like a piece of clay that can be molded to it’s environment. Aside from that it's fun and easy use. The smart phone can display pictures, it can use decision assistance medical programs, and that little thing – enter information into the EMR.

If I didn’t say I was enamored with the concept – I would not be truthful. We are talking about Apple here – Steve Jobs is the Walt Disney of cool gadgets. If I didn’t love my iPhone why would I have spent the money to replace and repair it 4 times...or maybe 5. The device is great – it offers a lot flexibility to the hospital workflow. Some may argue that it also provides a lot of challenges for a hospital when it comes to policy of what is appropriate use, but no more so than a PC.

I recommend checking out their new website http://www.voalte.com/

BTW - anyone who wants to indulge me the one CEO who has been on my list for years is Meg Whitman, former CEO of Ebay.

Translation Fascination Part 2

2010-04-30T08:56:00.000-07:00

The brilliance behind the early device integration software pioneers was the building of the library. There is significant VALUE in the library of integrations. Anyone can build a little black box with a rules engine. (Please don’t throw things at me Integration Software folks - it's only slightly sarcastic)

Many different models have been taken to gain the library. Some “skim” the information off without building a relationship. This is a dangerous model that – while it works – updates can be missed. Some charge a fee to device manufactures which may seem like a poor model and not “open” but actually is smart. It makes people put skin in the game to ensure that development completes fully. Some work hard in the industry to build mutually beneficial relationships seeing a Co-development relationship that has more value long term and being less focused on the short term capital needs.
So why are these relationships so crucial? Think about it the changes in the language that might affect the way things are processed. Imagine if someone from 1776 tried to translate for someone in 2010. "OMG that is so wrong - lol." It wouldn’t work so well. That’s why building relationships between Integration Software and Device Manufactures is really important.

Sounds logical – almost easy right? Wrong. There are many device producers that are closed nations – they don’t share enough about their language to allow for high level translation.

So is "Interoperability" a dream?

Translation Fascination

2010-04-28T07:30:00.000-07:00

I have blessed to travel to several countries. I am always excited to see the sites, experience the culture, and of course – eat the food. One thing I have learned is in the countries where I don’t speak the language (so anywhere that they don’t speak English or Spanish) I can do very little without a translator. Believe me hand signals and acting out the need can only get you so far and does not work well in restaurants….and I do love to eat.

If you think about interoperability engines – each is a translator that allows for multiple items to speak with each other. The more “integrated” a engine provider is to the device the higher the level of communication you can provide. For example, I studied Spanish in a Classroom for 6+ years but I didn’t learn Spanish until I immersed myself in the culture and language when I lived in Seville, Spain. The culture and the language enhance your ability to communicate. The same is true for device integration – the more immersed you are in the product, the stronger the relationship - the more ability it will have.

Stay Tuned for Part 2

Top 5 Nurse Call: 2& 3

2010-04-23T19:09:00.000-07:00

2) Which has the best equipment warranty and lowest cost of ownership?

Nurse call no matter how you slice it is equipment. Equipment needs maintenance – physical maintenance. An electronic component breaks down.

As equipment, once it is in the wall it is challenging to replace due to back boxes, cable and other “installation” issues. The house we talked about previously if you decide you would like new Kitchen Cabinets and countertops once you change what is there it is really cost prohibitive (if not prohibitive, it’s a really bad investment choice) to change it 6 months later.

Therefore, the long term cost of ownership is important.

3) It’s broken – now what?

As Nurse Call Systems enter the realm of VOIP it is amazing that the support structure Du jour is “off site” or “call center” similar to the change from full service to self service at the gas station. As described above, a Nurse Call System is hardware that is controlled by software that interacts with other software and systems.

The item I do think is valuable is using the hospital help desk to assess the issue, but they need to be aware that diagnosing the issue is more than just dialing into a software platform and making an assessment. If a clinician calls in on a fully integrated system and says “my phone doesn’t work” then the person answering the call needs to know it’s probably not the “phone” that’s broken. That’s why we developed a “Help Desk” training program that assists a call center in diagnosing the problem in an integration.

It is necessary to have an available group to be on-site within a period of time. If your disaster plan or maintenance plan categorizes a Nurse Call System to only be down for a set period of time then you need to make sure a response on-site can be within that time.

Top 5 for Nurse Call: 1) Can it do the workflow we have designed for our hospital?

2010-04-19T08:48:00.000-07:00

Pre-Determining how the system will function is the only way you can determine which system will fully meet your needs. This can be done internally but utilizing a 3rd part workflow designer. If you are a do it yourself kind of place figure out what you are doing currently and how it would need to change to be better. One of the biggest mistakes made is allowing an equipment vendor to design the vision for a patient call system. Yes, they have experience but they are also partial to the system they are providing.

To put it in perspective, one of the largest personal purchase decisions you will make is buying a house. When evaluating houses inevitably you will begin to picture yourself in that house – what you will be doing? If you visit the house and the listing agent (seller's rep) is there – they are going to direct your eye to all of the “great” features and downplay any of the features their house is lacking. For example, if the house is a split entry the selling agent is not going to point out to you that you will be climbing stairs every week with multiple trips to carry in groceries. They will be directing your attention to beautiful view of the Cul-De-Sac and how your kids will love playing there.

The same is true for Nurse Call (stay with me techy geeks) If you have all of the Nurse Call Vendors present and you do not know what is important to you – then they will tell you what is important to you based on their systems capabilities. This is called features based selling. It’s not wrong or deceptive. It’s them presenting their product in the best way possible. It’s only deceptive if you ask them if their system can do something and they tell you it can when it can’t. Or they sell you a “road-mapped” item as current.

Entering the house with your top 10 criteria is the best way to approach purchasing houses. Understanding why you are purchasing is crucial. Has your family expanded, therefore you need more room? Are you getting older (or plan to grow old in the house) and need fewer steps? Carry this thought process into purchasing a nurse call system.

The best tactic for reviewing vendors is to provide them with pre-determined workflow prior to their presentation then let them explain how they would provide you with that workflow. Verify they can meet the expectation. At that point they can show you additional items you may find of interest based on their products specific capabilities. This IS valuable information because your core need is being met. Their additional “features” then become the icing on the cake.

Stay Tuned for #2 Evaluating equipment warranty and lowest cost of ownership?

Patient Communication & Technology Part One

2010-04-13T06:35:00.000-07:00

People ask me all the time why Sphere3 addresses Nurse Call first when we look at Alarm Automation. Quite Simply - it is the hub of all patient interaction at a hospital. If you want to see immediate change then address the way caregivers are interacting with patients. Nurse Call is the only Patient controlled device in the room that is related to their care. (Yes, interactive TV people may disagree) It is a life line for patients to interact with people who know how to help no matter what the request.

This is a medical device that is required to be in every hospital for notification of patient need. However, if you are just using it for that type of interaction then you are not fully leveraging the investment. For example, if you can purchase a button that can be used for bed management as opposed to a bed management system then isn’t it leveraging that base platform more efficiently? The key word above is “required” but the key idea is how do you leverage a required piece of equipment for innovative workflow processes that are outside the basic scope. Nurse Call purist will disagree with this point by saying that adding extra workflow processes decreases safety. By not using the system for its intended use you actually increase risk that a peripheral function would disrupt a critical one. However, most platforms are designed so that you can’t disrupt a critical process unless it’s not implemented correctly.

Further, when evaluating the system it’s important to define how it will be used. I have found that a majority of the time the system is being evaluated on a few key features – not necessarily on how the system will be used. Don’t follow the Shiny Ball folks!

To put it in other words – a hospital knows they need a nurse call system for communication but rarely has its uses or additional workflows been pre-defined. Many rely on vendors to provide outlines and designs on how the system set up, but that’s how it is looked at as “system setup” not workflow. There may be some base anecdotal type information about wanting to “send it to a phone” but not a true plan. Having a plan of how each aspect of the nurse call is to be used prior to making a purchase decision is crucial.

Important: System design is how the components and cabling are put into the hospital. Workflow design is how the caregivers use the system. Workflow design overlaps system design because there are specific component needs that enable the workflow.

Stay Tuned for the next post: Top 5 things a hospital should look at when evaluating a Nurse Call System

Keep it Simple Sweetie.....

2010-03-24T11:08:00.000-07:00

I was recently asked why I related healthcare IT to a car in a previous post, and did I think that it made me sound less “techy” or intelligent? Forgive me while I soap box a bit - One of the things that bothers me about healthcare IT is we use overly fancy words, acronyms, and phrases to describe something really simple. While I understand this is similar in many industries – for example, the dentist yesterday he used 15 different words to describe my sore tooth. It’s the second tooth from the back on the right side people! Bicuspus chomper regularus painfulugus!

It would be easier if we could all just translate a little. That’s why I try to use a lot of non-healthcare and non-IT analogies. Not because I don’t understand – because I do. I understand that to most people we work with the concept is more powerful then a detailed description of the program or Code. The result is more critical then the how.

To those of you who program – don’t get me wrong I understand that the details must be covered and if not then the concept can never occur. To those of you who live in the concept – the details drive you nuts but without them your vision is just words. Words accomplish very little.

With everything occuring in Healthcare IT - communicating between technical and non-technical people is critical to making things work right.

What do I know? I am just a little gal from Missouri…..with a company that takes “Anything that rings, dings, or buzzes and we design the workflow to get it to a wireless gadget that a caregiver carries.”

Grady Health Systems Surgical Service Workflow

2010-03-18T07:47:00.000-07:00

At HIMSS I had the opportunity to tour the Surgical Services area of Grady Health System in Atlanta. The visit was facilitated by Centrak and hosted by Hakan Iliken the Director of Anesthesia and Director of Process Improvement. Iliken was an exciting individual who shared his vast knowledge of process design which is rooted in his Industrial Engineering, Software Development, and CEO background. Iliken is in charge of making sure the technology applies and assists the caregivers, patients, and doctors throughout the day. What I found unique about Iliken was his ability to not only look at things through clinical glasses, but also examine it with a business mindset - balancing clinical and business. The technology implemented was a Centrak RTLS System tied into a Perioptimum tracking board.

According to Iliken - The Goal of the Implementation is to “Improve Surgical Services throughput and productivity by utilizing a system with Real Time Accuracy.” A secondary goal was to "Increase Transparency."

The Primary Goal is “easily” definable – increase utilization, and ultimately increase revenues. Iliken has seen a 10% increase in Utilization during Prime Time. They are mobilizing staff and moving patients more efficiently and effectively, and they are able to identify bottlenecks readily.

One of the key ways that they accomplished documenting efficiency was to utilize the three flexible buttons on the In-touch badge. The way Iliken designed the processes ,which were enabled by the technology, is each button represented the next step in the process – the wow factor in the design is as the badge physically moved into a different area (Pre-OP, OR, PACU, etc) the buttons would change meaning. Thus, offering extreme flexibility. For example button 1 (represented by a *) means “Anes ready” in PreOp, in OR it means “Induction Begins”, and in PACU the same button means “Phase 1 Complete”. To aide in the ease of use color coding was used on the tracking boards in the staff area recording and identifying the patient’s location and specific steps in the process. Each staff member is provided with a "cheat sheet" that is card sized and fits into the ID badge holder. In addition, since the button pushes were not tied to a physical item such as a wall it provides for additional future flexibility.

The ability to dissect a process is a powerful tool. Think of it like an assembly line at Ford. Each person in the process touches the product, and with extreme accuracy they can identify where the issue occured. They can also identify if it was a people or process issue. Can all of this be achieved with RTLS and process design in a hospital? While I am on board with lean and six sigma design and the ability to reduce errors by using strict process – I believe that healthcare at its core is about people helping people. People who are sick and people who are taking care of them – no matter how we try there will always be a people element. Technology is a tool – it’s not always total the answer.
Stay Tuned for Part Two - The secondary goal, I found most fascinating, probably because of my groupie like appreciation for Paul Levy’s blog. Transparency means no holds bar real data – the truth that bypasses the finger pointing and assumptions.

The Patient Within the Code

2010-03-04T19:57:00.000-08:00

HIMSS made me have one of those “Wow” moments where the world was once flat and now is in full Spherical shape. I was amazed at the bright colorful booths, the well dressed executives, and the hustle and bustle of it all. As I had a complete geek out moment – playing with widgets, talking tech with providers and hospitals – I began to get lost in the forest of tech and saw how it would be easy to lose the patient amongst the code.

Technology is enabling – Technology is empowering – Technology can become overwhelming and overused.

I had the luxury at HIMSS to tour Grady Hospital with Hakan Ilikan, Director of Process Improvement. Ilikan’s passion is to see technology make life better for the caregivers, patients, and families. I will tell you the full story in a later post, but one moment stood out. As I walked through the waiting room of the OR my gaze carried past the screen of information about the patients progression through surgery and I made eye contact with a woman – for a brief moment I was reminded why we are all doing this – for her and her loved one.

How many times a day does the patient enter your conversation?
How about their family?
How many times a day do you visualize how your technology helps them?
Does your technology really help them at all?

Maybe I am the only techy geek that sometimes forgets what it’s all about – maybe I am not. I keep a picture on our website which serves as a reminder for myself and my team of why we do this – why we focus on making life better.

Technologists – Manufactures – Service Providers is it possible that we are so consumed with the competition, development, deployments, that the patient becomes de-emphasized in our equation?

Don’t misplace the patient among the code – Don’t forget why we are all in this game.

We as a company have not shared our Vision but I think it is important – it’s not long – we didn’t hire a large consulting firm to help us –it’s pretty simple “To Make Life Better” followed by our Mission “To Empower Organizations with integration of people, process, and technology.”

Disruption is NOT Always in the Initial Splash

2010-02-22T20:14:00.000-08:00

Disruptive Technology – at first glance it almost sounds negative. Disruption as a term means to throw into confusion or disorder. Disruptive Technology is disruptive to a process, disruptive to an industry, but most importantly disruptive to a mindset.

I sat in two conferences. One a group of well intentioned manufactures wanting to disrupt the space surrounding falls in hospitals and the other with a group who wants to disrupt current processes in healthcare by reducing workloads. Phrases like “Change is inevitable” and “If we don’t change then we will be left behind” resonated with me as I tried to collect my thoughts over the weekend. How does this add value to the hospital? How does a hospital make sure it’s not just one more PO on a piece of technology that could end up never being used because of its inability to fit into the life of the caregiver?

As we drove back to the office, my Analyst had a stroke of genius (which happens often) she said “You know that vital device we saw – that could save at least 30 minutes.” To which I replied “30 minutes a day doesn’t change much.” “Not a day! Every time they do that! Kourtney, that would allow us to decentralize at .…..” as she rattled on through several scenarios. (As a former caregiver, she is always excited to find ways to save time.) Then it really hit me – The disruption does not always lie in the immediate process sometimes it’s in the ripple effect.

Have you ever watched a pebble thrown in a pond or puddle? The initial splash is sometimes impressive but what’s truly impressive is to watch the rings as they multiply and span out over the water. Think through the ripples – there is an assumption that the time being gained is used for productive activities and that the productive activities free up another area.

As the ripple gets larger there are more related items that could fill that 30 minutes of time saved, and possibly more time can be gained in other areas. The direct connection back to “that” 30-minutes becomes looser as you move farther from the initial “splash”. In theory and on paper assumptions become strong cases to justify the actions/purchases of administration. I think we will see a lot of that in the coming year, and while skeptics might balk at simple associations – without the creativity of process design – no one would’ve found “that” 30 minutes and we would still be wasting it today.

Have you ever thought about that – let your mind wander through all of the things that one item changes? You have heard of 6 degrees of Kevin Bacon – what’s the 6 degrees of one innovation? How many rings does it make? That’s the true value.

My instruction “Blow it Up”! We work in an industry that is so ripe for innovation. There is a new era of change – not just change for the sake of change. We are not talking about technology that ends up in a recycle bin because its value was linked to “fancy” and not linked to improving the day of the caregiver. We are in an era where healthcare providers are demanding follow through on a promise and PROOF in the pudding.

Workflow Ability - The Final in the Series!

2010-02-15T09:02:00.000-08:00

Workflow Ability takes into account the product life (base ability) combined with the technology life (things we can’t live without) and balances it against the Optimal Workflow. It is determined by examining specific parameters such as staffing, unit layout, and technical acumen. Optimal workflow is not wholly determined by the technology that is in place, but does take that into account as a limiting or enabling item. Onceit is determined then the limitations of old technology can be balanced and married with the enhancements of the new utilizing a unifying technology.

So, for example, a cell phone allows a person to call while mobile. In its raw basic form – it’s clunky – you have to learn to dial one handed, hold a phone to your ear and drive. (Plus drink your latte, manage the kids, and change the radio station - not that I have ever done that.)

The iPhone is equipped with a unifying technology called Blue Tooth. If a person wants hands-free calling utilizing their iPhone then they need to upgrade their car to a 2010 model with Microsoft SYNC technology. SYNC provides voice command dialing and open voice communications over the cars speakers. (Like a Vocera Badge) However, to get SYNC you have to purchase a brand new 2010 Ford. OR you can utilize a different unifying technology which leverages the abilities of the iPhone in hands-free mode over the car speakers. Until you purchase the new car, you will still have to do the one hand dial, but at least you can set the phone in the cup holder and drive with your both hands on the wheel at 10 and 2.

Now apply this principle into the world of nurse call or other healthcare technology. Upgrading an entire nurse call system can be in excess of $5,000 per room. I will be the first to tell every caregiver – the new system will make your life easier and offers a number of flexibilities. However, it is better to decide workflow prior to purchase, decide if you can utilize existing systems with a unifying technology – then make the upgrade decisions.

While the capabilities of the new system will become a necessity ( I almost didn’t drive the other day because my front end collision warning was not working due to the snow even though I have driven without it for 15 years) leveraging existing platforms is a real possibility.

Stay Tuned for Our Next Blog post – Disruptive Technology and its Influence on Workflow - insights gained from our recent trip to Cerner.

Product Life, Technology Life, Workflow Ability - Part 3

2010-02-08T07:02:00.000-08:00

Technology Life Decisions are more readily linked to the exciting features that differentiate the products one from another. Some might call them frivolities, some might see them as necessities. Either way they are items that enhance the base goal of the product.

Technology Life Decisions are difficult to make due to the ever changing nature of technology. The “lifespan” for many technology decisions for medical devices is shortened to 5-6 years (sometimes more or less depending on the flexibility of the platform that is being purchased). Hospitals may delay purchase to wait for the next model to be released. Road Mapped items become decision points and actual realities become less critical. Not to say that a product, software, or service that has a vision for the future is unimportant but reality is more critical than vaporware.

Interestingly, the technology life decision points – things that a manufacture or developer creates to differentiate their product - often become base product decisions. Think of power windows. 20 or fewer years ago wasn’t it suitable to have a crank and before that wasn’t it a luxury to have a crank? Power Windows are an enhancement, but because of the end users interest they have become the standard. The point is often the technological enhancements won’t be enhancements for long .

Early Nurse Call Light Systems consisted of one light and one tone. Now we have systems that have unlimited light and sequence capability through LED and unlimited tones by allowing for wave files to be uploaded. Eventually, this will not be a technological enhancement – it too will become the standard.

So how do we bridge the gap between the technological enhancements of the new products and the apparent short comings of previous products. We believe the answer lies in Unifying Technologies coupled with proper workflow design.

For example, in a car, Micosoft SYNC integration allows the information from your mobile phone to download into the car and allows for voice command and hands-free calling through voice command. While all base capability of making a phone call while mobile is available using just your mobile phone, SYNC increases the value of the vehicle by enhancing your experience with the phone.

SYNC’s value is enhanced because of a unifying technology called BlueTooth.
Similarly, all nurse call systems can notify a caregiver of a patient’s need with a light and a tone. However, some can integrate to wireless phones allowing the caregiver to be mobile while speaking to the patient. There is intrinsic value to the time savings that a hospital will find by integrating their nurse call system to the nurses wireless phones. According to our research, over 30 minutes per day per RN or more depending on the style in which the integration is made. However, prior to today all of that is only possible with a unifying technology called Middleware. Interestingly, this "feature" and ability developed by a vendor outside of nurse call is becoming part of nurse call systems. Eliminating the need for a "unifying technology" all together.

Stay Tuned for
Workflow Ability and how you can transition from one platform to the next more easily and over a longer term investment.

Product Life, Technology Life, and Workflow Ability Part 2

2010-02-02T09:05:00.000-08:00

The first step is to define the base purpose for the purchase. Every product has a basic underlying goal. For example, I purchase a car to get me from point A to point B. Yes, I am glad it’s red but red is not my reason for purchase – color does not necessitate a change.

A hospital purchases a nurse call system to notify a caregiver of a patient need. This can be fulfilled with ANY nurse call. The basic ability to light a light and tone a tone are the requirements for the nurse call system to meet code. The same is true for every medical device. They each have a basic function that has to be fulfilled. Features are provided to reduce the ability for the product to become commoditized.

The reason we need to appreciate basic functionality is to start to build on the decision points/ timelines. The first is Product Life. Just like your car, a piece of medical equipment cannot live forever, as the product ages the cost of ownership increases. Generally, the product life of a medical device is 10-12 years. This doesn’t mean it will suddenly stop working (though on occasion this may occur) quite simply put the older it is the more costly it is. Eventually, replacement parts will become more and more scarce, and ware and tare will take its toll. This is why for product life decisions items like Mean Time before Failure, Maintenance Costs, and availability of service providers becomes the basis.

Making a matrix of decision points on Product Life is a good way to assess competition. All products within a category should meet the base goal, but utilizing a scoring method to assess mean time before failure, maintenance cost, serviceability, and availability of support can solve half of the equation.

However, if driving from point A to point B were the only criteria that mattered then everyone would drive the least expensive highest miles per gallon car. The fact is that billions of dollars are made each year in the auto industry by creating vehicles to meet the specific goals and desires of drivers. Taking otherwise frivolous items such as navigation systems, built in DVD players, and (dare I say it as a frivolity) power windows and pairing them against the competition as necessities. Driving up costs and changing the spectrum of competition.

Leading to the next Decision Point: Technology Life

Stay Tuned!
Technology Life
Workflow Ability
Unifying Technology

Technology Life, Economic Life, and Workflow Life

2010-01-31T15:24:00.000-08:00

“What color do you want?” This is the first question I am asked when I go car shopping. (Yes, it does irritate me.) While I see that is an important decision for most people, do people really buy a car for it’s color?

Wouldn’t it be more effective to ask – “Why are you shopping for a car?” This should be the question of every vendor pushing a medical device to a hospital. "Why are you purchasing this product? Why now? What initatives are you trying to solve with this purchase?"

If you look at purchase decisions. Most will fall into one of two timelines or life-spans: Product Life and Technology Life. Product Life is the underlying practical reason for the purchase, and Technology life is the technological enhancements we "can't live without". We believe there is a third area for medical devices that can leverage existing platforms, blend their usage with new product platforms making transitions easier – we call it Workflow Ability.

Technology Life = 5-6 years vs Product Life = 10-12 years

Workflow Ability can extend the Technology Life 3-5 years balancing out the difference between Technology and Product Life. It allows for proper transition between platforms.

So how do we bridge the gap between the technological enhancements of new products and the apparent short comings of a previous investment?

Many hospitals will simply make a Capital Investment and change to the new platform, but is that really necessary? In these economic times is that really a practical decision?

We believe that the first two decision points (product and technology), while important in making a transitional question are lacking in their ability to allow the hospital to make a long-term transitional change. We believe that Workflow coupled with unifying technology can really increase the lifespan of existing platforms thus leverage the hospitals original investment.

This is a LONG post so I am breaking it up into sections.

Stay tuned for more on:

Product Life

Technology Life

Workflow Ability with Unifying Technology

Patient Satisfaction and Value

2010-01-09T08:03:00.000-08:00

Patient Safety initiatives can readily be linked directly to value for the hospital. If a hospital reduces one fall there are savings of litigation, and non-reimbursable care. Patient Satisfaction can be a little more abstract when measuring results – not that you can’t get a score very readily from a Press Ganey Survey. What does that mean for dollars? How can we measure our effectiveness in these initiative? Adding new dimension to this is the HCAPS Surveys and how they will affect reimbursement for care.

Every business uses some sort of performance metrics. Often quantity of incoming requests (similar to incoming patients) and quantity of “credits” given for mistaken work (similar to non-reimbursable care) – not that these are exactly the same in all instances but they are similar and make the point that tracking specific information can be helpful when improving business practices.

Sphere3 believes that a stand-alone metric, while valuable information, is less effective as one that is cross-referenced with another. For example, if a hospital were to look at average response time balanced with the staff to patient ratio and correlated with total average call volume – you could use the information together and create a multi-faceted metric. Then take that metric and see if there is safety improvement and if there is also an improvement in patient satisfaction score.

Most importantly, what is the link it to dollars? Will the hospitals elective surgeries increase? Will the hospital have a consistently higher census? I understand there are some large assumptions when loosely linking these two data points but the point is if you had the power to easily look at information such as (1) your response times, (2) quantity of direct interactions with patients, (3) average wait time before exit, and (4) total call volume, would you be able to make specific linkages to improvement in patient satisfaction? Would you be able to take that information and link it to increase in electives and increase in revenues based on increase of paying heads in beds?

Our new Sphere3 Scorecard™ will make it easier for hospitals to get specific information on clinician response and interaction which can be compared to patient satisfaction.

Call us for a full presentation.

Location, Utilization, and Movement

2010-01-03T14:41:00.000-08:00

I had an interesting call with Will Lukens, Vice President of CENTRAK, a Real Time Locating System (RTLS) company. There are a number of debates swirling around RTLS such as what’s the best technology to use? (Wi-Fi, RF, Hybrid - Check out JHIM from Fall 2008 for further reading on the technology.) No matter what technology you use in the background, RTLS is a great mechanism to track the effectiveness of workflow for staff and “stuff”.

Step One is always to decide “what” you want to accomplish prior to deciding “how” or with which technology you want to use. The "what" or goal froma workflow perspective can be evaluated in three areas Location, Utilization, and Movement. Using these areas you can evaluate numerous abilities to track implemented technologies and initiatives.

LOCATION: It’s been reported that caregivers currently spend less than 30% of their time at the patient bedside, but that’s an average which is not applicable for every facility. Using RTLS a hospital could track the actual time frames that a caregiver spends with a patient and set a baseline for their specific facility.

Location is the portion of the puzzle that has the most value and the most apprehension. The ability to track caregiver’s locations with detailed reports of who, when is sometimes labeled “Big Brother” and “Micro-Management” and honestly, would you be pleased to wear a tag that tracked your movement the entire time you are at the office? “Bob, you spent way too much time at the coffee pot.” Using this as a coporate means of improvement as opposed to individual tool for punishment is really key.

UTILIZATION: “Work Around Artists” is a term that Karen Cox, Executive Vice President of Children’s Mercy Hospital in Kansas City coined in the last issue of Ingrams. That name captures the innovative spirit of the caregiver. They are the modern day MacGyvers using available resources to find more efficient paths.

Often hospitals will implement initiatives, or provide technologies with the desire to see an improvement in something that is lacking. For example, if there are high infection rates they may implement a hand washing initiative and provide a new sink in every patient room. What if the utilization of the sink could be documented automatically – even more so what if that information could be correlated back to the reduction of infection rate.

MOVEMENT: Frank Lloyd Wright would watch people’s movement habit’s to design walk ways. Once he didn’t put in a single side walk at a University until after the students had worn paths to show where he should be putting those walk-ways. RTLS is the modern day observation and automated documentation of movement habits. A caregiver walks 1 to 4 miles per day (depending on size of facility and quantity of patients) often a technology is provided to reduce that foot traffic. Hospitals can have humans track the movement with clipboards and pens or pedometers, but if they have an RTLS system that information is being collected.

Before you begin your journey - A great resource when planning RTLS purchase and implementation Robert Konishi’s RFID-RTLS Strategy and Planning Guide. Robert is the former CTO of UCLA Medical Center, and Current CEO of T2 Technology Group. According Konishi, there are four main areas that can be assessed to link to value when evaluating the RTLS system for equipment tracking:

• Cost savings associated with rental or duplicate purchases
• Lost Revenue and Opportunity Cost due to utilization
• Lost Time for Staff
• Quality of Patient Care, Throughput, and Regulatory

Konishi provides very helpful insights in the article from RFID News (http://www.rfidproductnews.com/pages/searchview.php?key=konishi&p=issues/2008.03/medical2.php) and a subsequent RFID-RTLS Strategy and Planning Guide.

The power of RTLS is the ability to track specific information. That information can become a metric which can be used to help the hospital better assess their workflow choices. A metric on it’s own is important – every business needs to track it’s ability to improve – however correlating those metrics with other data is the most powerful way to look at the data. That's why Sphere3 has developed our automated web based Sphere3 Scorecard™.

We look forward to sharing it with you.

Hospital Noise

2009-12-09T08:41:00.000-08:00

Ring, Buzz, Tone, all sounded as Caregivers bustled and hustled past my seat with IV bags, food, charts, and doctors. My heart rate increased. It seems no matter how long I have worked with hospitals those noises still make me nervous. It’s kind of like taking your first airplane ride – you are not quite sure what the noises mean but you know the plane could fall from the sky at any moment. I began thinking about noise, as I waited to speak to the Nursing Director, why is it so noisy? When you are sick all you want to do is rest, yet how do you rest when an IV pump - that sounds like the worst alarm clock in the world - is going off randomly down the hallway.

Noise is measured in decibels(db) - I learned that from my early days of designing sound systems. The average bedside monitor is approximately 79db (Hospitals & Health Networks Dagmara Scalise Mayo Clinic May 2004) but what does that mean? Compare it to a heavy truck driving by – a diesel mind you – which is 80 decibels. At Mayo clinic they documented the loudest point of the day to be at a pre-intervention shift change which was at 113db – to compare a gunshot is 140db.

Is a “decibel” really the right method or measure? Do we really expect the Clinicians to be concerned with actual decibel readings? Is it practical to think that they are going to carry around a little decibel meter in their pocket and then say ohhh we are 15 decibels too loud? Impractical, Difficult, and Inefficient….

Since assessing all noise on a unit is a huge undertaking (footsteps, conversations, cell phones, chatter, beds running into walls) - What if we took the section of noise that has to do with alarms and began to create a method to quickly and efficiently assess it? Total quantity of alarms multiplied by total devices in the rooms = the Noise Issue. (that’s way too simplistic but it helps establish the initial concept)

The initial solution by hospitals (and manufactures trying to sell a product) is “send it to a wireless phone or device”. While I am onboard with the mobility revolution – I think that it’s an overused medium that manufactures and vendors use to pull at the overworked heart strings of the caregivers. The mantra “We can make your life easier – just send it to a wireless phone” conceptually is wonderful but realistically how many alarms can we actually take on our hip? (See earlier post) Don’t jump on the band wagon that mobility is always best - jump on the band wagon that efficiency – ease of use – reduced redundancy is always best.

At Sphere3 we utilize a sophisticated equation in our workflow analysis and link it back to proper categorization of alarms which decreases alarm fatigue. One of the items we look at is noise and utilizing a scoring system we help establish the most effective area to automate.

I think that it would be interesting to create a calculator that the caregivers could easily use to establish their noise level – efficiently and effectively. Anyone interested?

Check out the article posted by @BhawkesRN (Beth Hawkes) on Noise.

Single Source of Truth

2009-12-04T13:27:00.000-08:00

The Clinical Transformation blog is about workflow – how do we positively impact the caregiver’s day by providing technology that is purposefully chosen based on process. Remember if you pick the product without knowing the workflow you want to achieve up front – then you are shopping for a book based on the picture on the cover not the content of the material.

That being said - I am totally enamored with what is occurring with device connectivity platforms and the flexibilities they offer. I am equally enamored by the marketplace shift that is occurring. Companies large and small move into a space as a disruptive technology, and it begins a ripple effect. This starts to shift our view of status quo and wonder – is there a better way?

One of the best parts of our growing start up is all of the interesting people I get to meet. Wednesday, I had the opportunity to sit down with Tom Herzog, VP of IT and Medical Device Technology – head of the MDBUS. Tom is a fascinating individual who is very intelligent and a visionary in the marketplace - I was blown away by our conversation and truly appreciated the interaction. He is someone to watch. MDBUS is Cerner’s connectivity platform that connects medical devices to the EMR. While MDBUS has several similarities to CapsuleTech (blogged about earlier) they have built tight relationships in the marketplace with companies such as Hill-Rom that allow them to garner additional information on an interactive touchscreen, and interactive integration software piece that allows a user to query systems using a handheld device.

The one items that stands out to me as their biggest challenge (this might be the elephant in the room) in the market place is the blessing and curse of the Cerner brand. Cerner is well known for innovative thinking and product development – if you have been to a smart room you would agree. The blessing of the brand is it’s trusted stability in the marketplace with a growing enterprise EMR market share documented at 13%(2006 HIMMS) which I have read other sites to be closer to 20%. This is a great base of clients who are prime candidates for “the bus”. As a relatively unknown startup – I am envious of having such a well known brand. What Mr. Patterson has done is amazing.

The curse of the Cerner brand is it’s tight tie to a specific EMR. While the product is designed to be EMR vendor agnostic - it would only be logical to utilize the product to position themselves in competitive accounts. Why would Epic invite a Cerner product into the mix? I could be way off base here but this seems counter intuitive. While it may occur – GE still utilizes Emergin (aka Phillips) Emergin as a standalone brand had the ability to be Vendor Agnostic but now linked to Phillips it is a leverage point to bring Phillips into an account.

All of that aside – the thought process used in developing MDBUS is correct – the product is really impressive. Open Source – Open Data – Single Source of Truth (as Tom would say) is important in healthcare. It offers significant abilities to decrease caregivers workload and increase safety.

I think that every hospital should be evaluating these types of systems and DOCUMENTING their validity.
What method are you using to see if this is garnering you results?
Is it going to positively affect safety, accountability, redundancy, and noise?
Is it affecting their caregiver satisfaction, patient satisfaction, and safety?

I think that Capsuletech (Brian McAlpine) and Cerner MDBUS (Tom Herzog) are fellas that you should watch – I know I am. I appreciate this interaction.

Who would’ve thought – a little gal from Kansas would be talking to such powerful industry changing people. All it took was Twitter and a choice to join the conversation – are you ready to join?

Thanks Tom – look forward to learning more.
www.cerner.com

Stay tuned – I am working on a thought provoking post about Cerner’s vision of allowing people to write apps to their Iphone and utilize the EcoSystem to share (possibly sell) that work. Probably one of the most innovative ideas I have heard in a long time – not sure I am on board with the ide, but I can’t wait to experience it myself.

The 5 I's of Fall Mitigation

2009-12-01T13:41:00.000-08:00

Our Goal is to reduce falls in the patient rooms – whether or not you hire Sphere3. I believe in the power of the conversation for the overall improvement of healthcare. I encourage you to read what is written and add to it. We have had a great team working to develop this framework but I believe in the power of collaboration.

Collaboration outside of healthcare can also be powerful. As many hospitals have discovered, manufacturing may have some ideas that could answer some of the questions. What are other industries that may compliment process improvement for healthcare?

The First "I": Introduce

The basic premise of the first “I” is to describe how the patient is introduced to the unit. This is not a, “hello my name is Joe, what’s yours?” It is how do they get there and once they are there how do people know? Not that we are recommending a camp like cheering section to greet them in a tunnel but how are the caregivers on the unit provided with information that a new patient has arrived. What’s the “on-boarding” process? One consideration for this process will be, is it important for everyone to know a new patient has arrived?

There is considerable time savings opportunities (and cost savings as well) prior to arrival on the unit. There are several areas to consider including how are you tracking the time from entry to bed and all the steps in between? How is the transporter contacted and how are they tracked? How does the hand-off work?

What are your thoughts on Introduce – Transport – Notification?

Our team works with your hospital to customize a strategy to respond to the above questions. Our Fall Mitigation Analysis software program allows us to document, analyze, and provide innovative recommendations for improvement. Your information is assessed against best practices for optimal results.

Patient Association

2009-11-06T07:35:00.000-08:00

Sphere3 has a goal and focus to increase caregiver satisfaction by utilizing technology to automate workflow. The key is we don’t want to make life MORE complex by adding unnecessary technology nor do we want the hospital to spend additional dollars if existing technologies can be leveraged to increase functionality.

I had an interesting conversation with Brian McAlpine of Capsuletech (www.capusletech.com) about patient association. Capsule is highly focused on the documentation, and the ease of delivery of information.

I encourage you all to join in the conversation to increase the overall knowledge in the industry. This is my perspective - which is meant to be very elementary in it's approach.

Caregivers are challenged to manage information – whether it’s an alert to their wireless, a piece of data that needs to be documented, or request that is made or received. Adding technology to “make things better” will sometimes add steps as it requires several steps to interact with the new technology.

Traditionally, in alert automation software, the information is linked to a room number. The association to a patient is generally made by the integration to the admitting system (sometimes this is done manually) – so connection is only made by linkage to room number. The key is that the alerting device must be “tethered” (aka plugged in) to the patient room to be linked to the room number and sent to the appropriate caregiver, or the hospital must purchase additional software packages which in turn increases the number of "adapters" that must be purchased for integration software. Adding to the difficulty, new devices are wireless and can float to any room so a nurse must interact with the piece of equipment to identify it's location.

So, the question becomes will it become more necessary for alert automation to associate with the Patient as opposed to simply the room? Potentially, it could be easier to associate to the patient. This could increase the flexibility for integrating that information to medical record for multiple devices such as mobile telemetry, vents, pumps, etc. It will also blow away the current assignment process for integration software, nurse call, and other vendors. (Yes, I recognize there will be disagreement on this one.)

The Nurse Call information is the most popular item to automate directly to wireless mainly because of its highly visible patient satisfaction and caregiver satisfaction influences. The telemetry is a close second, while the loss of the waveform has been challenging to most sites, it’s still very necessary to have that alert at the “hip”. While it’s not highly critical to associate the patients name or identifier to a wireless device for nurse call, documenting the interaction can be critical if an issue arises.

Most of the companies focused on alert automation do not consider the charting piece because it’s “out of their scope” but hospitals will at some point (if not already) be tasked to correlate that information. If you read Brian McAlpines Blog you will read more about patient association, devices and documentation.

Products such as Capsuletech offer a vendor neutral integration point in the patient room. Their product can collect data from devices and correlate it with patient information, all of which can be confirmed at the bedside either manually or automatically.

Clinical Transformation

2009-08-31T06:11:00.000-07:00

I love the new Bing.com commercial. The daughter asks the parents a simple question and they begin to rattle off information containing the word within the request. Notice that they never get her the right information to answer her question.

The internet has made us more connected, and more informed than ever before. We are masters and weeding quickly through information, and scanning documents to find the nugget that we need, but how do we know we are getting the right information? How do we assess the nugget is not just information containing the word but not really providing the answer? Apply that thought process to the speed at which information travels to our clinicians. How do we make sure the right nugget of information gets to their hands at the right moment? How do we delineate critical vs clutter?Stay Tuned for the next post as we continue the discussion.

Clinical Transformation is an evaluation of the information, process, people, and technology. It provides a solution for how these items interact. It’s focused on the distinct goal to increase value. It does not simply use the processes to monetarily create value but also by value through improving quality of care delivery. Removing the Clutter from the caregiver and providing them with the right Data, at the right time, and in the right format. Patients need access to caregivers and vice versa. Caregivers need access to patient’s information.

ECRI Institute (www.ecri.org ) pointed out in their paper about the Top 10 Technologies for the “C-Suite” to watch in 2009, that Alarm Automation Tools will be an important hospital tool. However, they encourage hospitals to consider the following questions:

« Which patients are assigned to which nurses at any given time?
« Which devices are assigned to which patients at any given time?
« What data will be transmitted?
« Which patients’ alarms should be sent to which nurses?
« Which alarm escalation model will be employed?

We add this question, once you start automating your alarms how is your response to the need categorized? Do you have a response plan based on the categorization or on the specific alarm?

Sphere3 offers a number of solutions to how to effectively categorize alerts to have more effective alarm response.

Alarm Overload

2009-08-22T19:23:00.000-07:00

Alarm OVERLOAD
If your hospital is considering using the wireless device to receive clinical alarms direct to caregivers to “make them more efficient” consider this:

Automating the Nurse Call System on average can send 5 alarms (not considering escalation which could double this potential) per patient
Automating the Telemetry on average can send 15+ alarms per patient
Automating the Vents and Pumps without Data (ie through a contact closure – not the full information available) can provide 2 alarms per patient
Automating the Bed Exit Alarm is a single alarm per patient

Automating the additional Bed Alarms can send up to 28 alerts per patientThis does not include things like Bed Management, Lab Results, Orders, Automated Process Stations, etc. The question is balance. If you were to automate all of these alarms you could be sending over 51 alarms to your caregivers per patient. In a 1:4 Ratio situation that’s over 200 alarms! Planning and preparing for these are crucial. Categorizing alarms and keeping response procedures simple can improve the process of automation. At Sphere3 we specialize in evaluating the current situation and providing best practices solutions. Understanding the information that is being processed, the systems that are sending the data, and the caregivers workflow is our specialty. Many providers will encourage automation as a decision point for their product, but understanding the full scope of the integration is the key.

Contact us for more information

Sphere3

2009-08-22T19:21:00.001-07:00

I just enjoyed the X3 Summit in San Fransico. The learning and collaboration was great, and I look forward to engaging more with my new colleagues. From now on when you read the blog we will work in groups of 3 - this will keep the blogs concise and the information structured in a optimal learning paradigm - the power of 3.

Social Media
Having the conversation - is intimidating to say the least. Presenting your learning in a manner which readers can engage and interact with the findings puts the presenter in danger of "being wrong". I would object - that the conversation should not be able being wrong, especially when we are looking at healthcare. It must be about finding the best solution to our ever growing need. Having the conversation is about engagin new ideas, challenging the thinking of the norm, and establishing whether status quo is most effective or needs to be adjusted. In a world of Twitter, Facebook, and Blogs our thoughts are moved freely our abilities to assess are only limited by our abilities to tolerate the conversation. Long-Term -- Healthcare can be improved by these conversations but we must be prepared to move thoughts and words into action.

ROI
Many of the hospital learners were discussing ways to justify purchases based on a Return On Investment analysis and several good points were made. I must admit my view point was challenged as well. When assessesing ROI projections from vendors understanding their starting point is crucial. Each vendor has the ability to mold the ROI to their benefit based on small feature sets that differentiate their product. Establishing your goals associated with a return is crucial. It may be beneficial to engage a firm or team with outside perspective to help establish the correct principles.

You also need to assess - if we are reducing work in a process what is the person going to do with the additional time and how is that improving the overall picture. If you simply add technology to save time - you have to decide prior to implementation what the new found time will be used for - if not you won't see any global productivity changes.

Technology Infrastructure
I was enlightened to the world of "Healthcare IT Consultants" during this visit. It's a broad term that can be interperted in several ways. Some are focused on the low voltage aspects, while others are focused on the technology, and others are foucsed on the transition. While my initial perspective was - you don't need them just evaluate the products you are presented with associated with your needs. At the end of the conference - I am convinced that a technologist is needed during a construction process. As a former vendor, who didn't appreciate the consultant, I now see that they are extremely valuable in decreasing the hospitals overall costs associated with purchasing and making sure that the workflow dictates the technology - not the other way around.