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

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....

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

Living here in Kansas City everyone “knows” or more accurately claims to know something about Neal Patterson.  As the iconic entrepreneur walked by my second row seat and took the stage for his Keynote at the Cerner Health Conference,  I wasn’t sure what to expect.    I tried to brush aside all the good and bad I’ve heard and just listen to see if I could connect to him and Cerner.  

I expected a politician – slick with perfectly constructed and managed content.  A more accurate description is comfortable, confident and owning the content.   Dressed casually, he appeared more approachable than intimidating. His speech style was more conversational than choreographed.  The “picture in his head” is much more detailed than what he could share in the time frame.   He was funny and entertaining – much more than I expected.  I take time to describe him because when you read about what he said I want you to see this picture of him.   These are sound bites with my interpretation. 

“We must separate Health and Care”
Cerner, throughout the conference, delivered the next frontier of their ambitious goals: Managing health as opposed to maintaining a sick society.   The Solutions Gallery Floor was split into three areas Foundation, Organizational Excellence, and Community.  When you entered the solutions gallery floor the first thing you see is Foundation.  Many times when I have talked to people about being able to interpret data we have to step back and look at the way it’s collected and the model in which it is stored.  The Foundation is representing the “Care”.  How hospitals document and gather the information that improves the care of the patient.   Though the pods were a little fragmented and hard to see the vision of how they all played together the message was one foundational platform to collect data.

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

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

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

I found this statement extremely bold, but accurate. The challenge with most leaders is to be able to drive vision, growth and domination in an industry you are often seen as prideful.  While I agree with some of the pundits – a self comparison to the actions of Apple, the benchmark 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 of processes and have systematically transformed it into a billable standard. And amazingly have driven such change into the industry that the government has seen the benefits of this documentation and will now subsidize their growth through mandates to their core customers.

The thing I would challenge Cerner on is this – Apple has the unique ability to take a complex idea 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 – not saying they won’t get there.   They have built a firm foundation – collection and storage of data.  The hard part is the presentation of the data in a useable manageable format. 

The center of their Solutions Gallery was the Organizational Excellence.   I stopped in to see their dashboards and examine their process.   My take away and I hope this isn’t too harsh – they are just not there yet….a little bland and canned.   My encouragement to them – the people who will be successful in the BI space are those who can take the data and do what Neal told the audience Cerner will do “We will future proof your organization” he said that in regards to how the government will change reimbursement based on the collected data.   Somehow you have to take your incredibly complex data set and deliver it to leaders in the hospital in 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 to do this first and from being first they will build the standard.  If you are not all ready in the space you are all 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 listened to what Neal Patterson was saying they were actually quite revealing to who he is as a person.  

“We are all mortal with 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 this thought to the audience – it was a directive.   From a technical standpoint this is the push to build PHR and build it well.  Driving home the point that we must manage health creating a foundational platform like Cerner has done in the “Care” space for the “health” space.  Fixing PHR.  

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

I am not sure if the crowd heard it, but I heard frustration in this statement.   When you hold great power, knowledge, data……when you can see the future and you are pulling those around you to understand it…..when your mind understands that all the pieces of the puzzle are there and all we have to do is put them together….. it’s almost excruciating.  It’s a blessing 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 he wanted to accomplish in this decade – one was “Save Linda’s Life”.    Linda, his sister in law, died from Sepsis.    Can you imagine being one of the most powerful people in healthcare and losing a loved one to a preventable medical error?   Knowing that the data contained in your servers 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 would describe as “friendly” place but they are knowledgeable and they are incredibly capable and powerful.  They will find answers and save lives.   I am not sold on them as an organization, but after this speech I do see that the leader has passion and purpose.  

The Immersion Principle

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

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

I met some really great folks at the Connexall User conference in Toronto.   One was Craig Martin an “IT Guy” from University of Michigan Health System.  Craig and his IT team have immersed themselves into the different units to gain clear knowledge of clinical needs.    Craig described his goal of disintegrating silos and creating more effectiveness in development and decision making ideals around purchasing and creating healthcare products.   The formula is really quite simple from a high level view -  it’s to become the foreign exchange student on the clinical unit – to immerse yourself in the culture and life of the people who will be most affected by the choices on technology - the end user.  On a hospital level Craig’s “Immersion Principle” takes a person from IT and attaches them to the hip of a nurse to experience a day or week in the life of someone who is directly engaged in patient care.  Craig said  “We in healthcare IT cannot hide from the sometimes overwhelming things that go on in our hospitals.” 

I am impressed by this team they were focused on creating environments for 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 a hospital for something other than a sales call?  Where does your passion for product come from? Is it in a paycheck or is it in the realization that what you are doing is making a difference in the lives of the sick and helpless.  This which we do for the least of our brothers…….

After being in the hospital with #4 for a week – I will never 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 perspective is forever changed.   Do you need an inspiration?  Spend a day on the floor of a hospital with a nurse doing nothing but observing – not selling, not creating, just observe.  Let their reality become your reality.  

A Coloring Page for Root Cause Analysis

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

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

As I have been reviewing RCA’s from different hospitals and researching the rebuild of the incident – I find it interesting that many hospitals do not build the picture from data that is very representative of what is occurring in the room.   Many times this is simply that they do not know that the data is available or that they have systems in place that the data is locked inside and not accessible. 

I was working with a hospital on a fall analysis - extracting data to begin to layout the outline of a picture of what happened surrounding the patient fall.   The patient requests and responses are a lot like a blank coloring sheet.  The outline is your basic patient request data and based on the patterns it began to paint a picture.  The physiological alarm data, the medication data, and other bits and pieces began to color in the outlines to give a full view of what was occurring in that patient’s room.   Did the patient have a critical telemetry alarm?  Who received it? What were they doing?

Another interesting piece of the puzzle is communications between caregivers.  I was having a conversation with Voalte’s Trey Laudedale about the value of the Text Message.   As I was thinking about this blog it occurred to me – the text messages are the hand drawn fighter jet in the picture.  Sometimes the outlines and the information we are looking for does not create the whole picture. Sometimes the picture needs to have more data then what we would normally consider to complete it.  

So here is my tip for an RCA

·         Review the Patient Requests from the Nurse Call and Response of the Caregivers
·         Review the Physiological alarm data that was sent to the Caregivers
·         Review the text messages between clinicians

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

The 3rd Annual Medical Device Conference

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

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

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

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

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

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....

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.....

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......

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

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"?

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"

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

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

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....

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

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.