Ascom Wireless Acquires GE Nurse Call

You may have remembered back during HIMSS – I made some comments  on the blog about GE’s nurse call and may have even said something along the “lack of vision” lines.  (which my mother said was shockingly not nice of me to say)  GE did have a strong lack of vision surrounding its nurse call product…if you remember GE purchased EST who had purchased the once competitive Dukane line.  As they divested the “Security” division of their product lines (EST) due to the lack luster performance the nurse call line was shuffled around and never could get past their market status of third place.

So here is what really blows my mind - GE potentially they had the perfect scenario…..how cool would it be to walk in and offer everything soup to nuts to make your hospital run. (If you are a dreamer thinker – why wouldn’t GE just have a hospital…why not?)   Even if the hospital didn’t want everything – how amazing would it have been to have access to every piece of a hospital – think of the flexibility and potential for innovation.  The potential intellectual capital was just squandered – to me this was purely an execution faux-paux on the part of GE.  They had all the pieces – they just couldn’t get them to move together.

I find the acquisition to be really interesting play for Ascom Wireless as well – while they have had reportedly good success with their nurse call line Internationally – I do wonder if the same model will apply in the US.   The company line is that the nurse call and wireless phone system will be “kept separate” as to not upset too many apple carts (since Ascom distributes both through nurse call manufactures, and independent integrators).  It would be silly to keep that mindset for long.

Ascom offers a nice middleware product called Unite – same thought process of all middleware it interfaces to different alarm generating technologies such as nurse call and distributes the information the assigned caregiver.   The acquisition gives them more control on the development side of the product – creating better workflows but it limits their vendor agnostic approach to market.   It’s perplexing why that they would tether themselves to another “end point” device – like they have done with their handsets – Yes, I know that Unite integrates with several handset devices BUT if you know middleware you know they integrate best to their own handset.

Areas where disruption may occur in the space – Distribution (who is selling it, not who is shipping it), IP consolidation, and IP development……further market consolidation.

Nurse Call is a really interesting technology....not interesting in a creative way - interesting in a how are we going to mold this old school technology, that's required by code, into a new highly relevant technology.....as my new favorite CMIO would say - "Where is the Disruption?!"  It's hardware and software blended together and without one being high quality it will fail to meet the expectations of the hospital.   

My firm belief is that the hardware will continue to decrease in value and the software will continue to increase….but not just software the content of that software is the real value.     Watch the market - I think another Nurse Call company will make movement like this soon......

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. 

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.

Changing Lanes

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.

Command Centers

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. 

Patient Communication & Technology Part One

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

Technology Life, Economic Life, and Workflow Life

“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

Single Source of Truth

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.