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 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.

Defining What "Matters"

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

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

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

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

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

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

Grady Health Systems Surgical Service Workflow

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


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

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

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

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

The Patient Within the Code

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


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

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

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

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

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


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


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

Disruption is NOT Always in the Initial Splash

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

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

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

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

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

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

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