Margin

I grew up in a family where the expectation was clearly set that you would advance in knowledge beyond what the teacher was teaching at school, the preacher taught on Sunday’s, or any coach could provide.  It was your responsibility to grow in wisdom.   I have carried that thru into my adult life by maintaining a daily “quiet time” to read, study, and grow - setting aside 45 min to an hour each morning. (which happens to be the quietest time available in a house with 4 young boys.)  

A few weeks ago I started a study called “Balancing Life’s Demands” which discusses mental, physical, emotional, relational and spiritual balance.   The study uses the word “Margin” and defines it as the difference between what needs to be done and the time you have to do it.  I will have yet another birthday soon….not real thrilled about it…..so the identification of what one would call balance or margin is becoming a more focused effort.    

The ironic part of this life assessment is over the past 14 years, I have consulted with dozens of hospitals on defining margin for their organization. I analyze the obscure data generated by specific variable workflow activities and give recommendation on utilizing technology to enhance it.  The software we developed automates much of that process and enables continuous improvement.   Aperum uses data visualization to identify the often misunderstood work load driven form theinconsistent demands on their care teams generated by patients.  

I keep telling myself this life assessment should be a no brainer - life margin should not be elusive or nebulous.  I have built an entire business on designing “at a glance visuals” – where the metric quickly and effectively means something to an organization. However, it’s easy to say “I prioritize my family and church first” but if you look at the quantifiable data of hours spent per week – it’s not really a balanced metric.  (Same is true in nursing if you analyze where they spend the most time – you will find it’s not at the bedside so the perception is the main priority is not “direct” patient care….but that’s another blog.)

Strangely enough, I was a week or so in to this new study when Ed Marx posted his blog Bank Life, Not Vacation Days.  I loved that he had thought of a metric for evaluating whether or not he was in check for his commitment to balance – PTO hours accumulated vs PTO hours used.   A simple and easy to define number that encompasses a lot of information.  That’s the key – everyone knows that you have fewer PTO hours than you do total work hours – so it’s not a 1 for 1 equivalent.   It’s a predefined measurement of additional time away from work. Our payroll company generates that automatically and posts it to our online account – I honestly have never looked at it.  Not because I am pretentious and think the walls would fall down without me (I travel enough to know that my team has the operations side handled).  Mainly, I love work and I don’t really think about it unless prompted by my husband that a vacation would be nice.  I took a look after reading his blog…..let’s just say I booked a vacation next month. 

Thanks Ed.

If you are in Health IT and are not familiar with Ed’s blog  –CIO Unplugged –  he is a consistent blogger that has a way of communicating things that present more than just HIT initiatives – he gets “real”.

Community Garden

Recently, we had planting day for the community garden in South Kansas City.  Six months ago when I was asked to serve on the board of a local ministry, a community garden was not in the job description……a point I keep making to the group and I am sure they are tired of hearing.    Luckily, the garden has a fearless and passionate leader in Cama Suess (and her ever supportive and able husband Chuck) who pushed ahead and pulled me a long.  I am so glad she has done that…..

There are two aspects of a community garden.  The most apparent, it's a garden, a place to grow food to supply the need of those in need with healthy fresh produce.   It's an environment where we can do more than offer processed non-perishable food items.

A few years ago at the Cerner Conference there was a lot of buzz about “health and care” and the distinction between the two words.  We talk about solving the problems of healthcare thru better documentation, better technology, better process but a lot of solving the problems of our health system is by improving the health of the general public.   Often healthy living is reserved for those with means – it’s less expensive and easier to fill up a family on pizza rolls then it is to buy and prepare fresh food.   Food pantries are filled with the “helpers” (hamburger, tuna, chicken), canned meats & vegetables, and other processed non-perishable food items.   Not that they aren’t important but I keep thinking we can do better.

This garden will feed about 40+ families with fresh produce this summer.  It has corn, green beans, tomatoes, okra, squash, peppers, zucchini, and melons.  We plan to hand out recipes and cooking instructions with the produce.  

The second aspect is community.  This garden is about creating a sustainable renewable effort to provide an environment to serve others.  It’s a place to connect.  It’s a place where people can learn how to grow their own food while tending a garden.

On planting day, I gardened next to seasoned veterans who shared insights that you just don’t get on Pintrest. I shared a shovel with people who grew up in rural areas and have grown their own vedge for years.  I learned and so will others who work there this summer and in the future.

A garden has no boundaries, while we are a Christian ministry, this garden is a spot where people from any church, or any faith can come and serve the need of our community.  It’s about supporting a community of people – as my brother says “Being the change we want to see in the world starts with me”.

 I have launched a start-up with a zero dollar budget and had to be creative with this blog, twitter, and networking to get the word out, but I did it because it was the right thing to do patients.  It’s hard work.  As I thought about this garden – the expense, the work, the liability……the hard work…..I keep coming back to the same thought this is the right thing to do for our community.    That being said – we are getting creative to fund it and need your help. 

Please visit our Crowdfunding website and consider donating to the cause

http://www.faithlauncher.com/projects/184-south-kansas-city-community-garden#/

If you are in Kansas City - Be a part of the effort - come out and grab a shovel – visit the as I AM ministries – Outreach facebook page to learn more or visit our website www.asIAMministries.org

Thank you!

If not you….then who…..if not now…..then when.

A Passion for Patients

I am often on planes – seems to be the blessing and curse of success - I have to admit, after working and being away from my family for several days, I usually just want to slip on my head phones and look out the window, but sometimes my seat mate just wants to chat. 

It was a Thursday, I missed #2’s baseball game the night before so I was a little grouchy, and I was eager to get home to spend time with my boys.  I had splurged $50 to upgrade to Airtran “1^st class” which generally translates to a comfortable quiet trip home.  As I was praying the plane wouldn’t break, in walked my seat buddy – a 6’5  55+year old woman carrying a 10 month old baby.  There went quiet….though the conversation that followed was much more than I ever imagined.

We talked about the airplane – we talked about raising children – we talked about travel abroad - we talked about the Lord and then we talked about her adorable baby.   Soon I learned her name was “Mary” and it was her grandson who was only 4 months old when his mother, her youngest daughter, had passed away.  The story struck me, but more than that - staring into the face of the little boy on her lap - it broke my heart to imagine my boys growing up without me. 

Her daughter was a vibrant healthy young woman who became ill and deteriorated over several months.  She had several visits to the emergency room of their rural hospital with little answers.   Eventually, she was admitted to that hospital, Mary kept her children and her husband stayed with her as her advocate.  The baby became ill and Mary had to bring him to ER, when she arrived her son-in-law left his wife alone and met her to check in and see his son.  While he was gone, his wife pressed her call light – with no response she went to the bathroom alone then returned to her bed.  When he returned to the floor, he saw the call light on in the hallway outside her room.  He found his wife unresponsive.  In his confusion, he pressed the call button and began yelling for help – with no answer he ran to the nurses’ station.  The unit secretary ran to another patient’s room to find the nurse.   A few moments later – Mary heard a Code Blue call to her daughter’s room.  Leaving the baby with the ER nurse she flew to the floor, but nothing could be done.  Her daughter had died.

My mind immediately went to Regina and the E-patient movement. I shared about the Walking Gallery and my dear friend’s story of the loss of her husband.  How she had inspired me, and how the people in the gallery inspire me. 

She asked me what I did in healthcare – so I shared about Noah, and what we do at Sphere3.  She asked if I could get the data about her daughter’s incident. “I am not sure” I responded – seeing disappointment flush her face – I tried to explain that some technology does not support historical records – some technology does not save any records at all especially in small rural hospitals.  There are ways for me to get to data on a go forward basis, but many times it's a challenge to get to the retrospective data if it was not planned for when the initial technology was installed.  However, I would take a look if she ever wanted me too.

I wrote a while back about the drive to do more, to make a greater impact, to intercept the incidents, to save lives…..when patients are your driver – when people are your purpose - you do more.  You find yourself listening on an airplane - when you just wanted to look out the window.  You connect with people who inspire you and will drive you to go further.   

Are you doing this for the sake of profits?
Are you doing this for the sake of the patients? 
Are you inspiring a conversation in the HIT community or are you riding on the wave of government funded HIT? 

Don't ride the wave - find your inspiration and drive for change that matters.  

The Art of the Report

I always really enjoyed stories but a confession - and I hope Mrs. Karnes is not reading thi s- I rarely read an entire book.   Generally, the beginning was interesting and so was the end but everything else was just filler.  Most  of the time after I got to know the characters a bit – I would just make up my own story.   (That's why now I stick with non-fiction)

The challenge with reading for school was the book report….due at the end of the designated reading time.  As I have started working with my kids on their book reports the reason behind the reports is becoming clear.  It’s less about the “report” of the book and more about the function of the activity.

A book report had several purposes but mainly it helps a child move from basic reading skills to true understand of the authors intent.   It teaches you to look into the materials you are reading and disect important information.  You don’t start out in 1^st grade being able to read a book and describe the message.   You must first start with pulling the phonograms (sounds) into words – the words into sentences – the sentences into paragraphs – the paragraphs into stories – the stories to interpreting the materials to find its meaning. 

This is the way I look at data – right now it’s pretty dispirit – it’s a lot like phonograms.  If you don’t know about phonograms – they are a single or small group of letters that makes a sound.  My favorite is “er” as in her.   As in that example, however, “er” is part of several words – such as deter – same ending phonic but when coupled together with “de” instead of “h” it’s a different word.  Data is kind of like that too – depending on how we look at it – what pieces we add together the different pieces of data can give us different words.  The phonic does not change but the word does.  Once we build those words we can begin to link them together into sentences and so on. 

All the pieces of information could be pulled together to tell an overlying story but today – in health IT  - as we look at data most are just trying to make the phonograms say a word.    Once we are able to get the words we will be able to pick out simple attributes such as  characters names, locations, time period, etc   Once we are able to move past those simple attributes - We can progress to inferred things such as attitudes.   For example, she cried when she found out her beloved dog died.  Nowhere in the sentence does it say she was sad but you can figure it out based on what you know about crying and what you know about the death of a beloved pet.  As you progress to high school you are asked to identify big picture items such as theme.  We apply knowledge filters every day to assumptions – what do we already know to be true and how does that influence what we are looking at to get to the next level.  We reference other materials - we talk to teachers who know.

Eventually, we will be able to take the attributes and the inferred understanding of situations then apply it into a bigger picture understanding of the story – what is the theme – what is the message – what is it saying about society in general.

So what?  My small group leader at church says that at the end of each Bible Study – meaning so what does this mean to me – how do I apply this towards real life today.

The data in the medical devices, the medical records, and other technologies are independent data sets – the parts and pieces within them are the phonograms which need to be pulled together into words and will tell us a story about the patient.  As we begin to compile that data – review it across a population – it will tell us more.  Think about research papers you wrote in college – did you reference only one book? The challlenge before us is the sheer quantity of data that will need to be analyzed to get to the final answers.  Note: Not impossible.....just a challenge. :-)

HIMSS 2012 Day 1

HIMSS is an ADD nightmare – moving shapes, lots of people, so much to take in and experience.  I get a little overwhelmed with the amount of information to absorb.    My day was spent in meetings with clients and colleagues understanding how different technologies could impact healthcare.   Looking into products, services, and software that Sphere3 clients would find of value.

My day started with a great meeting with a friend from Press Ganey – excited to go by their booth #552 tomorrow and take a look at their technology offering.  I am always impressed with people who know their offering well and know how it specifically impacts the hospital and patients. 

 I headed to the Cerner booth where I was able to enjoy a few moments with Clay Patterson.  We chatted about Health + Care (my favorite tag line at HIMSS because Cerner really means it),  the HIMSS show, and of course Sporting KC.   Then I enjoyed a presentation on Clarvia – Cerner’s latest acquisition.  I think is a great product.  It has that has the ability to apply data into the assignment models for the floor.  They focused on the dollars saved which don't get me wrong - is impressive and had great impact to the hospital bottom line.  However, what I saw was a tool that would create a an incredible environment to ensure that patients are cared for in the most effective way by optimizing the hospitals ability to leverage available staff.   It was geeky and cool (my highest compliment)  It will play into their suite of products well.  If you get a chance stop by Cerner’s booth # 476 and ask to see a demo of Clarvia.

I walked over to see the new GE Teligence workflow station that will challenge the Rauland Staff Terminal and the HilRom Graphical Room Station.   Their workflow station matches the competition in the ability to provide automatic alerting at the press of a button but really lacks the visual appeal of the two other products.  Don’t get me wrong - just because it’s not pretty does not mean it’s not effective, but I have concerns with all of these types of stations.  Is there a true ability to improve care and reduce workload?   The fuzzy line between automation and documentation is not well reported.   The only think I will add about the GE is that I am a little surprised that a company that offers EMR and owns a nurse call company would not make some logical alignment between the two products….you have all the pieces and they could talk to each other…in a really meaningful way.  See it for yourself at Booth #2635

While walking over to the Centrak booth – I happened upon Tibco #3571 really interesting take on compiling data and utilizing a “collaboration tool” which is much like facebook to drive better understanding.    Tibco, was really interesting.

The final booth I visited was Isorona # 12414 – the booth is in the lower level by the interoperability show case.  It is a software based medical device data collection tool - I assume kind of like capsule.  It would have been nice to see more about the product and learn more about it while there at the booth.  The description I received was that it collects the data from multiple sets of data and distributes them to EMR and alarm/alert software.   

Tomorrow you will catch me checking out medical device connectivity tools and you may even find me at the Burwood booth – great people who I really enjoy – in booth #8310.  If you have suggestions on booths I should see and maybe blog about send me a twitter message or comment on the blog.   @Sphere3CEO

All in all this has been a great day - while I am not a big fan of Las Vegas – the venue is actually a lot more convenient than most of the other cities HIMSS has been in years prior.  There is a lot better access to coffee and easy walk to the convention center – it’s nice to get some fresh air. (just avoid the smokers and the people with the little papers…oh my gracious)  

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.  

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.

Keep it Simple Sweetie.....

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

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

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

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

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