Interruptions.....

I stopped to visit a friend in the hospital and had a chance to observe some clinical workflow in person.  The Nurse walked in.  She had a large brick of a phone wrapped in a plastic case pulling the side of her scrubs uncomfortably down.   She began asking questions as she prepared the medications.  She reached into her pocket and pulled out an Iphone……confusing…..then I realized it was her medication scanner.

As she was preparing to hand the medications to my friend the brick rang…..loud….very loud…. She apologized as she reached down and complained that the previous shift must have had the ringer turned up. (I was there at 8am in the morning so evidently night shift likes to carry a mobile alarm clock) She silenced it and went back to medication work.  I asked “Do you like your phone” – she held up her iphone and said “This isn’t used as a phone it’s just for meds and stuff.” I laughed and smiled “No the brick wrapped in bubble wrap hooked to your scrubs.”  She laughed and said “No Comment” as she finished putting the medication in the cup and talking to Holly she looked at me and said “That thing interrupts me when I am trying to work with a patient and it’s just rude to the patient. I don’t think it’s very practical…..I like to be fully engaged when I am with a patient”

Ouch…every technologist who has designed a decentralized workflow should wince when they hear that – this nurse is a young lady who grew up with a cell phone in her hand wanted to be what? “fully engaged with her patient”  She wanted to walk into a patient’s room and only think about what she needs to do in that moment.  She wanted to focus on getting my friends medications accurate, make sure she didn’t miss any aspect that could be a warning sign…..crazy thing….she wanted to be a nurse.

As I worked on this post – I started writing about ideas for fixing….pointing out that holding on to old technology only hurts your facility….listening to nursing because they actually do the work….blah blah blah…..but then I started think this isn’t just a hospital thing.

I was sitting in my family room – Noah (aka #4) on my lap talking about his day and my phone rang…..in that moment I stopped engaging with Noah and answered my phone…I tried to justify in my mind that I had tried to get ahold of this person all day and needed the information….as I hung up Noah said “Mom, can you just talk to me for a minute”….ouch…. As I began writing this blog for “Linkedin Content” to promote my industry knowledge…..I am pausing for a moment.

Our workflow design reflects our society design….the nurses response is reflecting the shift in our society to tolerate interruptions.   She recognizes that everyone would like a bit of undivided attention, especially when they are in a new environment.  She recognizes that the technology she had been given was not serving her well and was making her less effective in her job.  She recognizes that – just like Noah – her focus on my friend in that moment should be the most important part of her day.

So this post should serve two purposes – rethink how you are designing your clinical workflow and alarm design.  Clinicians are fatigued because their attention is constantly being split.  Clinicians are fatigued because we, as technologist, aren’t doing our jobs.

The second purpose – does your personal life reflect an interrupt driven society? When will that become not ok for you?

Last night…..I left my phablet in the kitchen….turned the ringer off….and enjoyed my family and some friends.  It was probably the best night I have had in months…..today…..the ringer is still turned off.

It's a Tool not a Toy

I had to make a change….it was hard…my needs weren’t being met…..after lots of consideration….I got a new phone.   It all started when my husband made a change I couldn’t believe… he bought a Samsung Galaxy (aka the phablet – phone/tablet).  I teased him a lot…why would anyone want anything other than the iphone.  

My love of these little Apple Devices started about 4 years ago…..The first time I saw our software, Aperum, on an iPad I was hooked – mobilizing our software allowed it to be utilized at the point of care.  The ipad is so simple to use – it’s cute – it’s trendy – dare I say sexy. In the past 4 years, I have purchased dozens of “i” products.  (Especially after I met the REQUIRED otterbox – nothing breaks like an iphone.)   As we have grown, we have made lots of trips to the AT&T store to buy new iPads for our people.  On one such trip, Kristal (our VP) and I were waiting on the salesman to retrieve our next iPad when she asked about the Samsung that David just purchased.  I teased – I joked – but by the time our sales guy got back with the tablet we were logged into Aperum and playing with it on the Samsung.  Then….it happened….he began to run us thru features…I drooled…. These were things we only dreamed about on the Apple. 

Here is what I love and why I eventually bought a Phablet….

1)      The built in Stylus….I admit I thought this is really useless and will never be used.   I use it all the time – it automatically unlocks the device when removed from its safe little corner home.  It makes selecting and typing a breeze.

2)      Typing….using the slide function where instead of typing you slide the stylus across a series of letters.  Frankly, it looks like magic that it knows what word to select.  It’s super simple and quick.

3)      Writing…there is a function on the tablet where you can write with the stylus.  I will admit the first few times it wrote some words…. maybe it was just me getting used to it but it seemed to learn my handwriting the more I used it.  It became more accurate as time went on. Which was good because I had a really embarrassing demo when it translated what I wrote into a swear word…

4)      Voice Recording…yes…it works…it’s cool. Again, use it a few times before you demonstrate it….

Here is what I find troubling…..we talk to dozens of hospitals a month and it is a rare event that the clinical staff is enabled with a tablet or even a smart phone.  I am not even just talking about floor nurses – I am talking clinical leadership. 

When we show our software and how easy it is to use at the bedside… we have nurse managers asking their CNO if they can bring in their own tablet to use.  Why?  It’s not only because they see the value of automation in their leadership rounding process using Aperum.  Frankly, they see the value of smart devices – it is not uncommon for nurses carry their personal smart phones in the pockets so they can use aps that help them do their jobs.

So, what is holding hospitals back? Budgets? Device Selection? Device Management? “Ap” Selection / Deployment? 

Here are some quicks Do’s and Don’ts:

·         Don’t Buy a Tablet for one application. (unless it’s ours.. J)  The hospital should create a team to research and understand the usability for different applications in their hospital.  Different teams need different applications.  These applications should show value in safety and satisfaction.

·         Do identify application that align with the hospital’s care models and strategies to enable safer and more satisfying patient care.

·         Do identify a mobile device management platform that meets your needs.

·         Do engage IT…. I know it sounds silly to say, but there have been times when we come to hospitals and the IT department is avoided by the clinical department (which is a blog all in itself)

·         Do buy cases….a serious cases like Otter Boxes.  Make sure you engage your infection control team to identify how these devices will be cleaned.  We have tested all sorts of cases….ones with built in keypads, zipper fronts, plush, and flashy – some of our hospitals launch their tablets naked….let’s just say mistakes were made….

·         Do understand that they are practically disposable….did I say that outloud? Yes, just like your “purpose driven” wireless phones that nurses carry.  Either buy the replacement plans for them or have a budget allocated for replacements.

·         Do buy a nice tablet….I have the war wounds on this one…cheap tablets stink in a hospital setting.  Spend the money get a name brand.

We are going to be testing Aperum in some live environments with different tools in the coming weeks.  We have hospitals looking at the Surface and others looking at the new Spectralink Smart Phone – it’s fun to be vendor neutral and get to play with all sorts of different toys…I mean tools. J  I will update you all on what we identify as positives and negatives.

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HIMSS Day 2 & Histalkapalooza

My goal with HIMSS is generally to have meetings, see the vendors, and get inspired and rejuvenated for the next 11 months – being with 33K other geeks really helps me get refocused on what is really “innovative”.    However, as John Moore (@John_Chilmark) tweeted there are a lot of “Me toos” and at HIMSS.  It’s true you can see the wide  red ocean of nothing new being under the sun.  Or people thinking they are disrupters but really they are noise makers in an already disrupted space.

The booth that I was able to spend the most time in (ironically since I live less than 15 minutes from their Innovation Campus and pass it on my way to work every day – I hoped on two airplanes and a taxi to see them here) was Cerner.    Their Care Connect area was very impressive.  I am still a huge fan of  Mystation (even though it’s still not on an IPad where is should be).  I like the concept of driving more patient understanding and engagement throughout their care process.  This is something that could follow them home and be part of the home health model....not sure if she said that but that’s where my mind went.   Ashleigh showed me the Care Connect mobile device area.  It’s not easy to give a concise presentation that shows how really powerful a tool is and she did a great job.  If you have time stop by and ask for her.   The tool lets you see not only your patients but their status it’s a really nice blend of EMR with alarm notification information.  

I popped into the Hil-Rom booth – and got the standard – “who are you and why are you here”  after saying who I was I told them about the blog and one replied “yes only if you write nice things about us….”  (that should be the number one thing not to say to a blogger – it just makes it tempting to write less than flattering things….) I will do my best.  The challenge with nurse call is since it’s hardware and we live in a software world – it looks the same for a number of years before a new system comes out….same is true for Hil-Rom – it looks the same as it did the last couple of HIMSS.   However, they did make a statement which perked my interest – that “we don’t need middleware” – I think I am going to work on a post called “the death of middleware”.    It’s true – most nurse call light systems don’t need middleware but the implication from Hil-Rom is that they were middleware with the ability to automate information from their bed, their fetal link alert system, and their nurse call…..so that’s where you get the ding…..it’s not about “your” anything in middleware it’s about “their” everything.  So long as you have a single vendor ecosystem you can achieve what they described – kind of like how EMR sells their interoperability.  

I stopped briefly by Rauland - same as Hil-Rom the hardware just is what it has been for the last few years.  However, their newest software addition is Responder SYNC.  I have heard people call this single sign on...which I say kind of.  Sync claims to deliver on the promise that the alarm notification world has been talking about for years – Single Assignment.  Middleware claims this service by allowing a single point of assignment for multiple devices but as everyone knows that doesn’t really “sign you in” to nurse call – the lights and the tones do not follow the middleware assignment.   From what I saw - the greatest benefit to SYNC is the ability to sign on using EMR.  You are still limited in who can do this (Connexall and Cerner have made the interface) but evidently it's "open".     Stop by and ask about it - it's worth the converstation.

In general the floor seemed very steady but not busy – not the shoulder to shoulder crowd we sometime experience at HIMSS – but it was steady.  I did hear several vendors say there were fewer people….

My evening ended at the HISTalkapalooza event – I was not fashionably late.  I saw some amazing shoes (especially @TIMURDC which were my favorites) and was able to chat with lots of interesting people including the folks from Dr. First – I am going to see their booth today because it sounds amazing.   I chatted with Jonathan Bush about his lack of ability to score soccer tickets while sitting next to Neal Patterson….  I ended up on the front row of the prizes and was able to snap some fun photos....  the one of @Farzad_ONC has been retweeted a lot.  As I left, once again ran I into Judy from Epic.  Thanks for the invite Mr. H.

 If you have time today - I am speaking at the Burwood Booth 5019 @ 3:15p  come check it out.

 

 

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

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

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

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

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

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

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

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