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.

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.

 

 

Nurse Call Selection Process

 I thought I would share some tips to anyone looking to upgrade their nurse call system or drive any change within their current platform (upgrade is a variable term which encompasses hardware and software)  Sphere3 has walked a number of hospitals through this process and are glad to be of service to any hospital looking to update.

Hospital Tips:

1)      Define the REASON for change first – it’s generally three things – new construction, remodel, or existing system is "old". Your hospital will have some SOPs attached to each one. If you are looking for definition around "old" we have tools you can use to define and structure your business case for update.
 
2)      Define the INITIATIVES you want to improve which will be enabled by the change. Strip away everything that does not align with those initiatives, and compare the systems.

3)       Define the WORKFLOW associated with improvement of these initiatives.  Don't think about the technologies - define what would be the best process to improve your initiatives.  I know this can be very chicken and the egg for some folks.   There are groups like Sphere3, Burwood and others that can provide you with a vendor agnostic view of what current technology CAN do which allows you to define HOW you want the system to work.    
 
4)      Pick Three Systems and review for alignment with your core workflow, and meet with representatives.  Provide them all with the same workflow and initiative information and allow them to present how their system will meet your needs.  Their presentation MUST show you how their product will perform the workflows you have described.

They will all have “Whiz Bang” features and will highlight them as something that you should use to make your decision.  The truth is  if “Whiz Bang features”(which can only be supplied by “one” vendor) become decision points then it really detracts from your ability to make a workflow decision.  Please note – talk paths, voice over IP, single sign on for multiple applications, SQL databases, etc these are not Whiz Bang – these are essential functionality statements.  Understanding each systems IT structure and potential limitations is really important.  We should never make a decision in a bubble – multiple parties use the system and multiple parties maintain the system.   Make a clear delineation between Whiz Bang and Functionality.  
 
5)      Reduce to 2 systems and set up site visits of ACTUAL working client sites – their factory tours are all cool and the experience is meant to be incredible. Whether you go to the “farm” or an “experience center” you will be wowed…..that’s the point. Though I will agree with the vendors – having the opportunity to see all of the flexibilities of the systems can be valuable.   Go visit at least one real client site….proof is in the live pudding. 
 
6)      Review the database for ease of reporting AND structure.  If they claim have ability to interface with other products such as middleware, RTLS, phones,  Aperum® etc ask for them to provide a site where the data has been validated. Then ask for a sample DE-identified file for review. I need to emphasize here – there are holes in the way certain systems record data – it’s important to understand what those are and how it will impact your ability to use their data to make decisions in the future.
 
7)      Get your prices and take time to understand what is in them (or hire someone to review them for you who will understand the gotchas.) I have found on several projects now that pricing can be challenging to review (even for me and I started working with nurse call in 1986….if you do the math that’s a funny statement.) I have seen simple parts lists with a price to a 300+ page document.  If they send you a 300+ page document – read it – wow is it revealing about what they will and will not guarantee. (Check the contract if they will not “guarantee the operation of their IT system” runaway)

When you strip away everything that is “fluff” in these proposals and get down to the brass tacks of will this do what you want, will the vendor be available to service you when you need (not when they can make time to get to your area), and is the hardware AND software high quality and reliable  --- then you know you are making a good decision based on your specific needs not on their competitive advantages.

I could write pages on this process – if you are making a change this is a major capital and operational investment that affects a hospitals HCAHPS scores (which leads to reimbursement etc) it's important to really do your homework.  The industry changes are really interesting right now so don’t get caught with a system that won’t be here in a year or a company that can’t support your needs. 

If you have questions feel free to email me or call us.

kgovro@sphere3consulting.com

The Fire Sale

 If you have been listening in the last 2 weeks you know the nurse call industry is in a flutter….to say the least. A price war has ensued with what appeared to be slashing like I haven’t experienced prior. My phone has been ringing a lot…..a lot is kind of an understatement. I would think that it’s a competitive thing but in actuality it may be a fire sale which has caused a ripple effect throughout the industry.

 

A few months ago I wrote about GE being acquired by Ascom. Call me crazy but when a manufacture of telecom handsets purchases a nurse call system then cuts the price significantly does it signal more than just we want to take market share? To call their pricing strategy “creative” would also be an understatement.  I am not suggesting "trouble" by any means - I am suggesting a strategic change in approach to market AND possibility that a new nurse call - one which lines up closer to their UNITE product may be in the works.  Possibly there is a need to make some sales to secure the client and move them to a new platform when it's released.   

To remain competitive it appears that the other others are indeed re-evaluating their strategies – essentially relying on the value in their hardware to secure their place.   In my opinion (humble as it may be) Nurse Call has spent the last 3 years trying to prove their overreaching “workflow” value in the market place only to play the games of a contractor today.   I am not trying to pick on GE by any means - they are just making the biggest change.

So what does this mean? Is it a signal in the market place of the devaluation of nurse call? Remids me of the blog I wrote a few years ago about Electronic Life, Technology Life and Workflow Ability. (I wrote a little algorithm to help hospitals understand this by answering a few questions and scoring the results per unit – helps phase installs – if you are planning an upgrade - give us a call.)

I don't think it's a devaluation - I believe the shift has started in redefining Nurse Call to a more patient centric cloud based product.

Stay Tuned - I will post some tips for hospitals making the decision on new nurse call.