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. 

The Trauma at Seattle Grace

Normally, I would not blog about a television show, especially Grey’s Anatomy. Personal views aside, I was drawn in to the finale this year.  A disturbed man entered the hospital with a gun and the facility went on lockdown. Doctors, Nurses, Visitors, and Patients were held in terror for 2 hours as he made his way throughout Seattle Grace. No one permitted in or out as the local police department determined the proper course of action. No one inside knew where the shootings were occurring, or what to do to protect themselves. The shooter made his way through the building killing and terrorizing all.

Hospitals will be receiving increasing pressure from AHJ (Authorities Having Jurisdiction) to be prepared for these types of events. Seattle Grace (as depicted in the show) was horribly ill prepared and it resulted in a number of dramatic losses and over dramatic saves. It was as if the building had no internal security system. (They should partner up with the hospital on the tv show 24 – they were able to view cameras in the hospitals on a tablet PC - by the way that's not as difficult as it may sound)

Here are just a few thoughts on “acts of terror” on a hospital. The security office should have access to view both internally and remotely all security cameras.  They should have a cooperative program with the local police department.  Providing access to the local police is not as challenging or space age as it may sound. Digital and IP based cameras can be network based or the Video Server can be leveraged. The security plan and threat assessment should determine how to notify staff of the location of the shooter. The Mass Notification should identify the following: What is occurring and what should the people do to be safe? Imagine if there were a series of cameras in the hospital that could identify where the shooter was and begin to strategically lock down areas within the hospital to keep him out. You can’t necessarily evacuate a hospital but you could minimize casualties by limiting the shooters movements within the building.

Additionally, there was no internal communications occurring. The doctors had pagers, but there were no internal wireless phones. The saddest scene in the show was when Dr. Bailey dragged the dying young doctor to the elevators only to find they had been shut down. She has no ability to call for help - she had to sit and hold him as he died. She had a pager. If she has wireless phones in this situation she could have called a central command post. To take it a step further, if there was a central command post they could have been able to see the entire situation unfold on a camera and have dispatched a help team.

This TV show depicted what Mass Notification Emergency Communication (MNEC) is all about. It’s sad that we live in an age where people find release in killing others, but casualty counts can be reduced if proper security people, process and technology are applied.

MNEC is really about choreographing movement based on the threat that is occurring. It’s about knowing who needs to get what information and how are we going to get it to them.

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