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. :-)

The Patitent as a Person - my lunch with Clay Patterson

The patient’s position in the HIT marketplace is that of data….that is a really strong statement but if you look at the Medical Record you know it’s actually a fact. The focused push to enable EMR in hospitals IS critical and has to occur. The mindset around it, to me, is often concerning.

Somehow the “data” has to evolve back into a “patient” who has to evolve back into a “person”.


As most of you know – my professional passion is the patient, the one who must take up residence within the walls of a hospital for a period of time. However, if we limit ourselves to seeing the “patient” only within those walls then we limit our view of the health continuum.

On Monday I enjoyed a wonderful lunch with Cerner’s Clay Patterson. I wasn’t sure what to expect – Cerner is an enigma – when people ask me about it I say “It’s shiny” meaning it’s very exciting, cool new innovations, amazing technology, thriving business, and flashy interactive gadgets. However, nothing I had seen to date gave me the feeling of heart – innovation, yes – incredible business, absolutely – heart, not so much. The heart I was missing was the patient – the person. Then I met Clay. His passion is getting medical data in a useable format so that a person can better interact with their health. This incredibly engaging and friendly man painted a picture of Cerner unlike any I had seen before – he shared a vision of people not products.

As he spoke, the picture that formed in my head was a giant sphere and inside of it there were stations of a person’s health journey. They include Hospital, Family Doctor, Medications, Tests, and even Diet & Exercise. (which I call DEA - which is a blog for another day) all surrounding the ability to research within the platform. The components within the sphere are interconnected and the data can ride freely between them.

The Sphere is taking information that is generally spaghetti and putting it into waffle format. When it’s in waffle format it can be searched, analyzed, cross referenced, and made into useable information. Think of it like managing your finances. Many of us keep our receipts in a box – or a wallet – or the center console of our car (or for some of us all of those places). You may have to dig them out if you need to return something, but the data of what you bought and when generally goes nowhere. However, if you use an online banking service then it automatically can analyze your spending habits and you can toss your little pieces of dispirit papers. The evaluation can lead to better planning, better habits, and overall better financial wellness. WHY? Because Data itself is not valuable – Data analyzed and applied into information is valuable.

But will adoption of this medium really occur. My prediction is yes – if you look at the slow recovery of our economy, you notice that people are spending less with credit cards and more with cash. Why because when you lose your home due to over spending you must take drastic measures to get things under control. People have had to learn to live within their means. Currently, the US is one of the most unhealthy nations in the world. Out of necessity a time is coming when we are going to have to reclaim our health. Sooner than later change will occur – not because there is some cool gadget but because consumers will realize that managing their health is the same as managing their finances.

The challenge will be education, access, and funding. How are we going to teach masses of people how to engage with their health while using a computer based tool?  Encouraging people to take control of their health is only part of the puzzle.  How are people going to get access to this portal?  This is a really layered portion of the equation including socioeconomic, locations, etc.  Who is going to provide access to this cool portal and who will “own” the data? Remember the data isn’t the value, the value is in the analysis….. when the data becomes information. As with everything else, it all comes back to who is going to pay for it? In a time when socialized healthcare is looming are we going to drive consumers to pay (not likely), employers, payers, ACOs?

If you believe that the patient is the heart of all we do then you must believe that the patient’s ability to interact with their health is critical to our success.

Stay Tuned for an exciting announcement from Cerner in the coming months.

The New Economy

During my visit to San Diego for the NSCA leadership conference Economist Lee McPheters spoke about the economic changes and challenges facing our nation. While the economy seems a daunting – I think that the needed productivity changes are also a huge opportunities for those of us in process redesign and we just need to find ways monetize the work associated. The American worker has been asked to increase their productivity – put in the extra hours – in hopes to help their company make it through the rough waters. The challenge is we can only work so many hours – we can only work at high capacity for so long before it requires an innovation change.

The interesting change is that while businesses have pushed their employees to be “lean” and move faster and do more with less – the American consumer has become more demanding. They expect more, because they are spending less. The American consumer is adopting the Ramsean principals of if you don’t need it don’t buy it - if you don't have the cash then don't buy it.   They are also spending their capital in a more focused manner with a thought process of  you should be treated like a customer instead of a consumer and the idea of disposable society should go by the wayside.

So what does all of this mean for healthcare? It means that the patients – who are customers – should be treated as such and that their demands will become more and more extensive.

Let’s Dream Weave?

If my grandma eats breakfast every morning at 6:30am when she is at home, then when she is in the hospital for hip replacement shouldn’t the hospital know when Grandma would like to eat breakfast? Tools like A-Frame Digital and Parental Health’s Misty can feed into her “record” and begin to create a model of how she chooses to be cared for when she is not in her home. The more data we can drive from the home to the health record the more we can allow our parents to age in place. 
The scenarios of how we function in the home should model how we are cared for in the hospital. The concept of a Patient Communications Platform should encompass more than just request from point A to point B – it should encompass consumer data modeling that preemptively leads to care.

If I document my life in Facebook and am comfortable sharing it with 400+ of my closest friends wouldn’t I be comfortable with sharing my comfort models with the hospital? If I document my food and exercise in My Fitness Pal (ap on the iphone) then why wouldn’t I share my nureotic eating habits with the place that is supposed to heal my ailments? (What if my ailments are caused by my addiction to Latte’s?)

These models allow us to improve patient care. At Sphere3 we use Performance IndiCares™ which are items relating to the behavior and performance of Caregivers and Patient IndiCares™ which are items relating to the behaviors of the patient. We tie the information together to create Risk Models or Risk IndiCares™ clearly finding paths to reduce risk and improve performance. All of these things lead to our three core values Patient Satisfaction, Caregiver Satisfaction, and Safety.

Health IT companies should feel challenged. If the farthest horizon you are looking at is within the walls of the hospital, then you are going to miss the boat.

Symphony of Information

Have you ever heard a 9th grade band on their first few days of rehearsal? I lived it – well a much heavier, awkward, glasses wearing, hair out of control, version of myself. The interesting thing about 9th grade band is everyone has had their instruments for a while so most can make a noise that resembles music, but “musicality” is really lacking. What they teach you in that critical year is how to be “Symphonic” which means taking something that is very complex and diverse and pull it together harmoniously. For a percussionist (like myself) that means - just because you can play the loudest doesn’t mean you should and that following the conductor is not an optional activity.

As I was reviewing data this week (reams and reams of data) I began to notice a series of new patterns. Patterns, within themselves, are fascinating but they get interesting when variations occur. So in musical terms if you have 4 measures of quarter notes and then a measure of 8th notes and then a measure of 16th notes the original pattern varied to a pattern that builds intensity. Intensity builds excitement and excitement builds to the climax of the song. As geeky as this may sound the workflow data we review is often like a musical score to me – sometimes just out of sync.

I don’t know about you but when my mind gets stuck on patterns I have a hard time breaking free. My solution has always been to get in my car and turn the radio up to blaring sound to let my mind focus on the patterns in the music. After a few minutes identifying them, and figuring out the layering it is easier to refocus on something new.  This week was especially overwhelming as we discovered patterns outside of alarms that affect our data points AND that the information is readily available.

That’s when it hit me – the problem with the patterns that I was seeing for this particular hospitals report were that they are simply out of sync with the other dimensions of the unit. (Clear as Mud?) Think of it like a musical score – if the woodwinds are playing 3 measures behind the brass who is playing two measures ahead of the percussion it sounds like noise. However, if the conductor is able to see how the patterns line up and is able to pull everyone into sync then it’s an amazing symphony.

Music at it's base is a complex math equation - music at it's core is art and soul.  The key to making beautiful music is to be able to define where the math ends and the soul begins.  The same is true in clinical workflow design the numbers may speak the "truth" but the answer may lie in the "soul" of the work.  That's what we do - we help the hospital define the math so that the clinicians can better create the soul.

I know this is two months in a row of shameless plugs but we are creating a new dashboard that is unlike anything in the market today.  We have welcomed several new team members in to help us mold the product into something that can quickly help a hospital reduce falls, increase patient satisfaction, and increase safety. 

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.

Changing Lanes

I was driving to work yesterday in the Tahoe (aka Mommy Mobile) since my car (aka Princess) has a flat. As I sped down the road with Cruise Control set – I couldn’t figure out why the Tahoe wasn’t slowing down as I approached a much slower moving vehicle. All of the sudden, I remembered that the Tahoe does not have the cruise control distance feature that Princess has built in to ebb and flow with traffic.  I slammed on the break as to not hit the vehicle in front of me. You see, the Princess car can practically drive itself. You set cruise control and it slows down as it approaches a vehicle and once that vehicle moves out of your lane it resumes its constant speed.

This change in vehicles has caused a number of issues for me this week. I have no hands free calling if I push a button on my steering wheel and say “Call Dad on Cell” it only changes the radio. When I go to change lanes there is no light telling me there is someone in my blind spot. When I go to back up, I actually have to look over my shoulder because the radio does not change into a back up camera picture. All fun and joking aside - This experience really relates to what we are seeing with devices and workflow design in healthcare. (Bet you didn’t see that coming.)

There are really two paradigm shifts. First, there is an expectation that a technology will provide more and require us to “do” less. This does not discount the fact that we still need human interaction. Princess really can’t drive herself, but Ford has developed ways to reduce the amount of action I need to take while driving. They looked at the driving requirements and removed steps out of the process that could be replaced with technology. They also provided technology that could enhance the driver’s ability to make decision. Isn’t that what all technology is supposed to do?

There is a warning that should be going off in your head at this point.  All of this high tech stuff is great but what do you do if the technology is different from unit to unit? What if Med-Surge is driving a Tahoe and Med-Oncology is driving a Princess? Caregivers float between units. They are asked to shift from one process to another without missing a beat. This is the second paradigm shift, technology must be flexible but the flexibility must be tempered by continuity. We ask a caregiver to go from driving a full featured princess car to driving a low featured school bus then we wonder why there are mistakes.

Workflow design should be based in finding commonalities and working to drive similarities between the units. Every car is different but every car has a turn signal, break lights, head lights, and there are requirements to use them within the standard confines of the law. Then that has to be monitored to drive the similarities to be consistencies.

Please heed my warning to all of you in Kansas City – especially those at Cerner because I pass your facility daily - If you are driving home and see a large Tahoe barreling up behind you – I recommend you just change lanes. I am not an aggressive driver but sometimes I forget what technology I have (or don’t have) at my finger tips.

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. 

To Wash or Not to Wash....

Recently, I enjoyed a spirited conversation with Hill-Rom’s GM and Vice President, Mike Gallup. Mike is a former IBM consultant who has been tasked with creating an unstoppable force in the Hill-Rom HITS (Healthcare Information Technology Systems) Group. His goal is to systematically coordinate the design of applications, creation of partnerships, and integration of collaborative initiatives that will strategically confront the marketplace status quo.  He was gracious to share his thoughts and a new project that they are going to be launching soon.

Hill-Rom as written and developed a patent on hand washing that should cause the industry to sit up and take notice. Hospital infections are costly and many are preventable. Those two items are ear perking to people who focus on providing value to a hospital. Not to mention the pain and discomfort that they cause a patient, and potential additional infections throughout the hospital. The ability to decrease infection by a simple hand washing or sanitization is crucial. To put dollars to the thought, according to Hill-Rom MRSA infections can cost in excess of $200,000.

Hill-Rom approached the marketplace trying to identify a strategic partnership with an RTLS provider that could meet the system and software requirements developed in the patent. After much research they decided on Centrak. Centrak’s ability to get granular in the patient room allows for the proximity of the caregiver to the dispenser to be identified. It also detects the actual motion and interaction with the cleaner.

Sound a little like Star Trek? It’s not.

The concept is actually quite simple, but software and application is really brilliant. The motion sensor within the Centrak tag notices movement of the dispenser when it is touhed and the badges correlate the proximity of the caregiver. To “fool” it you would actually have to have a caregiver bump the dispenser on purpose and not clean their hands. This would seem to be a farfetched idea. I am not an expert on hand washing, by any means, but I would assume that a majority of the time that a caregiver didn’t wash their hands prior to interacting with a patient would be more out of forgetting, and not intentionally avoiding.

I see this as a brilliant tool. Since it’s a standalone system it could be tied into a number of different integration points to track the effectiveness, but also offer some proactive notifications to the caregiver or manager. While the application is not prime time at a facility today the system has made it through all of the Hill-Rom and Centrak’s internal testing. Mike’s projection is to have it live within the next three month.

Thanks again to Mike Gallup – www.hillrom.com I look forward to more spirited interactions about healthcare in the future.

Top 5 for Nurse Call: 1) Can it do the workflow we have designed for our hospital?

Pre-Determining how the system will function is the only way you can determine which system will fully meet your needs. This can be done internally but utilizing a 3rd part workflow designer. If you are a do it yourself kind of place figure out what you are doing currently and how it would need to change to be better. One of the biggest mistakes made is allowing an equipment vendor to design the vision for a patient call system. Yes, they have experience but they are also partial to the system they are providing.

To put it in perspective, one of the largest personal purchase decisions you will make is buying a house. When evaluating houses inevitably you will begin to picture yourself in that house – what you will be doing? If you visit the house and the listing agent (seller's rep) is there – they are going to direct your eye to all of the “great” features and downplay any of the features their house is lacking. For example, if the house is a split entry the selling agent is not going to point out to you that you will be climbing stairs every week with multiple trips to carry in groceries. They will be directing your attention to beautiful view of the Cul-De-Sac and how your kids will love playing there.

The same is true for Nurse Call (stay with me techy geeks) If you have all of the Nurse Call Vendors present and you do not know what is important to you – then they will tell you what is important to you based on their systems capabilities. This is called features based selling. It’s not wrong or deceptive. It’s them presenting their product in the best way possible. It’s only deceptive if you ask them if their system can do something and they tell you it can when it can’t. Or they sell you a “road-mapped” item as current.

Entering the house with your top 10 criteria is the best way to approach purchasing houses. Understanding why you are purchasing is crucial. Has your family expanded, therefore you need more room? Are you getting older (or plan to grow old in the house) and need fewer steps?  Carry this thought process into purchasing a nurse call system.

The best tactic for reviewing vendors is to provide them with pre-determined workflow prior to their presentation then let them explain how they would provide you with that workflow.  Verify they can meet the expectation.   At that point they can show you additional items you may find of interest based on their products specific capabilities. This IS valuable information because your core need is being met. Their additional “features” then become the icing on the cake.

Stay Tuned for #2 Evaluating equipment warranty and lowest cost of ownership?

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.”

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.

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.

Workflow Ability - The Final in the Series!

Workflow Ability takes into account the product life (base ability) combined with the technology life (things we can’t live without) and balances it against the Optimal Workflow. It is determined by examining specific parameters such as staffing, unit layout, and technical acumen. Optimal workflow is not wholly determined by the technology that is in place, but does take that into account as a limiting or enabling item. Onceit is determined then the limitations of old technology can be balanced and married with the enhancements of the new utilizing a unifying technology.

So, for example, a cell phone allows a person to call while mobile. In its raw basic form – it’s clunky – you have to learn to dial one handed, hold a phone to your ear and drive. (Plus drink your latte, manage the kids, and change the radio station - not that I have ever done that.)

The iPhone is equipped with a unifying technology called Blue Tooth. If a person wants hands-free calling utilizing their iPhone then they need to upgrade their car to a 2010 model with Microsoft SYNC technology. SYNC provides voice command dialing and open voice communications over the cars speakers. (Like a Vocera Badge) However, to get SYNC you have to purchase a brand new 2010 Ford. OR you can utilize a different unifying technology which leverages the abilities of the iPhone in hands-free mode over the car speakers. Until you purchase the new car, you will still have to do the one hand dial, but at least you can set the phone in the cup holder and drive with your both hands on the wheel at 10 and 2.

Now apply this principle into the world of nurse call or other healthcare technology. Upgrading an entire nurse call system can be in excess of $5,000 per room. I will be the first to tell every caregiver – the new system will make your life easier and offers a number of flexibilities. However, it is better to decide workflow prior to purchase, decide if you can utilize existing systems with a unifying technology – then make the upgrade decisions.

While the capabilities of the new system will become a necessity ( I almost didn’t drive the other day because my front end collision warning was not working due to the snow even though I have driven without it for 15 years) leveraging existing platforms is a real possibility.

Stay Tuned for Our Next Blog post – Disruptive Technology and its Influence on Workflow - insights gained from our recent trip to Cerner.

Product Life, Technology Life, Workflow Ability - Part 3

Technology Life Decisions are more readily linked to the exciting features that differentiate the products one from another. Some might call them frivolities, some might see them as necessities. Either way they are items that enhance the base goal of the product.

Technology Life Decisions are difficult to make due to the ever changing nature of technology. The “lifespan” for many technology decisions for medical devices is shortened to 5-6 years (sometimes more or less depending on the flexibility of the platform that is being purchased). Hospitals may delay purchase to wait for the next model to be released. Road Mapped items become decision points and actual realities become less critical. Not to say that a product, software, or service that has a vision for the future is unimportant but reality is more critical than vaporware.

Interestingly, the technology life decision points – things that a manufacture or developer creates to differentiate their product - often become base product decisions. Think of power windows. 20 or fewer years ago wasn’t it suitable to have a crank and before that wasn’t it a luxury to have a crank? Power Windows are an enhancement, but because of the end users interest they have become the standard. The point is often the technological enhancements won’t be enhancements for long .

Early Nurse Call Light Systems consisted of one light and one tone. Now we have systems that have unlimited light and sequence capability through LED and unlimited tones by allowing for wave files to be uploaded. Eventually, this will not be a technological enhancement – it too will become the standard.

So how do we bridge the gap between the technological enhancements of the new products and the apparent short comings of previous products. We believe the answer lies in Unifying Technologies coupled with proper workflow design.

For example, in a car, Micosoft SYNC integration allows the information from your mobile phone to download into the car and allows for voice command and hands-free calling through voice command. While all base capability of making a phone call while mobile is available using just your mobile phone, SYNC increases the value of the vehicle by enhancing your experience with the phone.

SYNC’s value is enhanced because of a unifying technology called BlueTooth.
Similarly, all nurse call systems can notify a caregiver of a patient’s need with a light and a tone. However, some can integrate to wireless phones allowing the caregiver to be mobile while speaking to the patient. There is intrinsic value to the time savings that a hospital will find by integrating their nurse call system to the nurses wireless phones. According to our research, over 30 minutes per day per RN or more depending on the style in which the integration is made. However, prior to today all of that is only possible with a unifying technology called Middleware. Interestingly, this "feature" and ability developed by a vendor outside of nurse call is becoming part of nurse call systems. Eliminating the need for a "unifying technology" all together.

Stay Tuned for
Workflow Ability and how you can transition from one platform to the next more easily and over a longer term investment.

Technology Life, Economic Life, and Workflow Life

“What color do you want?” This is the first question I am asked when I go car shopping. (Yes, it does irritate me.) While I see that is an important decision for most people, do people really buy a car for it’s color?

Wouldn’t it be more effective to ask – “Why are you shopping for a car?” This should be the question of every vendor pushing a medical device to a hospital. "Why are you purchasing this product? Why now? What initatives are you trying to solve with this purchase?"

If you look at purchase decisions. Most will fall into one of two timelines or life-spans: Product Life and Technology Life. Product Life is the underlying practical reason for the purchase, and Technology life is the technological enhancements we "can't live without". We believe there is a third area for medical devices that can leverage existing platforms, blend their usage with new product platforms making transitions easier – we call it Workflow Ability.

Technology Life = 5-6 years vs Product Life = 10-12 years

Workflow Ability can extend the Technology Life 3-5 years balancing out the difference between Technology and Product Life. It allows for proper transition between platforms.

So how do we bridge the gap between the technological enhancements of new products and the apparent short comings of a previous investment?

Many hospitals will simply make a Capital Investment and change to the new platform, but is that really necessary? In these economic times is that really a practical decision?

We believe that the first two decision points (product and technology), while important in making a transitional question are lacking in their ability to allow the hospital to make a long-term transitional change. We believe that Workflow coupled with unifying technology can really increase the lifespan of existing platforms thus leverage the hospitals original investment.

This is a LONG post so I am breaking it up into sections.

Stay tuned for more on:

Product Life

Technology Life

Workflow Ability with Unifying Technology

The 5 I's of Fall Mitigation

Our Goal is to reduce falls in the patient rooms – whether or not you hire Sphere3. I believe in the power of the conversation for the overall improvement of healthcare. I encourage you to read what is written and add to it. We have had a great team working to develop this framework but I believe in the power of collaboration.

Collaboration outside of healthcare can also be powerful. As many hospitals have discovered, manufacturing may have some ideas that could answer some of the questions. What are other industries that may compliment process improvement for healthcare?


The First "I": Introduce

The basic premise of the first “I” is to describe how the patient is introduced to the unit. This is not a, “hello my name is Joe, what’s yours?” It is how do they get there and once they are there how do people know? Not that we are recommending a camp like cheering section to greet them in a tunnel but how are the caregivers on the unit provided with information that a new patient has arrived. What’s the “on-boarding” process? One consideration for this process will be, is it important for everyone to know a new patient has arrived?

There is considerable time savings opportunities (and cost savings as well) prior to arrival on the unit. There are several areas to consider including how are you tracking the time from entry to bed and all the steps in between? How is the transporter contacted and how are they tracked? How does the hand-off work?

What are your thoughts on Introduce – Transport – Notification?

Our team works with your hospital to customize a strategy to respond to the above questions. Our Fall Mitigation Analysis software program allows us to document, analyze, and provide innovative recommendations for improvement. Your information is assessed against best practices for optimal results.