Cultivating Innovation instead of Conformity

I had the opportunity to see Neal Patterson speak at the American Royal scholarship lunch. For those of you non-Kansas City people who read my blog – American Royal is a foundational aspect of Kansas City which is facing a momentous challenge….but I will close with my thoughts on that…

Neal has an interesting way of communicating, if you haven’t experienced him in a large venue you should. He speaks as if looking at a whiteboard – where he can see how everything fits nicely together yet he is searching for the next white space that he is supposed to identify and fill. As he moved into a segment on Healthcare (industry) he made several statements that have sat with me for the last few days.

Here was my take away: We as a culture/ industry have moved from innovating in healthcare to finding a way to work within the constraints the government has put on us. This has created a mantra of focusing our creative efforts towards efficiency and conformity to squeeze the turnip. Many have resigned to the idea that government provided healthcare will be our new way of life. I believe this will strangle and destroy the ability for the innovators to create a new way of being.

Gut check…..how is the product we have created and our roadmap conforming to the government constraints? Are we answering the problems of today without considering the opportunity of a future that is NOT created by Obamacare?

As a company, Sphere3 has been tagged in number of different buckets. Early on people continuously called us a “bolt on reporting software for nurse call” which always annoyed me. Their short sighted understanding of what “reporting” is and what the impact of patient generated data could be on the care delivery model….if you can’t see beyond “reporting” then you are stuck in the early 1990s and need to get your head out of the sand. Reporting is dead – it is a post mortem and if your company is still focused on reports…..then to quote my 10 year old “dude”.

Most recently, we have been tagged as a survey tool…..ugh….while our tool can gather everything from patient experience to site specific data. The FUNCTION of survey is really meaningless without a true intersection of patient behavioral and caregiver engagement information. When we try to use “feeling” to define process we lose the ability to have long lasting impact.

I believe that a product category will emerge this year that will even go beyond Alarm Fatigue. It will identify how the patient generated data produced in a useable format at the point of care beyond dashboards and beyond that of an alarm or alert. I believe the category will be AS impactful as Electronic Medical Record. This spider web of information produced BY the patient will be AS important as information produced ABOUT the patient. The information produced BY the patient must be compiled and visually produced in a useable manner as engageable digestible information…at the point of care.

Hospital Leaders, do me a favor the next time a sales person shows you their reports….ask them “How do you expect me to use that at the point of care? How do you expect me to create an environment of quality care that is actively evolving with a piece of paper?” The next time a sales person shows you their survey tool…… ask them “How do the actions of the care team compare to that patients perception?” The next time a sales person throws the word “Alarm Fatigue” make them really tell you how their tool will impact care….how will they really engage and change the behaviors of your care team other than a Pavlovian response to yet another alarm…….

I promised a close on the American Royal….so if you are not from here then the end is not for you but I welcome you to read on.

Our city has a lack of vision accompanied by a lack of appreciation for our Agrarian roots that should be seen as a strength and not a weakness. Do you not see that the American Royal is part of who we are? Or are you trying to define us by the music concerts and monster truck rallies at the Sprint center?

My personal rant which is shared in good company by Neal Patterson..…children today do not understand how food gets to our tables, but there is an uprising of individuals who believe in buying local or even producing their own food. I live in a rural area. (Across the street from cows and surrounded by farming) I desire to know where my food originates. We have an obligation to our community and region to continue to support and promote those who feed us. There is a slippery slope and danger to a community that fails to recognize where our food originates. We have an obligation to our area to encourage and enable young people to learn how to be the next generation of farmers.

Agriculture has become a growth industry again in our economy. The promise of technology and innovation as America feeds the expanding population of the world is a great opportunity. Our youth have an opportunity to cultivate promising careers in a sector of our economy undergoing great change.

My question back to the AR is how are you cultivating growth in the city which birthed you? How are you innovating beyond rural to impact the local community beyond merely brining in additional attendees to your events? How are you reaching into the schools to provide education and perspective?

Don’t you agree city leaders……or do you think that your food comes from a grocery store?

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.

The Future of Nurse Call

I grew up the daughter of an integrator – for those of you who don’t know what that is in the 1970s and 1980s an integrator was a person who made two hardware systems talk to each other.  The 1990s brought more integration via software and now the software controls the hardware and integration is becoming interfacing.   As with other “trades” my siblings and I were immersed in technology and projects from a young age.  While Dad did everything from sound to security, fire to paging, intercom to burglar – our specialty was always nurse call.

I believe an era is coming where there will be no nurse call as we know it.  The integrator will again be asked to shift their model as the hardware will become as simple as a light switch and the software will be interchangeable.  Kind of like a computer – they all run Microsoft Word.  

I had the opportunity to talk to Brian Yarnell, CEO of Starling Health.  Brian is one of the many “non-healthcare” folks to enter the space.  His background is in business intelligence for the retail industry.   His focus is creating a methodology to capture data to truly evaluate performance management by allowing patients the opportunity to direct their own care in any language they speak.  

Starling has developed a “Ap” (for lack of better terms because it runs on any tablet OS) that not only allows the patient to “have it their way” but allows the hospital to capture data about specific performance improvement.   With the simple touch of an icon the patient can request a number of items and the workflow can be transitionally tracked in the database.  Did I mention that it can automatically change to any language.  It’s a really patient centric tool for patient request.

For most standard nurse call systems decentralized modeling is a challenge (mostly because few hospitals look at the request quantities prior to design and implementation) so many hospitals have started to look at the war room model to better triage the need of the patient.   While it’s clearly not a “nurse call” product - it would not, by itself meet, most regulatory standards.  However, today with simple integration (the old school way) it could compliment a UL1069 listed system – making an inexpensive featureless system very feature rich.   There is even greater opportunity in the future through interfacing with a higher quality more software centric platform to really create amazing workflow.

Starling is certainly the most interesting product I have seen in a long time.  Brian’s vision will allow patient the opportunity to direct their own care in any language they speak.    Check out their website www.starlinghealth.com

The revolution of the IP based nurse call was challenging to many integration firms and another shift is on the horizon.   It used to be the major argument was who “owned” the assignment process - now it’s who is the “hub” – what if there were no “hub”.   Systems with strategies of open infrastructure – well written API will be the winner in the battle – those who don’t want to leave the old school proprietary mindset will be left behind.   You have to be flexible to integrate to innovation and accept the fact that your company may not be able to innovate everything.

Ascom Wireless Acquires GE Nurse Call

You may have remembered back during HIMSS – I made some comments  on the blog about GE’s nurse call and may have even said something along the “lack of vision” lines.  (which my mother said was shockingly not nice of me to say)  GE did have a strong lack of vision surrounding its nurse call product…if you remember GE purchased EST who had purchased the once competitive Dukane line.  As they divested the “Security” division of their product lines (EST) due to the lack luster performance the nurse call line was shuffled around and never could get past their market status of third place.

So here is what really blows my mind - GE potentially they had the perfect scenario…..how cool would it be to walk in and offer everything soup to nuts to make your hospital run. (If you are a dreamer thinker – why wouldn’t GE just have a hospital…why not?)   Even if the hospital didn’t want everything – how amazing would it have been to have access to every piece of a hospital – think of the flexibility and potential for innovation.  The potential intellectual capital was just squandered – to me this was purely an execution faux-paux on the part of GE.  They had all the pieces – they just couldn’t get them to move together.

I find the acquisition to be really interesting play for Ascom Wireless as well – while they have had reportedly good success with their nurse call line Internationally – I do wonder if the same model will apply in the US.   The company line is that the nurse call and wireless phone system will be “kept separate” as to not upset too many apple carts (since Ascom distributes both through nurse call manufactures, and independent integrators).  It would be silly to keep that mindset for long.

Ascom offers a nice middleware product called Unite – same thought process of all middleware it interfaces to different alarm generating technologies such as nurse call and distributes the information the assigned caregiver.   The acquisition gives them more control on the development side of the product – creating better workflows but it limits their vendor agnostic approach to market.   It’s perplexing why that they would tether themselves to another “end point” device – like they have done with their handsets – Yes, I know that Unite integrates with several handset devices BUT if you know middleware you know they integrate best to their own handset.

Areas where disruption may occur in the space – Distribution (who is selling it, not who is shipping it), IP consolidation, and IP development……further market consolidation.

Nurse Call is a really interesting technology....not interesting in a creative way - interesting in a how are we going to mold this old school technology, that's required by code, into a new highly relevant technology.....as my new favorite CMIO would say - "Where is the Disruption?!"  It's hardware and software blended together and without one being high quality it will fail to meet the expectations of the hospital.   

My firm belief is that the hardware will continue to decrease in value and the software will continue to increase….but not just software the content of that software is the real value.     Watch the market - I think another Nurse Call company will make movement like this soon......

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.  

Intego Acquired by CAS

Recently, I had the chance to chat with Charles Bell, Founder of Intego Nurse Call.  I always enjoy meeting fellow entrepreneurs - for those of you who don't know entrepreneurship is an incurable disease as much as it is a passion.

Listening to Charles, I am reminded of the raw creativity and passion that drives innovation and ultimately new jobs into our struggling economy.  Charles started his company in the early 1980s but has been in the industry since the early 1970s.  He regaled me with stories of old Zettler systems that he was able to wire and do innovative things with, but finally settled on the fact that he needed to build something all his own that would challenge the status quo.

The Intego mindset is simplicity - how can we provide a system let the RNs be with patients more?  How can we leverage what has to be there in the wall In a communication model that compliments ease of use? 

Charles speaks highly of what he calls the ROC - this model takes all the patients calls from nurse call and routes them directly to the centralized operator core.  Thus, removing the direct interaction from the caregiver and allowing her to prioritize her response using her skill set as a nurse to determine who/ what needs attention first.   The strategy is to utilize a low cost device - such as a pager - that can compile the messages the caregiver receives.

This model is one that I have been promoting for a while as well.  The data models that I have run support the idea that providing greater context to the alarm and alert message can be extremely valuable to the caregiver.  The challenge is the design model - the clinical aspects of the design must be setup by a RN with a technology background.   Someone who understands the information being recievded in the command center and how it can be distributed in a meaningful way. 

The theory is this - patient presses the big red button on their pillow speaker (aka the "paddle") the call goes to a centralized point in the hospital, such as the operator area (where external calls are received) then the operator triages them back to the floor.  (Look back to the blog I did on Chris Heim from AmCom) 

Since you are using a lay person to triage - its important to design a really simple decision tree process.  (Similar thought if you have your IT Help Desk triaging Nurse Call issues)  

What I have found looking at this model is often laziness kills it's effectiveness.  The operators may not use the available messages and only distribute a blank - assigned message - ie "PCT Needed".  If the team answering the calls are not driven to follow the process it becomes garbage in garbage out.  It is critical to manage the data associated with their effectiveness and following the process. 

The other side of this data is to identify if the caregivers are using a task list approach or varying their response based on type of need - you cannot run the data model or report on this model any more effectively than decentralized to phones if you are not following the process correctly.   

I also HIGHLY recommend coupling this with strategic automatic distribution of specific Emergency level call types AND allowing the caregiver to call back into the patients room via a call back feature on their wireless phone (or smart phone if available).

This strategy is complimented by Intego recently being acquitred by Critical Alert Systems. CAS is a relative new comer to the industry, as its a purpose built organization to compile specific technologies to drive full throttle into the industry. Charles will remain with Intego focused on driving new business and strategic relationships. 

Great conversation - thanks to Charles for taking the time to chat with me.

If you have a health IT business in the medical device space and want to be featured in the blog email me - our next feature is with Strykers Rich Mayoras - talking about their new wireless bed.

HIMSS 2012

I am really looking forward to HIMSS this year - it's always a lot of fun to see everyone and catch up on the year.  For the first time Sphere3 will be not simply attending HIMSS - we will be displaying in two of our partners booths. 

This is our new video that has had over 100 views in the past 2 days.

The Burwood Group is a consulting firm out of Chicago that really has an incredible practice around healthcare technology.  I have had the pleasure to work with them on several projects in the past year and would highly recommend their services to any hospital.  Their clinicians are really well spoken people with a great depth of knowledge in technology and transition planning.   

I will be presenting at their booth on Thursday at 11am  you can register here http://www.burwood.com/himss12

We will also have the pleasure of being a part of the Connexall Booth.  Connexall is an industry leader that has more than doubled their market size in the past year.  Their team is lead by John Elms and Mary Baum.  They are aligning the brand of Connexall US with transformational care by spending a great amount of time listening to hospitals across the United States.
http://www.connexall.com/listening/

As I did last year - I will be updating the blog throughout the conference sharing thoughts and learning.  Send me an email if you would like to see Aperum in person and we can coordinate a time to meet.

A Coloring Page for Root Cause Analysis

The other day #2 boy brought home a coloring sheet from church.  I asked him to tell me about his picture.  He went into a wonderful description of the story of David and Goliath.   Goliath was colored blue similar to a giant smurf and David was wearing a green skirt.  He had added grass, bushes, and even some small animals.  His hands flew through the air describing his well colored picture and telling me in detail that Golliath blue from him blueberry pancakes and why David was “late to the party”.  As he talked, I began to focus in on the upper corner of his paper to the small gray airplane.  “What is that?” I asked.  Tucker’s eyes lit up and he replied “That’s the fighter pilot backing up David in case he missed.”

It's interesting when we begin see the outline of a picture and think we have the whole story.    

As I have been reviewing RCA’s from different hospitals and researching the rebuild of the incident – I find it interesting that many hospitals do not build the picture from data that is very representative of what is occurring in the room.   Many times this is simply that they do not know that the data is available or that they have systems in place that the data is locked inside and not accessible. 

I was working with a hospital on a fall analysis - extracting data to begin to layout the outline of a picture of what happened surrounding the patient fall.   The patient requests and responses are a lot like a blank coloring sheet.  The outline is your basic patient request data and based on the patterns it began to paint a picture.  The physiological alarm data, the medication data, and other bits and pieces began to color in the outlines to give a full view of what was occurring in that patient’s room.   Did the patient have a critical telemetry alarm?  Who received it? What were they doing?

Another interesting piece of the puzzle is communications between caregivers.  I was having a conversation with Voalte’s Trey Laudedale about the value of the Text Message.   As I was thinking about this blog it occurred to me – the text messages are the hand drawn fighter jet in the picture.  Sometimes the outlines and the information we are looking for does not create the whole picture. Sometimes the picture needs to have more data then what we would normally consider to complete it.  

So here is my tip for an RCA

·         Review the Patient Requests from the Nurse Call and Response of the Caregivers
·         Review the Physiological alarm data that was sent to the Caregivers
·         Review the text messages between clinicians

Remember data is always available if you are careful to set up your technology correctly.

The 3rd Annual Medical Device Conference

I am really excited about the workshop S3 is presenting at the Medical Device Conference.  The presentation will take a look at how different types of industries measure effectiveness.  We are in process of touring, interviewing, observing, and documenting several interesting places to bring value to the MDC attendees. We will be looking at Shatto Milk Company, US Toy's 750,000 sq foot Distribution Center, a Call Center, a manufacturing facility, and more.  During the workshop we will use the case studies to determine how efficiency and effectiveness metrics were used to improve productivity, customer satisfaction, and more.   We will be applying the learning to developing useful metrics (IndicaresTM) for your hospital's patient communication platform.

I will be blogging about some of the experiences prior to the class so stay tuned to learn more.

Sign Up - this will be a lot of fun!

http://www.tcbi.org/files/agendas/MDC3_Agenda.pdf

An Industry in Flux

It strikes me that there are some fascinating industry changes occurring in the “middleware” space and more are on the horizon. Interestingly, its not aggressive competitive behavior - it’s shuffles, buyouts, ReOrgs, partnerships, major players leaving major organizations, and simply surprising business decisions.
Dramatic human capital changes as opposed to dramatic technology change.
But what does it all mean – is it that alarm notification tools are not doing the job they set out to do, is it that the alarm notification tools promised too much and delivered too little, or is it that creativity and design ability was not balanced with well researched deployment on the cause and effect of the disruptive technology.

My thought is well intentioned creative individuals saw an opportunity in the marketplace that allowed the perception of faster communications. (If you haven’t figured it out – I believe most people are well intentioned.) The crux is more than 10 years after Michael McNeals press to market with the game changing Emergin platform – the cluttered market space is starting to relax and mature into a “what’s next” mentality.

Major platform changes are needed to meet the demands of a healthcare ecosystem that has a broader expectation of what information needs to go to which person. The new mantra is not about “alarm notification” it is more about “information distribution” and “decision support”. “Notification” brings with it the thought of disruption while information distribution and decision support bring the picture of well balanced and focused approach to patient care.

The problem is alarm notification has not reached maturity before the next change. What I mean by that is we have started to move to a new thinking without truly looking at the data associated with the “old thinking”. We have no base line comparison to clearly identify how information distribution will affect the ability of the clinicians to serve better. The industry has no clear baseline of information to compare the emerging decision support capabilities of the patient communications platforms (aka Nurse Call) with the old way.

Technologists, ask yourself:

Are we making things more flashy, exciting, techy because we can or because it’s right?

I challenge Nurse Call providers – Middleware developers – and even you EMR players who get in the game to prove it.

Show us how a change to status quo solves….if it doesn’t make the patient’s and caregiver’s lives better in documentable, data backed ways – then don’t waste your development dollars.

My prediction – major change is coming – large players will be motivated to change their focus and new players will be motivated to create better platforms.

"The Immediacy Conundrum"

Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button.


“after you pressed the call button”

Patience is not in abundant supply at Gate’s BBQ. When you walk in the door they shout at you - “Hi May I help you?” you must know to yell back very quickly – there is no patience for Umm or questions – by either the counter staff or the patrons behind you. You must shout back – quickly with full confidence - “Yes, I want a burnt end sandwich, fries, and a Ice Tea.” The food arrives to the counter very quickly – you can watch the man through the cook window constantly chopping and slicing meat to serve – you know it will be good, hot, and fresh.

The Gates atmosphere creates an expectation for an immediate response to questions, there must be no hesitation. I have reviewed reams of data from nurse call systems and 4 years ago when we started – the average wait time before exit of the bed for a patient was about 1:13. Now we see a majority falling under the 30 second threshold. Are people getting more impatient? Maybe…

We live in a world where as soon as I want to be connected my expectation is to have connection. The problem with “after you pressed the call button” is many patients expectation is immediate. Geeky techy stuff – if you have a nurse call system older than 2 years and you are functioning in decentralized – there is a lag time. Depending on the specific system – it can be an “eternity” in terms of immediacy. This is not a reflection on caregivers, it may actually be a reflection on the implementation of technology. Yet, caregivers are under pressure. Just like Gates, the health system and government is creating an atmosphere around hospitals that require immediacy. By its ever- more acute care criteria for entry, there is an equal expectation for immediate response?

Let’s talk solutions to the immediacy conundrum. The Decentralized Nurse Call craze of a few years ago is beginning to subside as hospitals realize the limitations of moving the patient call to an individual who is mobile and has variable task responsibilities on the unit. Decentralizing or sending the “Normal” patient call to a wireless device does not solve for immediacy – it’s actually the most difficult methodology for nursing to utilize because there is no immediate feedback on volume of requests or the “queue”. Immediacy requires the “queue” to be low and the person answering the call to interact and disconnect quickly. Think Economics - Basic Supply and Demand Theory – if you have too many nurses and not enough calls then you are fine. However, what is generally the case at documentable specific periods of shifts, if you have too many calls and not enough staff then you are going to get low scores on question 4.

The trick is the patient has a need and since they are not in their home environment and have very little control of their surroundings – many “wants” become needs. Not to mention the variation in expectation. The patient requires an immediate interaction – not an immediate solution. This is a really important point – so don’t miss it – the patient needs an immediate interaction and a sense that their need has been identified and help is on the way. The second key to this is you must deliver on the promise. So, if you have pushed your button and someone has quickly told you “help is on the way” then help must really be on the way. The only way to manage that is to develop a methodology to alert the needed caregiver with a specific request – data rich. Then Mobilize AND Monitor their action towards delivery. What does this mean – the person interacting with the patients request should be air traffic control – they should be able to monitor the total quantity of requests and estimate a delivery time. If there is a change in delivery time – maybe the patient should even be notified…..

BBQ and Nurse Call

I have noticed that several of my blog posts involve food…diets…etc It’s a true statement that one of my vices is really good food – not pretentiously good food – just plain good food. My pallet is not well refined, but I know when something tastes good and when I am served well.



One of my favorite restaurants is Jack Stack BBQ. Disclaimer: I live in Kansas City and talking BBQ is similar to talking about religion. There are alliances to BBQ that span generations of families. So, to be fair let me list the other greats in the Kansas City: 1)Gates – where “HI MAY I HELP YOU” is shouted at you when you walk in the door, 2) Arthur Bryants - where sweat is integral to experiencing the meal, and 3) Oklahoma Joes - only loses points because of the name.


According to the Kansas City BBQ Society (http://www.kcbs.us/ ), Carolyn Wells Ph. B, tells me it is measured on Appearance, Taste, and Tenderness. To achieve success in competition you must have quality in 5 areas: cooking unit, meat, seasoning, fuel, and most elusive, expertise of the chef.


For those of us with the untrained tongue, the challenge with BBQ is all data to assess are qualitative judgment’s – meaning, based on how I feel at that very moment I have made a judgment call on its goodness. Don’t get me wrong - when you taste a crispy chopped burnt end sandwich with just the right amount of salt, spicy sauce, and for me Cole Slaw on top, you will know what heaven will be like and I challenge anyone to say it’s not good.


So, what does BBQ have to do with Nurse Call? I look at Question #4 “During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?” Answers: Never, Sometimes, Usually, Always, and I never pressed the call button. I think would I ever answer "Always"?

One of the most concerning aspects of healthcare is measuring qualitative – questions based on “feelings” without creating a reasonable expectation for delivery. For example, asking “Did Jack Stack taste good?” to a random selection of people. (I have heard you East Coast folks think you know BBQ.) My perception of good BBQ is different than a person who prefers Memphis “Dry” BBQ , a North Carolina Vinegar based BBQ, and Texas hunk of meat they call BBQ.


In the next few blog posts I plan to break down question #4 and dig through how we can really expect to build continuous improvement and value from a “feelings” based survey question. How hospitals can use data that is existing in their facility to create quantitative Inidications of Care or what we call IndiCares™.


Just to get you started:


“During your hospital stay” this is a variable length of time. A metric based on an inconsistent variable is not easily understood and does not lend itself to being fixed. The time frame “your hospital stay” could be 1 day, 2 days, 1 week, or in a rare situation 1 month. The variable also could be a “frequent flier” as my favorite Children’s hospital calls their recurrent patients vs a one time in five years visitor. Their time may be short and consistent or random and long. 

We have evaluated data from over 30,000 patient days and the interesting thing about the data it is until you break it down by specific consistent measures there are very few patterns.  You have to stop looking at the data as Spaghetti and create a waffle structure.


A parting thought - If the data is barcoded according to which patient submitted it – why not just look at their nurse call statistics after their stay in comparison to their responses? If you are a hospital and don't know how to do that - call me or email me - I will tell you how to get to your data. 

The Recipe Matters

I love a challenge, and recently I have taken to making cakes. I am not Duff or Carlos, but I am determined to conquer the cake. My weakness is I don’t like recipes – ok, so I don’t like being told what to do, and I feel a recipe is just Betty Crocker’s way of bossing me around. When cooking, her recipes are general suggestions, but unfortunately in baking, it’s an order.

The thing with a recipe in Betty’s book is someone experienced has documented it – it has been verified – and it has made it to the general public. A recipe is successful because the common language used in each step. We are taught in grade school the standard terms of measure – cup, teaspoon, tablespoon, etc. We are also taught time – minutes, seconds, or hours. We are taught by our moms how to “preheat”, and we are taught by the Food Network how to “fold” in an ingredient.

Documentation of anything requires standard terms and common language. In a recent revelation in speaking with others about my professional passion for clinical alarm data and the picture of patient needs hidden within it, I found that there is not a current standard terminology in the arena of clinical alarm design. Therefore, I am proposing one. Just to set the minds of my readers at ease – Patient Communications Platforms are in my blood. You could say my youth encoded a understanding of clinical alarms into my DNA. I went to my first “nurse call” training before I could drive a car, and had a doll house with RTLS. I am not a novice, however, I am not so proud to think that what I’m proposing can’t be improved upon. Actually, I’d be thrilled if this proposal sparked a debate. So,I challenge all of my readers (all 700 of you) to comment. Collaboration can only occur if we are not so prideful to think we are perfect – if we can agree that little companies have as good of ideas as big companies – if we can solidly stand by saying we must create things for the betterment of healthcare because it’s really about patients – not all about profits.

This is Sphere3’s proposal for common language for documentation of Clinical Alarms. Below is a cascade of action – reaction that can either be generated by a person or the configuration of the clinical alarm system.

Initiating Action:

This is the beginning of the call. It can be manual, such as a patient pressing a button or physiological, such as a telemetry alert. The initiating action can also be a system trigger such as an occlusion or a system creating an alert based on a malfunction or necessary service request. The easy way to remember an Initiating Action is “it’s gotta start somewhere”.

Example:

Patient Press a “Normal Call” button on their Nurse Call System

Patient’s heart beat indicates a “V-Tach”
Notification Action:

How do people know that a clinical alarm has occurred? A Notification Action is the ring, ding, buzz, text, etc. This is the way in which a caregiver knows that an initiating action has occurred – they way they know the patient is in need. There are generally multiple Notification Actions for every Initiating Action. Every Notification Action is an invitation for the Caregiver to interact with the patient or their device.
Example:

Initiating Action = Patient Presses the “Normal Call Button”

Notification Action 1 = The Dome Light is White

Notification Action 2 = The PCT’s Wireless Device buzzes

Notification Action 3 = The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance OR Rejection Actions:
If the Notification Action is the caregivers invitation to interact with the patients need it forces an acceptance of that request or a rejection. Accepting the alert requires an interaction with the patient or their technology. A rejection is a “delay of response” while it could indicate that the call is being ignored, mostly it indicates that the capacity of the caregiver to interact with the workload is challenged.
Example:

Notification Action3: The PCT receives a Text Message “Normal Call Room #” with the option to “dial back” to the patient room.

Acceptance Action 1: The PCT presses “Accept” it “dials back” into the patient’s room, they communicate with the patient.

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action:

A Patient Communication Platform (aka Nurse Call) has a feature called “always an answer” where it will bounce a call if it’s not handled within a set time frame. Anytime a call is rejected, it bounces either automatically based on timeframe or physically based on a button push. That being said anytime a call is “rejected” technology should be programmed to create an automatic escalation action. Similar to an Initiating Action the escalation action is the technologies methodology of moving the call to the next person or place in line.

Example:

Rejection Action 1: The PCT is unable to answer the call due to being engaged with another patient.

Escalation Action1: Since the call has been “ignored” the technologies internal timer has allowed for a wait time of 2 minutes after which the call is sent to the RN’s wireless device with a message “Normal Call Rm 320”.
Escalations drives additional Acceptance and Rejection Actions, based on time frame. Again, a Rejection Action will create an additional Escalation. The hospital has to decide when the patient request (physiological or physical) has gone on too long, and at what point a failure to respond will generate the final Mandatory Action.
Mandatory Action:

The hospital’s determination of the final phase of the escalation process is the mandatory action. This designation is generally linked to Overtime calls. When a mandatory action occurs, the technology should force a physical face-to-face interaction with the patient. Mandatory Action is a new Initiating Action with a required interaction from staff.

Example:
Normal Call has not been answered in 4 minutes.

Mandatory Action: Due to escalation past allotted time frame the technology changes the alert verbiage to “Overtime Room 320” and tones at the main console and duty stations in all caregiver work areas on the unit. Additionally, the PCT and RN’s wireless phone receives a text message “Overtime Room 320” with no capability to call into the patient’s room. The call can only be cancelled at the patient’s bedside.

Now, let’s get back to baking cakes. Here is what I’ve learned in my most recent experience. There is a certain amount of discipline that comes with baking. To try to get creative on the basics is the best way to really ruin a dessert. Getting the basics of a cake right makes for a great foundation. But, the real fun and creativity begins once you have solid knowledge of the basic fundamentals of a cake. You see, I’ve now learned how to take a basic recipe and make an exciting dessert for my family—its about the secret additives, the substitutes that have just a little more interest in flavor, the interesting style of presentation, and complimentary chemistries of toppings, sides and coffees.

Clinical Alarms is the same thing. You have to know the basics and assure the foundational strategies in clinical alarm design were applied. BUT, once that is accomplished, there is so much more that can be done to enrich the patient and caregiver experience with request and response.

The documentation above associated with each phase is laid out similar to a process chart used in lean, however Sphere3 has created a methodology that is easy to understand and see at a glance. I will create a blog series on each phase of the process if there is feedback on this, but if there is not then we will just leave it as one persons attempt to create some normalcy to the market.

Comment Back – Ask Question - Email me kgovro@sphere3consulting.com if you don't want to post a comment – join this conversation.

It’s not “IP” it’s about creating something we can all use. This shouldn’t be an uneven playing field - this is Sphere3 stepping up and saying it's about the patient - not about the technology.  If alerts are designed incorrectly in the extreme case someone could die – in the most likely case a patient is dissatisfied with their care.