Consumable

Many of you who have read my blog for a while would read that title and think – here she goes again talking about food…not this time.  This time I am talking about the consumable nature of mobile technology used in the healthcare environment.   This post will focus mainly on hand held devices – in alarm notification that’s code for wireless phones.   I have heard them called all sorts of creative things – “workflow enablement tools” “mobile caregiver communication platforms” – all of which boils down to…. a wireless phone.   

Don’t get me wrong I was selling these innovative pieces of technology…..before the birth of #2.  (who turns 9 this week) While I recognize that platforms have changed (WiFi etc) – has the end user functionality really improved?  When a color screen is an “improvement” worth changing out all the handsets it’s kind of a sad statement for these little plastic wonders.

 I have been working in the medical device alarm and alert area of Health IT for many years (you might think I started working in grade school based on the number). I have noticed, wireless phones are becoming disposables….like gloves or needles…. (the sales tactics are certainly with that mindset) One of my hospitals has been offered 3 upgrades to their handsets from their single vendor…..when that happened all of the handsets (phones) needed to be traded in.   I heard that some EMR companies are wrapping it into the sale of their product….which just makes me scratch my head….and frankly should make any investor scratch their head as well.  Is that revenue worth the effort (because it’s surely not the margins)…..is it just a move to be more sticky in the client…..is it worth it?

When my clients ask me about the workflow of these plastic wonders, I quote one of my favorite CMIO  “It’s like fine tuning a model T, my friend.”  Really it’s time for better evaluation of end points, and if your hospital is still buying, replacing or upgrading your wireless phones….it’s time to rethink your strategy, ask yourself: 

·         Why am I buying a device that is as disposable as gloves?

·         Do I supplement our current wireless phone with other devices such as Ipads, Itouch, or other tablets (for those of you who have been able to keep away from the I-monopoly…..) could I combine it for more impact?

·         In the ever shifting reimbursement world – is a little plastic phone worth our time?  What’s the value vs return – could I attain more value with a different strategy?

·         If I have a lot of these devices…ie I was ahead of the curve 9 years ago – how do I phase them out to new devices?

·         Should I be evaluating the BYOD strategy for my hospital?

The point here is – hospitals are tired of disposable expensive technology that gives them Model T level experience?  They need to identify vendors that have the same mindset – how do we move to a modern “workflow enablement tool”?

Alarm Fatigue

I was cooking a BIG meal – one with several burners going, the oven on, and even the microwave.  It was one of those “Martha Stewart has nothing on me moments.” (Ok, I was really more like a I'm a tall version of Rachel Ray) There were 4 boys running in and out asking questions and trying to “help” - other kitchen noises like the garbage disposal, can opener, food processor plus of course the TV was on in the other room. It was loud - like the Chiefs Stadium when we beat the Chargers on Monday night – LOUD! The point is I had a lot going on and neglected to set the egg timer for one of my pans and ignored the beeping on the oven……all of this to say we ended up eating at Culvers that night.

My kitchen scenario is much LESS intense than a nursing floor. No one was critically ill, there were no emotionally distraught family members, there was no Code Blue – it was a kitchen. (Well, the food was critically ill by the end of it – I digress) The point is think about your most intense - loud - busy moments and then think of how much more intense - loud - and busy the nurse is and you will begin to understand  “Alarm Fatigue”.

On a floor with 30 patients with IV pumps, nurse call, telemetry, other physiological alarms, etc there is bound to be some noise. The current methodology of listening for an alarm can really hinder productivity – but leave productivity out of it – it is a major safety concern.

Let’s take an easy one - Do you know the most common way we document a response to an IV pump alarm? The patient has pressed their call button and the nurse is notified that the IV Pump was dinging in their room. Think about how scary that is for a patient and their family – who has no idea what the dining means. Do you know the most inexpensive way to fix that problem? Automate an IV pump alarm to the caregivers wireless and explain to the patient and their family what will happen if the alarm goes off. (BTW – repeat that information every time you enter the room for rounding.)

Here’s a freebie - Depending on your nurse call system there is generally a quarter inch jack that can take a contact closure alarm – old school – this is the way my Dad did it when he sold nurse call in the early 1980’s. Order the cord you can use it tomorrow in your hospital. IF you have a question (hospital) – call or email me I will walk you through it. There are much more expensive ways to automate these as well.

The challenge is at some point in alarm automation and “management” you simply begin to displace the problem. If a clinical alarm device is trigger happy then your wireless device will be as well. Too many alarms is still TOO MANY ALARMS – just because it’s quieter on the unit does not mean its better. At some point it’s time to really review the technology that is making the alarm happen, AND review the process of who is getting what alarm when and why. The event in Boston was not due to the alarm noise, really it wasn’t even due to accountability because no one “heard” the alarm. The Critical alarm was turned off and the Warning alarms were ignored. Some automation would’ve helped the issue but it may not have solved.

Patient safety officials across the country have said the heart patient’s death at Mass. General shines a spotlight on a national problem with heart sensors and other ubiquitous patient monitoring devices. Numerous deaths have been reported because of alarm fatigue, as beeps are ignored or go unheard, or because monitors are accidentally turned off or purposely disabled by staff who find the noise aggravating.  ()http://www.boston.com/news/local/massachusetts/articles/2010/04/03/alarm_fatigue_linked_to_heart_patients_death_at_mass_general/?page=1

It’s tragic that a death occurred due to an alarm issue, and no family should have to go through that.  That death should be a rally point for all of us in the device industry.  

The Trauma at Seattle Grace

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

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

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

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

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

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