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

Patient Satisfaction and Value

Patient Safety initiatives can readily be linked directly to value for the hospital. If a hospital reduces one fall there are savings of litigation, and non-reimbursable care. Patient Satisfaction can be a little more abstract when measuring results – not that you can’t get a score very readily from a Press Ganey Survey. What does that mean for dollars? How can we measure our effectiveness in these initiative? Adding new dimension to this is the HCAPS Surveys and how they will affect reimbursement for care.

Every business uses some sort of performance metrics. Often quantity of incoming requests (similar to incoming patients) and quantity of “credits” given for mistaken work (similar to non-reimbursable care) – not that these are exactly the same in all instances but they are similar and make the point that tracking specific information can be helpful when improving business practices.

Sphere3 believes that a stand-alone metric, while valuable information, is less effective as one that is cross-referenced with another. For example, if a hospital were to look at average response time balanced with the staff to patient ratio and correlated with total average call volume – you could use the information together and create a multi-faceted metric. Then take that metric and see if there is safety improvement and if there is also an improvement in patient satisfaction score.

Most importantly, what is the link it to dollars? Will the hospitals elective surgeries increase? Will the hospital have a consistently higher census? I understand there are some large assumptions when loosely linking these two data points but the point is if you had the power to easily look at information such as (1) your response times, (2) quantity of direct interactions with patients, (3) average wait time before exit, and (4) total call volume, would you be able to make specific linkages to improvement in patient satisfaction? Would you be able to take that information and link it to increase in electives and increase in revenues based on increase of paying heads in beds?

Our new Sphere3 Scorecard™ will make it easier for hospitals to get specific information on clinician response and interaction which can be compared to patient satisfaction.

Call us for a full presentation.

Location, Utilization, and Movement

I had an interesting call with Will Lukens, Vice President of CENTRAK, a Real Time Locating System (RTLS) company. There are a number of debates swirling around RTLS such as what’s the best technology to use? (Wi-Fi, RF, Hybrid - Check out JHIM from Fall 2008 for further reading on the technology.) No matter what technology you use in the background, RTLS is a great mechanism to track the effectiveness of workflow for staff and “stuff”.

Step One is always to decide “what” you want to accomplish prior to deciding “how” or with which technology you want to use. The "what" or goal froma workflow perspective can be evaluated in three areas Location, Utilization, and Movement. Using these areas you can evaluate numerous abilities to track implemented technologies and initiatives.

LOCATION: It’s been reported that caregivers currently spend less than 30% of their time at the patient bedside, but that’s an average which is not applicable for every facility. Using RTLS a hospital could track the actual time frames that a caregiver spends with a patient and set a baseline for their specific facility.

Location is the portion of the puzzle that has the most value and the most apprehension. The ability to track caregiver’s locations with detailed reports of who, when is sometimes labeled “Big Brother” and “Micro-Management” and honestly, would you be pleased to wear a tag that tracked your movement the entire time you are at the office? “Bob, you spent way too much time at the coffee pot.” Using this as a coporate means of improvement as opposed to individual tool for punishment is really key.

UTILIZATION: “Work Around Artists” is a term that Karen Cox, Executive Vice President of Children’s Mercy Hospital in Kansas City coined in the last issue of Ingrams. That name captures the innovative spirit of the caregiver. They are the modern day MacGyvers using available resources to find more efficient paths.

Often hospitals will implement initiatives, or provide technologies with the desire to see an improvement in something that is lacking. For example, if there are high infection rates they may implement a hand washing initiative and provide a new sink in every patient room. What if the utilization of the sink could be documented automatically – even more so what if that information could be correlated back to the reduction of infection rate.

MOVEMENT: Frank Lloyd Wright would watch people’s movement habit’s to design walk ways. Once he didn’t put in a single side walk at a University until after the students had worn paths to show where he should be putting those walk-ways. RTLS is the modern day observation and automated documentation of movement habits. A caregiver walks 1 to 4 miles per day (depending on size of facility and quantity of patients) often a technology is provided to reduce that foot traffic. Hospitals can have humans track the movement with clipboards and pens or pedometers, but if they have an RTLS system that information is being collected.

Before you begin your journey - A great resource when planning RTLS purchase and implementation Robert Konishi’s RFID-RTLS Strategy and Planning Guide. Robert is the former CTO of UCLA Medical Center, and Current CEO of T2 Technology Group. According Konishi, there are four main areas that can be assessed to link to value when evaluating the RTLS system for equipment tracking:

• Cost savings associated with rental or duplicate purchases
• Lost Revenue and Opportunity Cost due to utilization
• Lost Time for Staff
• Quality of Patient Care, Throughput, and Regulatory

Konishi provides very helpful insights in the article from RFID News (http://www.rfidproductnews.com/pages/searchview.php?key=konishi&p=issues/2008.03/medical2.php) and a subsequent RFID-RTLS Strategy and Planning Guide.

The power of RTLS is the ability to track specific information. That information can become a metric which can be used to help the hospital better assess their workflow choices. A metric on it’s own is important – every business needs to track it’s ability to improve – however correlating those metrics with other data is the most powerful way to look at the data. That's why Sphere3 has developed our automated web based Sphere3 Scorecard™.

We look forward to sharing it with you.

Hospital Noise

Ring, Buzz, Tone, all sounded as Caregivers bustled and hustled past my seat with IV bags, food, charts, and doctors. My heart rate increased. It seems no matter how long I have worked with hospitals those noises still make me nervous. It’s kind of like taking your first airplane ride – you are not quite sure what the noises mean but you know the plane could fall from the sky at any moment. I began thinking about noise, as I waited to speak to the Nursing Director, why is it so noisy? When you are sick all you want to do is rest, yet how do you rest when an IV pump - that sounds like the worst alarm clock in the world - is going off randomly down the hallway.

Noise is measured in decibels(db) - I learned that from my early days of designing sound systems. The average bedside monitor is approximately 79db (Hospitals & Health Networks Dagmara Scalise Mayo Clinic May 2004) but what does that mean? Compare it to a heavy truck driving by – a diesel mind you – which is 80 decibels. At Mayo clinic they documented the loudest point of the day to be at a pre-intervention shift change which was at 113db – to compare a gunshot is 140db.

Is a “decibel” really the right method or measure? Do we really expect the Clinicians to be concerned with actual decibel readings? Is it practical to think that they are going to carry around a little decibel meter in their pocket and then say ohhh we are 15 decibels too loud? Impractical, Difficult, and Inefficient….

Since assessing all noise on a unit is a huge undertaking (footsteps, conversations, cell phones, chatter, beds running into walls) - What if we took the section of noise that has to do with alarms and began to create a method to quickly and efficiently assess it? Total quantity of alarms multiplied by total devices in the rooms = the Noise Issue. (that’s way too simplistic but it helps establish the initial concept)

The initial solution by hospitals (and manufactures trying to sell a product) is “send it to a wireless phone or device”. While I am onboard with the mobility revolution – I think that it’s an overused medium that manufactures and vendors use to pull at the overworked heart strings of the caregivers. The mantra “We can make your life easier – just send it to a wireless phone” conceptually is wonderful but realistically how many alarms can we actually take on our hip? (See earlier post) Don’t jump on the band wagon that mobility is always best - jump on the band wagon that efficiency – ease of use – reduced redundancy is always best.

At Sphere3 we utilize a sophisticated equation in our workflow analysis and link it back to proper categorization of alarms which decreases alarm fatigue. One of the items we look at is noise and utilizing a scoring system we help establish the most effective area to automate.

I think that it would be interesting to create a calculator that the caregivers could easily use to establish their noise level – efficiently and effectively. Anyone interested?

Check out the article posted by @BhawkesRN (Beth Hawkes) on Noise.

Single Source of Truth

The Clinical Transformation blog is about workflow – how do we positively impact the caregiver’s day by providing technology that is purposefully chosen based on process. Remember if you pick the product without knowing the workflow you want to achieve up front – then you are shopping for a book based on the picture on the cover not the content of the material.

That being said - I am totally enamored with what is occurring with device connectivity platforms and the flexibilities they offer. I am equally enamored by the marketplace shift that is occurring. Companies large and small move into a space as a disruptive technology, and it begins a ripple effect. This starts to shift our view of status quo and wonder – is there a better way?

One of the best parts of our growing start up is all of the interesting people I get to meet. Wednesday, I had the opportunity to sit down with Tom Herzog, VP of IT and Medical Device Technology – head of the MDBUS. Tom is a fascinating individual who is very intelligent and a visionary in the marketplace - I was blown away by our conversation and truly appreciated the interaction. He is someone to watch. MDBUS is Cerner’s connectivity platform that connects medical devices to the EMR. While MDBUS has several similarities to CapsuleTech (blogged about earlier) they have built tight relationships in the marketplace with companies such as Hill-Rom that allow them to garner additional information on an interactive touchscreen, and interactive integration software piece that allows a user to query systems using a handheld device.

The one items that stands out to me as their biggest challenge (this might be the elephant in the room) in the market place is the blessing and curse of the Cerner brand. Cerner is well known for innovative thinking and product development – if you have been to a smart room you would agree. The blessing of the brand is it’s trusted stability in the marketplace with a growing enterprise EMR market share documented at 13%(2006 HIMMS) which I have read other sites to be closer to 20%. This is a great base of clients who are prime candidates for “the bus”. As a relatively unknown startup – I am envious of having such a well known brand. What Mr. Patterson has done is amazing.

The curse of the Cerner brand is it’s tight tie to a specific EMR. While the product is designed to be EMR vendor agnostic - it would only be logical to utilize the product to position themselves in competitive accounts. Why would Epic invite a Cerner product into the mix? I could be way off base here but this seems counter intuitive. While it may occur – GE still utilizes Emergin (aka Phillips) Emergin as a standalone brand had the ability to be Vendor Agnostic but now linked to Phillips it is a leverage point to bring Phillips into an account.

All of that aside – the thought process used in developing MDBUS is correct – the product is really impressive. Open Source – Open Data – Single Source of Truth (as Tom would say) is important in healthcare. It offers significant abilities to decrease caregivers workload and increase safety.

I think that every hospital should be evaluating these types of systems and DOCUMENTING their validity.
What method are you using to see if this is garnering you results?
Is it going to positively affect safety, accountability, redundancy, and noise?
Is it affecting their caregiver satisfaction, patient satisfaction, and safety?

I think that Capsuletech (Brian McAlpine) and Cerner MDBUS (Tom Herzog) are fellas that you should watch – I know I am. I appreciate this interaction.

Who would’ve thought – a little gal from Kansas would be talking to such powerful industry changing people. All it took was Twitter and a choice to join the conversation – are you ready to join?

Thanks Tom – look forward to learning more.
www.cerner.com

Stay tuned – I am working on a thought provoking post about Cerner’s vision of allowing people to write apps to their Iphone and utilize the EcoSystem to share (possibly sell) that work. Probably one of the most innovative ideas I have heard in a long time – not sure I am on board with the ide, but I can’t wait to experience it myself.

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.

Patient Association

Sphere3 has a goal and focus to increase caregiver satisfaction by utilizing technology to automate workflow. The key is we don’t want to make life MORE complex by adding unnecessary technology nor do we want the hospital to spend additional dollars if existing technologies can be leveraged to increase functionality.

I had an interesting conversation with Brian McAlpine of Capsuletech (www.capusletech.com) about patient association. Capsule is highly focused on the documentation, and the ease of delivery of information.

I encourage you all to join in the conversation to increase the overall knowledge in the industry. This is my perspective - which is meant to be very elementary in it's approach.

Caregivers are challenged to manage information – whether it’s an alert to their wireless, a piece of data that needs to be documented, or request that is made or received. Adding technology to “make things better” will sometimes add steps as it requires several steps to interact with the new technology.

Traditionally, in alert automation software, the information is linked to a room number. The association to a patient is generally made by the integration to the admitting system (sometimes this is done manually) – so connection is only made by linkage to room number. The key is that the alerting device must be “tethered” (aka plugged in) to the patient room to be linked to the room number and sent to the appropriate caregiver, or the hospital must purchase additional software packages which in turn increases the number of "adapters" that must be purchased for integration software. Adding to the difficulty, new devices are wireless and can float to any room so a nurse must interact with the piece of equipment to identify it's location.

So, the question becomes will it become more necessary for alert automation to associate with the Patient as opposed to simply the room? Potentially, it could be easier to associate to the patient. This could increase the flexibility for integrating that information to medical record for multiple devices such as mobile telemetry, vents, pumps, etc. It will also blow away the current assignment process for integration software, nurse call, and other vendors. (Yes, I recognize there will be disagreement on this one.)

The Nurse Call information is the most popular item to automate directly to wireless mainly because of its highly visible patient satisfaction and caregiver satisfaction influences. The telemetry is a close second, while the loss of the waveform has been challenging to most sites, it’s still very necessary to have that alert at the “hip”. While it’s not highly critical to associate the patients name or identifier to a wireless device for nurse call, documenting the interaction can be critical if an issue arises.

Most of the companies focused on alert automation do not consider the charting piece because it’s “out of their scope” but hospitals will at some point (if not already) be tasked to correlate that information. If you read Brian McAlpines Blog you will read more about patient association, devices and documentation.

Products such as Capsuletech offer a vendor neutral integration point in the patient room. Their product can collect data from devices and correlate it with patient information, all of which can be confirmed at the bedside either manually or automatically.