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.

The Patient Within the Code

HIMSS made me have one of those “Wow” moments where the world was once flat and now is in full Spherical shape. I was amazed at the bright colorful booths, the well dressed executives, and the hustle and bustle of it all. As I had a complete geek out moment – playing with widgets, talking tech with providers and hospitals – I began to get lost in the forest of tech and saw how it would be easy to lose the patient amongst the code.


Technology is enabling – Technology is empowering – Technology can become overwhelming and overused.

I had the luxury at HIMSS to tour Grady Hospital with Hakan Ilikan, Director of Process Improvement. Ilikan’s passion is to see technology make life better for the caregivers, patients, and families.  I will tell you the full story in a later post, but one moment stood out.  As I walked through the waiting room of the OR my gaze carried past the screen of information about the patients progression through surgery and I made eye contact with a woman – for a brief moment I was reminded why we are all doing this – for her and her loved one.

How many times a day does the patient enter your conversation?
How about their family?
How many times a day do you visualize how your technology helps them?
Does your technology really help them at all?

Maybe I am the only techy geek that sometimes forgets what it’s all about – maybe I am not. I keep a picture on our website which serves as a reminder for myself and my team of why we do this – why we focus on making life better. 

Technologists – Manufactures – Service Providers is it possible that we are so consumed with the competition, development, deployments, that the patient becomes de-emphasized in our equation?


Don’t misplace the patient among the code – Don’t forget why we are all in this game.


We as a company have not shared our Vision but I think it is important – it’s not long – we didn’t hire a large consulting firm to help us –it’s pretty simple “To Make Life Better” followed by our Mission “To Empower Organizations with integration of people, process, and technology.”

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.

Product Life, Technology Life, and Workflow Ability Part 2

The first step is to define the base purpose for the purchase. Every product has a basic underlying goal. For example, I purchase a car to get me from point A to point B. Yes, I am glad it’s red but red is not my reason for purchase – color does not necessitate a change.

A hospital purchases a nurse call system to notify a caregiver of a patient need. This can be fulfilled with ANY nurse call. The basic ability to light a light and tone a tone are the requirements for the nurse call system to meet code. The same is true for every medical device. They each have a basic function that has to be fulfilled. Features are provided to reduce the ability for the product to become commoditized.

The reason we need to appreciate basic functionality is to start to build on the decision points/ timelines. The first is Product Life. Just like your car, a piece of medical equipment cannot live forever, as the product ages the cost of ownership increases. Generally, the product life of a medical device is 10-12 years. This doesn’t mean it will suddenly stop working (though on occasion this may occur) quite simply put the older it is the more costly it is. Eventually, replacement parts will become more and more scarce, and ware and tare will take its toll. This is why for product life decisions items like Mean Time before Failure, Maintenance Costs, and availability of service providers becomes the basis.

Making a matrix of decision points on Product Life is a good way to assess competition. All products within a category should meet the base goal, but utilizing a scoring method to assess mean time before failure, maintenance cost, serviceability, and availability of support can solve half of the equation.

However, if driving from point A to point B were the only criteria that mattered then everyone would drive the least expensive highest miles per gallon car. The fact is that billions of dollars are made each year in the auto industry by creating vehicles to meet the specific goals and desires of drivers. Taking otherwise frivolous items such as navigation systems, built in DVD players, and (dare I say it as a frivolity) power windows and pairing them against the competition as necessities. Driving up costs and changing the spectrum of competition.

Leading to the next Decision Point: Technology Life

Stay Tuned!
Technology Life
Workflow Ability
Unifying Technology