Workflow and Growth

I have found with a start up there are several rules – I think of them like the If / Then statements we use in developing our software.


The three that I have found to be critical are:

1. IF you don’t have enough Capital THEN you are hosed.

2. IF you don’t make the right relationships THEN you are hosed.

3. IF you don’t create replicatable processes where every move isn’t hinged on you THEN you are hosed.

The third item I noted is one of my favorites – hence the reason for writing the Sphere3 Workflow Tool aka our software program. I don’t like to do the same thing twice, and it kind of drives me nuts to watch someone else do repetitive processes. (Once I have figured out the puzzle you might as well garage sale it because it’s not like revisiting an old friend for me, it’s just dull.)   I think that’s why I like to look at workflow – while there are patterns there are also variables around those patterns keep things interesting.

I recently found a kindred spirit in this vein, Tony Marsico, CEO of PCTS. Tony stopped by our office on a recent trip to Kansas City to get the “Grand” tour. Tony has a graduate degree in documentation of complex processes and corporate training. (No, I didn’t make that up, and yes I did laugh when he told me.) Which makes him perfectly suited to run PCTS, a analytic software firm that provides business intelligence for hospitals via an RTLS system.   He is an investors dream with his ability to clearly document and communicate process back out to his team.

PCTS provides real time business intelligence for Operating Rooms and Emergency Departments with “air traffic control” like screens, mobile buttons, and integration to systems and medical records. The really interesting thing about their product is its ability to run workflow rules and associate them with other rules. (That’s an over simplified way of describing that) Breaking down processes to physical movements, allowing for interaction levels and not only the “time association stand point” such as “IF the RN is in the room for X period of Time THEN do XYZ” obtaining information from other systems to validate the entry and interaction with patient specific information. All of which I have seen in “Demo” mode.

As I have said before I usually don’t believe it until I see it and PCTS was gracious enough to take me on a site visit and let me watch their team in action at Cook’s Children’s Hospital. This was an asset tracking project, so not nearly as complex as the workflow in an Emergency Department or OR, but interesting and exciting. The team was incredible, and the processes appeared to provide real time value to staff.  Including the ability to better locate, identify, and collect recalled pumps and modules.

It’s important to note – while PCTS is dependent on RTLS they are NOT an RTLS company. However, they do provide RTLS products. Tony’s explanation made a lot of sense.   Analytics based on workflow using RTLS is not simple and the validity of the information is a direct correlation to the installation of the RTLS product.    His challenges, similar to many companies I have talked to, is who to hitch his wagon to. He is in need of companies who understand analytics, understand workflow, and understand the relationship to hardware. (That last point may sound “easy” but take it from the voice of experience it’s not)

My assessment – Tony Marsico is an Investors dream - he could "McDonalize" processes within a company.  He has also surrounded himself with good people - which I have found to be the key to building a successful people.  (Yes, that's my secret - I hire people smarter than me.)  He is driven, intelligent, and has an eye for creating better workflow inside his firm and outside.

Tony’s Most Recent Read: Inside the Tornado – which I read the following week and it was a really interesting read. (Note to audience: Just read the first couple of chapters and you will get the gist of the entire book)

Sphere3 celebrated our first birthday in May. Though there was no noted celebration there was a strange, we have arrived moment – meaning that the phone has been ringing a lot and business is definitely starting to move. That momentum has really increased my travel - which has noteably decreased the blog posts. Stay tuned there are good posts to come later this month: Chad West, CEO of Ascom Wireless and Todd Plesko, CEO of Extension

Who put the "I" in Innovation....

It seems anytime you put an "I" in front of a product it can represent a number of different things.  In healthcare it means innovation, interaction, intelligence, and integral.  The goal however is to make sure that it does not become irrelevant, inferior, or illogical. 

The I-phone has spurned a number of discussions because of it's innovative nature.  The product has been built on a platform that allows everyone to create their own "Aps" - in my world that means design their workflow in a way that works for their unit not generically designed to work in all applications. (just a quick warning that can be bad also)

The flexibility of the platform that is open to large and small organizations (and individuals) is the best way to drive new ways to solve problems.  Let's face it - it's not always the big guys with all the ideas.  It's also not always those of us who break out and build a business - more times than not it's the people who live in the situations everyday. Therefore, the intelligence in the product is built by the users, and the flexibility allows it to become an integral part of the workflow and daily life.  So integral often times we overlook product "issues" such as durability and compatibility with infrastructure.

The challenge will be how do we make sure a strong "I" shaped platform does not become irrelevant and illogical.   The best way to approach this is to make sure that it's the workflow that drives the innovation and not the innovation.  Cool - for Cool sake - is not so Cool.  This is not meaning you need to run out and hire a Sphere3esque firm to document and help design your wireless device workflow - it just means if you are not currently doing it - why not? What innovative value are you missing?

The I-Phone is driving people to design applications that can be used in the healthcare space - in my world that's for automation of alerts to a wireless device.   Amcom releasing software that will automate information to the Iphone is interesting, but as you saw in my previous post about Voalte that application for clinical alarms to the Iphone is still hard for me to accept.  Durability has to be in the decision process for a clinical device not just innovation.  Also as we drive more information to a single device are we really making the best decision?  It sounds logical - don't get me wrong - one device that can get alerts, call the on-call doc, use decision making software, access facebook, see information on a med record, etc sounds great but is it really the best choice?  (I am throwing that out there for interaction sake because honestly I am not sure - I see benefits but I also see a lot of limitations due to the critical nature of alarm automation)

The device has more application to those who work outside the hospital, like a doctor but then the question becomes what information does he need that requires integration to the hospital.....this I know, but I will let  you ask me to find out.

From a market perspective - it's only good news to have multiple competitors in the on coming tornado that will occur with smart phones. 

Command Centers

In a strange turn my blog has lead me to interviewing – ok so not really interviewing more having conversations with really interesting leaders in the healthcare medical device community. I want to be transparent – probably don’t need to say this because it’s apparent – I am not a journalist and 100% of what you read is my opinion.


Since the blog started last May, I have encountered all sorts of people. Some I like- Some I didn’t like so much. One that I have really enjoyed getting to know, during my contracted work with his organization which is now complete, has been Chris Heim, CEO of AmCom Software.

Chris is a genuine nice guy which permeates the corporate culture of his organization. He is genuine because he has never forgotten his roots.   He started in a garage - not in a band but building a shipping software platform that grew and grew and was eventually sold for multi-million dollars.   A lot of people would be pretentious after achieving that, not him.  He is down to earth and even willing to talk shop and understand the journey of little start up software company like mine.  Just because he’s a nice guy doesn’t mean he isn’t competitive – think of the way that Magic Johnson and Larry Bird competed – tactically, well practiced, engaged, and with a team spirit. That’s the competitive attitude of Amcom.

In 2007, Am Com Software, an operator/ call center company, saw an opportunity to enter a market space purchased a middleware company called Com-Tech. From the view of most middleware players Com-Tech was a simple “point to point” solution, one that wouldn’t rival the depth of Emergin, the flexibility of Connexall, and the integration to wireless power of Ascom. While the perception of the product is a challenge, the team behind it is building a well researched powerful offering.

Even at a high level view AmCom has a unique market opportunity. Their core product is operator or call center software, with a unique application that provides doctor on-call contact information. Since I have only seen in it a lab – the view is appears well organized and easily attainable. If you were to create a central call command center, then the operator software and middleware for alarms this could be a valuable pairing.

Communication from a patient perspective is any interaction dealing with their care, whether it is a with a licensed care provider, a volunteer bringing an extra pillow for their spouse, or even with the dietary group to order lunch. Communication from a caregivers perspective is any interaction from a patient, other caregivers, doctors or services provided that enable them to provide better care or services within the hospital. The faster triaged information can be provided the faster care can be administered.

Notice that I said triaged information. Information overload can hinder the effectiveness of the hospital’s performance. Sometimes I hear caregivers say, “we had pagers and/ or phones but we quit using them because they didn’t help”. Most of the time they “didn’t help” because the information was not provided in a usable fashion – in a central command center portions of the communications can be triaged and managed more efficiently than by pure automation. I’m a geek – I would like to say let the computer make all the decisions, but I have also been a patient, a patient advocate, and a parent –human interaction is more than just obtaining and triaging information.  It's about connecting - not just systems, people.

If you look at a central call command center from the view point of one communication point, it is really just a fancy phone booth. (not discounting it's importance, but couldn't we do more?)  The value of that command center is exponentially increased by leveraging it for additional abilities.   Even non-clinical - Think about the value of this application from a Mass Notification Emergency Communication standpoint! (see previous post on Seattle Grace)

It appears to me that the AmCom suite coupled with the Com-Tech software could be the “Killer App” in a command center design. Granted, I have only seen this application and their middleware piece in a lab environment. You all know my stance, I have to see it live to believe it would really work. (I do live in the Show Me State)

AmCom has a lot of "futures" planned and they have an impressive team of individuals who are working to build a really powerful very well integrated platform.  I look forward to watching them grow. 

To Wash or Not to Wash....

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

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

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

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

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

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

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

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.

Power to the Pager....

Buzz Buzz the PCT’s pager sounded as he was taking my mother's vitals. He stopped – looked at the pager – then smiled and said “I never seem to be in the right place at the right time.” He silenced the pager and went back to checking her vitals. Before he could finish the pager sounded again – frustrated this time he smiled wearily at my groggy mother and said “I am popular today”.

The trouble with pagers when used in a decentralized methodology is their limitations on actively interacting with patients and the call while mobile. The message is received and its plain simple information about the patient such as the room number, the call type, and whether or not this is the initial notification. In a straight nurse call to pager design – even though they are cost effective they are not very effective. That’s not to say this is a useless piece of technology, because if applied correctly it can be very effective.

The reason that pagers are purchased in mass quantities for hospitals is primarily the price. They offer low initial cost and low total cost of ownership. While I am all for creating low cost options for alert designs and see pagers as very applicable in specific situations there are limitations to these power packed little boxes. For those of you who talk with the CFO – “if designed correctly – pagers used in a workflow application can see a payback potential”

Designing workflow in a way that properly leverages the power of the pager is critical. The power of the pager is it can be non-intrusive if used correctly. The Caregiver needs to know that there is information attached to the page that is specifically for them. They need to know that the patient need has all ready been triaged and that they can quickly and efficiently answer that need. For example, a pager should be used on Normal Calls only if triaged through a central point (whether through the PBX or Unit Secretary or Others) However, pagers can be leveraged with other emergency call types – such as Code Blue.

One final tip on pagers – this is a freebie – NEVER use an external pager system to automate a Code Blue. A Code Blue should only be automated to an internal paging system such as WaveWare. The latency and delays are a patient safety issue and should be seen and addressed that way. If your hospital is currently using an external paging system your delays can be in excess of 10 minutes during peak times. If your hospital is using an external paging system then the CFO will be pleased to know that by replacing 90% of the pagers with an internal system there are HUGE potential savings.

So the moral of the story – use a pager if you would like but design it properly.

A Personal Note: Spending time with my mother in the hospital brought back a lot of the initial reasons I started Sphere3. Ironically, it was 1 year ago this month that we launched. Designing alarm automation often times we get caught up in the geek side. It’s cool that through the air we can make something ring or buzz – it’s interesting to examine process maps and charts, apply lean principles that help us assess the efficiency of the process.

However, when you sit with your mother in a patient room – watching her recover - helplessly knowing that the red button is the only methodology we have to engage the outside world – your eyes are opened to the other side of the map – the human side. The human side is where lean and process don’t always compute. As much as we would like to make the processes as straightforward as building a cheeseburger at McDonalds the fact is my mom wasn’t a cheese burger.

I want to thank the team at Columbia Regional Hospital in Columbia, Missouri. My mother received excellent care. It wasn’t just the care that she received – it was the non-clinical emotional care that we all received while in that hospital. It was the true demonstration of team work that I saw between team RN and her Care Assistant. The friendly and helpful volunteers, and overly helpful support staff. Thank you from the bottom of my heart.

There's an Ap for that....

Some of you that know me well – know that growing up some people had pictures of Rock Stars on their walls – not me I had a file cabinet and books by Jack Welch. (I am serious, I asked for a file cabinet when I was 12 so I would have some place to store my budgets and letters). In other words – my rock stars were CEOs, movie producers, innovative genius, and other leaders. So, being able to talk with a great CEO is always high on my list.


I had a great conversation with Rob Campbell the CEO of Voalte. Rob, as you might know, has worked with the likes of Steve Jobs and Bill Gates on a little program – not well known at all – PowerPoint among others. Just talking to him was incredible. He has an amazing business mind and a keen understanding of the healthcare marketplace – which is surprising since he didn’t come from the file and ranks of an EMR vendor, medical device manufacture, etc. He is really an outsider who has stepped in to help launch the first Healthcare iPhone “App” for medical device connectivity.

What do you really think about that – an iPhone in the healthcare environment? Since I have been through 4 (yes, really) in the last two years I am a bit skeptical. The device, while loaded with features, is fragile. Dropping at the right angle can shatter a screen (been there) – not to mention that scratching a screen can render the device useless (done that). In addition the battery life can be – let’s say challenging (got the t-shirt). I have worked with wireless internal communication devices in hospitals for more than 10 years. They are as abused as a rental car in a third world country. That’s why Cisco rushed to replace earlier models that weren’t suited for being crushed by a Stryker bed, Ascom has made their phone survive the swim that often occurs when a Caregiver helps a patient off the toilet, and Spectralink’s case can be dropped and kicked down the hall.

Now, before you throw your hands up and run screaming from the device think about the flexibilities of what they have just developed. The Apple iPhone is one of the most user friendly devices on the market. If you are using the wireless device to receive patient calls and the average patient call per hour is 1.5 then making the “answer” function easy is essential. I challenge you to try answering a Cisco phone. (Hint: there are more than 3 button pushes to answer and speak with a patient) I don't claim to have experienced the Volate Answer process, but from what I have seen it appears very straightfoward.

Stop for a moment and think about the flexibility of this concept. How many Nurses currently have a “Smart Phone”? How many are using the facebook, twitter, yelp, urban spoon, or other crazy ap? The device is like a piece of clay that can be molded to it’s environment.  Aside from that it's fun and easy use.  The smart phone can display pictures, it can use decision assistance medical programs, and that little thing – enter information into the EMR.

If I didn’t say I was enamored with the concept – I would not be truthful. We are talking about Apple here – Steve Jobs is the Walt Disney of cool gadgets.   If I didn’t love my iPhone why would I have spent the money to replace and repair it 4 times...or maybe 5.   The device is great – it offers a lot flexibility to the hospital workflow. Some may argue that it also provides a lot of challenges for a hospital when it comes to policy of what is appropriate use, but no more so than a PC.

I recommend checking out their new website http://www.voalte.com/

BTW - anyone who wants to indulge me the one CEO who has been on my list for years is Meg Whitman, former CEO of Ebay.