HIMSS Day 3... Day???

I have been on the road for a solid week now as most of us in the industry know kind of forgetting what my house looks like and hopeful that my boys remember my name when they see me.

Yesterday – I was able to enjoy the Cedars Sinai & Voalte presentation.  Most of you know I have an affinity towards Voalte..yes, yes, I am vendor agnostic but there are products that are disruptive, innovative, and extremely functional for nursing that shift the paradigm.  Or maybe it’s just the pink pants…..

The presentation was great – I tweeted it out and saw lots of people liking the thoughts.  Darren Dworkin is a real thought leader – I have had the pleasure of working with him and his phenomenal staff and have experienced firsthand their ability to grasp a concept and mobilize it (no pun intended).    Dworkin was humble in the revelation that Cedars has tried a number of different technologies to really find the right fits for their organization that also fit the fast changing IT infrastructure.  For communications devices they have landed on a more “consumer” type product – the iphone.    They have deployed more than 1000 devices.  I was most impressed with the statement that nursing came to him and said “we don’t want a batman belt” and IT listened to the end users and sought out a product that would not only be forward thinking but serve the nurses well.  He said that nurses don’t come up and tell you how much they love EMR but they do come up and tell you what a difference this device has made. 

My biggest disappointment yesterday was on the statements made by Epic.  I have debated whether or not to post anything (when you are a startup it’s better not to ruffle too many feathers…which I tend to do with Cerner on occasion.... ) but for the few of you who read my blog you know it’s my opinion. 

I didn’t like their statement.  I understand they got bad press because they weren’t sitting there on stage from the beginning.  I also understand that it appears that they are being strong armed into the party – twitter and speakers are brutal and love a good bit of drama and gossip..we are all grown ups and can see it.  I also understand how they could take this as a competitive movement…. 

But OH MY WORD…CAN IT JUST BE ABOUT THE PATIENT FOR ONE DAY IN HEALTH IT?! 

Why not say – we weren’t invited to the party but we think this is an idea worth exploring because we believe in patient care.   Then take a look and if it’s not a great idea – make a statement then.  The point is can't they just sit down and talk about it.....somehow they got Neal to sit next to Jonathan Bush (which was visually awkward) but they were there willing to talk. 

I don’t know Neal personally – I don’t know the other men on the stage (I met Jonathan Bush…and wow still not sure what to think of him)   I have to believe – that somewhere each of these men have some part of them is good intentioned enough to believe that CommonWell is really what it says for the Common wellness of patients…….

I am weary – weary – of going to events and seeing so little about the patient – seeing the vendors latch on to analytics because it’s the next hot topic and it will “save money” and it will “improve your efficiency” – they need something new to sell.  I just want them to know you won’t be able to really love analytics  and serve the hospital well until you step back and see the people in the numbers. 

Ok, soap box complete for Day whatever it is....

 

 

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.

 

 

HIMSS Day 1 Clinical & Business Intelligence Symposium

Well, HIMSS13 has started off…..interesting in both good and bad ways.  After having some hiccups getting my morning caffeine fix (thank you to the HIMSS staff that helped me find the Starbucks at the Marriott) I headed to the Clinical & Business Intelligence Symposium.  Then at some point twitter began to show signs of a problem....water....the symposium leaders announced that we could not  drink the water.  This wasn't too bothersome until they announced that they were manually going to be flushing toilets with buckets of water ....I suddenly wished I wasn’t so hydrated……some tweets made me laugh (especially @SteveHuffmanCIO) but I must admit the people running everything didn't miss a beat and handled everything very well.

 

For me the water issue - while concerning - didn't deter from the Symposium - more gave a room full of geeks something to talk about other than the weather.   The Clinical & Business Intelligence Symposium was a not focused on a specific “type” of data – it was a well-built process that took us from defining to analyzing to improvement.

 

Each presenter took a different segment of the process of defining, analyzing, and improving using data in a meaningful way.  They gave applicable advice that any hospital could use if they were planning to head down the business intelligence route. Brian Jacobs, Children's National, (and others used the same definition) gave the following definition.

 Workflow‐integrated information which enables healthcare providers to drill from reports into detailed analyses of quality, safety, efficiency, effectiveness, regulatory and financial aspects of care practice to identify poor quality, waste, non‐standard practices, under or over‐utilized services, & opportunitiesfor improvement.

The most surprising thing for me - all of the presenters recommended that the BI group of the hospital NOT be under IT.   That while there are governance's and processes that are IT enabled it should be reporting directly to the Executive Team.  (Namely the COO)  Also that the area seemed so nebulous and undefined - I appreciated John Glasers statement that we had a lot to learn and will continue to learn and adjust the field because it's just that new.

The room was pretty mild - except for one woman who decided to soap box about how far behind the US was from other developed nations.  The presenters handled it well and while I am not ethnocentric and understand we have a long way to go - it struck me wrong that someone would sign up for a course that was to introduce hospitals to the "how to's" of doing business intelligence.  The presenters handled it well and we were able to move on after her dissertation.

Like usual I met some great people –  and even have a devoted KC Chiefs fan talked into joining me for a Sporting KC game.  (BTW – SKC won on Saturday!) 

 Today, I am going to meet with some good friends and check out several vendors and give some thoughts on the blog – if you want me to pop by send me a Twitter message @Sphere3CEO

Also will be at the Histalkapalooza tonight!  So excited.

Bed Alarms Don't Work??

I recently read a blog by KevinMD – a blogger I really enjoy following – regarding the use of bed alarms and their lack of ability to reduce fall rates.  (http://www.kevinmd.com/blog/2013/01/bed-alarms-work-reduce-patient-falls.html)

I found his blog very interesting (especially since we now interface more fully with smart bed technology).  So being the nerdy geek I am – I did some investigation.  The blog is referring to a study done that compared falls at a single ubran hospital over a period of time.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/

The simple summation is that “bed alarms” do not have a significant impact on reducing falls in a hospital. 

When someone says “Bed Alarms” they are generally reffering to any type of technology that notifies the caregiver that a patient has exited the bed.  So the technology itself is anything from a pressure pad to smart beds.   The study referenced was conducted using pressure pad type of alarm with two weight sensitivity settings.

Most pressure pad looks similar to a strip of material that is laid under the patient on a bed, to integrate it to a call light system (ie having the centralized notification) you plug it into a quarter inch jack. (A quarter inch jack is like a phone plug from the old operator based phone system where you crank the phone the operator answers and then physically connects your call to another)  The technology is a contact closure – it is “on” of “off”. 

The study used a pressure sensitive pad that is placed in the bed or chair.  So, if you scoot to the edge of the bed but keep the pressure applied to the pad then you will not trigger an alarm until the patient falls on the ground.   Or commonly when they are sleeping and the patient arches their back to adjust their gown, the alarm goes off – thus alarming and waking the patient.  (which would link to that whole “noise at night” issue with HCAHPS)  Further, this type of technology is prone to false alarms which can be linked to alarm fatigue situations. 

However, more modern “bed alarm” technology, such as Stryker’s iBed, allows the bed alarm to be triggered based on zones and weight of the patient.  There is an actual algorithm that evaluates the patient’s weight to determine where the center of gravity is located.   The cool factor here is that instead of an “on/off” technology it uses the potentially varying weight fo the patient to engineer a more precise alarm to indicate when the patient is moving TOWARD exit.  This does two things, it notifies prior to exit and reduces the occurrences of false alarms.  Think of it like the Indiana Jones scene where he replaces the idol with a bag of sand and it triggers the cave in. 

Some of the smart bed technology work on a similar assumption where a variation in weight triggers the alarm, the reason I think that Styker’s is so effective is that the “weight” is actual.  Most beds look for a shift of 20lbs or so but do not take into account the actual weight of the patient.  If a patient is 90lbs and 20lbs moves that significant if the patient is 300lbs and 20lbs moves that may not be as significant.

In the Styker product, the clinician determines the level of sensitivity.  It can be based on acuity or a fall evaluation.  The level of sensitivity will actually measure the movement of the patient TOWARDS egress not at the point of egress.   

So, do I agree with the study – yes, it appears that the technology that was evaluated in the study had little to no impact on the patients fall rate.  Do I agree that “bed alarms” as a category are ineffective? No, I don’t think technically that is the best assumption.

I do agree fully with KevinMDs statement “Maybe we need to rethink hospital fall prevention, and focus on more human and less technical solutions.”  

A bed alarm – like any medical device or alarm notification technology should be part of a more comprehensive plan – technology alone does not solve.  Think of it this way – if you buy a treadmill and just look at it, it won’t improve your health.  If you buy a treadmill and walk on it every once in a while….it won’t improve your health.  If you buy a treadmill and run on it every day but eat cupcakes every day….it won’t improve your health.  The “treadmill” is not the answer – the “treadmill” is a tool to be used in conjunction with behaviors and habits.  

Check out our clinical blog.  (www.sphere3consulting.com) where CNO Lynn Barrett discusses some of their holistic approaches to reducing falls.  

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”?

Compiling and Comparing Data

I work at a lot of coffee shops.  It’s not that we don’t have an office but there is something about being in a space with music, coffee, and energy.    There are always people there meeting for business – to stop collaborate and listen.   I have done it dozens of times myself – reached out to people who have expertise in a specific area or have started a business and can give insight from a been there, done that perspective.   This blog is spattered with some of those stories.

My one regret is how I have managed all the information that I have gathered in the last few years.  I take really crazy notes mostly with doodles and pictures.  When people say a picture speaks a thousand words- they are right (plus it’s easier to remember a picture).  The team jokes I have an addiction to spiral notebooks, there are about 50 in my office full of “valuable” information.   While I have gotten better about giving the algorithms to Kristal to be properly documented for evaluation, testing, and roadmapping  – there is a lot of information that is not that square – not a number, not an equation, more anecdotal but still important.   Those feelings that are just as important as a data point. 

I once had a friend describe working for a startup and watching the CEO of that company change in the years of its build.  The story itself was not uncommon to many I have heard before, but for some reason his words describing his perception of the emotional state of the CEO were.  Perception of the event or process – feelings – are as important as hard data.

We are working on ways to capture those thoughts of caregivers and nurses so that the square data can be compared to squiggly line data – thoughts, impressions, and ideas.  Active comparison to perception vs the reality of a situation will help to create more accurate benchmarks….just because you can be staffed to have a 10 second response time….is it necessary?  That was a hard question for me – my gut says YES of course if we can and we should but reality is there is always a cost associated with the movement.  I almost hate to say it but in this dynamically changing industry…. Is that worth the cost….

The balance between delivering the hospital leadership perception of service excellence and delivering an “Always” can be two different things. 

The “Always” can be more accurately attained if you understand the reality of the perception of the patient – if you create an expectation and meet it.  The “Always” cannot be obtained when we set unreasonable expectations with our patients, or we fail to meet a basic level of expectation.

Best Coffee Shops in KC for Working....

Mildreds in The CrossRoads District
Roasterie in Brookside
Latte Land in Briar Cliff

Haven't found any I love out South so open to suggestions....

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