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.

Translation Fascination Part 2

The brilliance behind the early device integration software pioneers was the building of the library. There is significant VALUE  in the library of integrations. Anyone can build a little black box with a rules engine. (Please don’t throw things at me Integration Software folks - it's only slightly sarcastic)

Many different models have been taken to gain the library. Some “skim” the information off without building a relationship. This is a dangerous model that – while it works – updates can be missed. Some charge a fee to device manufactures which may seem like a poor model and not “open” but actually is smart. It makes people put skin in the game to ensure that development completes fully. Some work hard in the industry to build mutually beneficial relationships seeing a Co-development relationship that has more value long term and being less focused on the short term capital needs.
So why are these relationships so crucial? Think about it the changes in the language that might affect the way things are processed. Imagine if someone from 1776 tried to translate for someone in 2010.  "OMG that is so wrong - lol."  It wouldn’t work so well. That’s why building relationships between Integration Software and Device Manufactures is really important.

Sounds logical – almost easy right? Wrong. There are many device producers that are closed nations – they don’t share enough about their language to allow for high level translation. 

So is "Interoperability" a dream?

Translation Fascination

I have blessed to travel to several countries. I am always excited to see the sites, experience the culture, and of course – eat the food. One thing I have learned is in the countries where I don’t speak the language (so anywhere that they don’t speak English or Spanish) I can do very little without a translator. Believe me hand signals and acting out the need can only get you so far and does not work well in restaurants….and I do love to eat.

If you think about interoperability engines – each is a translator that allows for multiple items to speak with each other. The more “integrated” a engine provider is to the device the higher the level of communication you can provide. For example, I studied Spanish in a Classroom for 6+ years but I didn’t learn Spanish until I immersed myself in the culture and language when I lived in Seville, Spain. The culture and the language enhance your ability to communicate. The same is true for device integration – the more immersed you are in the product, the stronger the relationship - the more ability it will have.

Stay Tuned for Part 2

Top 5 Nurse Call: 2& 3

2) Which has the best equipment warranty and lowest cost of ownership?

Nurse call no matter how you slice it is equipment. Equipment needs maintenance – physical maintenance. An electronic component breaks down.

As equipment, once it is in the wall it is challenging to replace due to back boxes, cable and other “installation” issues. The house we talked about previously if you decide you would like new Kitchen Cabinets and countertops once you change what is there it is really cost prohibitive (if not prohibitive, it’s a really bad investment choice) to change it 6 months later.

Therefore, the long term cost of ownership is important.

3) It’s broken – now what?

As Nurse Call Systems enter the realm of VOIP it is amazing that the support structure Du jour is “off site” or “call center” similar to the change from full service to self service at the gas station. As described above, a Nurse Call System is hardware that is controlled by software that interacts with other software and systems.

The item I do think is valuable is using the hospital help desk to assess the issue, but they need to be aware that diagnosing the issue is more than just dialing into a software platform and making an assessment. If a clinician calls in on a fully integrated system and says “my phone doesn’t work” then the person answering the call needs to know it’s probably not the “phone” that’s broken. That’s why we developed a “Help Desk” training program that assists a call center in diagnosing the problem in an integration.

It is necessary to have an available group to be on-site within a period of time. If your disaster plan or maintenance plan categorizes a Nurse Call System to only be down for a set period of time then you need to make sure a response on-site can be within that time.

Top 5 for Nurse Call: 1) Can it do the workflow we have designed for our hospital?

Pre-Determining how the system will function is the only way you can determine which system will fully meet your needs. This can be done internally but utilizing a 3rd part workflow designer. If you are a do it yourself kind of place figure out what you are doing currently and how it would need to change to be better. One of the biggest mistakes made is allowing an equipment vendor to design the vision for a patient call system. Yes, they have experience but they are also partial to the system they are providing.

To put it in perspective, one of the largest personal purchase decisions you will make is buying a house. When evaluating houses inevitably you will begin to picture yourself in that house – what you will be doing? If you visit the house and the listing agent (seller's rep) is there – they are going to direct your eye to all of the “great” features and downplay any of the features their house is lacking. For example, if the house is a split entry the selling agent is not going to point out to you that you will be climbing stairs every week with multiple trips to carry in groceries. They will be directing your attention to beautiful view of the Cul-De-Sac and how your kids will love playing there.

The same is true for Nurse Call (stay with me techy geeks) If you have all of the Nurse Call Vendors present and you do not know what is important to you – then they will tell you what is important to you based on their systems capabilities. This is called features based selling. It’s not wrong or deceptive. It’s them presenting their product in the best way possible. It’s only deceptive if you ask them if their system can do something and they tell you it can when it can’t. Or they sell you a “road-mapped” item as current.

Entering the house with your top 10 criteria is the best way to approach purchasing houses. Understanding why you are purchasing is crucial. Has your family expanded, therefore you need more room? Are you getting older (or plan to grow old in the house) and need fewer steps?  Carry this thought process into purchasing a nurse call system.

The best tactic for reviewing vendors is to provide them with pre-determined workflow prior to their presentation then let them explain how they would provide you with that workflow.  Verify they can meet the expectation.   At that point they can show you additional items you may find of interest based on their products specific capabilities. This IS valuable information because your core need is being met. Their additional “features” then become the icing on the cake.

Stay Tuned for #2 Evaluating equipment warranty and lowest cost of ownership?

Patient Communication & Technology Part One

People ask me all the time why Sphere3 addresses Nurse Call first when we look at Alarm Automation. Quite Simply - it is the hub of all patient interaction at a hospital. If you want to see immediate change then address the way caregivers are interacting with patients. Nurse Call is the only Patient controlled device in the room that is related to their care. (Yes, interactive TV people may disagree) It is a life line for patients to interact with people who know how to help no matter what the request.

This is a medical device that is required to be in every hospital for notification of patient need. However, if you are just using it for that type of interaction then you are not fully leveraging the investment. For example, if you can purchase a button that can be used for bed management as opposed to a bed management system then isn’t it leveraging that base platform more efficiently? The key word above is “required” but the key idea is how do you leverage a required piece of equipment for innovative workflow processes that are outside the basic scope. Nurse Call purist will disagree with this point by saying that adding extra workflow processes decreases safety. By not using the system for its intended use you actually increase risk that a peripheral function would disrupt a critical one. However, most platforms are designed so that you can’t disrupt a critical process unless it’s not implemented correctly.

Further, when evaluating the system it’s important to define how it will be used. I have found that a majority of the time the system is being evaluated on a few key features – not necessarily on how the system will be used. Don’t follow the Shiny Ball folks!

To put it in other words – a hospital knows they need a nurse call system for communication but rarely has its uses or additional workflows been pre-defined. Many rely on vendors to provide outlines and designs on how the system set up, but that’s how it is looked at as “system setup” not workflow. There may be some base anecdotal type information about wanting to “send it to a phone” but not a true plan.   Having a plan of how each aspect of the nurse call is to be used prior to making a purchase decision is crucial.

Important: System design is how the components and cabling are put into the hospital. Workflow design is how the caregivers use the system. Workflow design overlaps system design because there are specific component needs that enable the workflow.

Stay Tuned for the next post: Top 5 things a hospital should look at when evaluating a Nurse Call System