The Patitent as a Person - my lunch with Clay Patterson

The patient’s position in the HIT marketplace is that of data….that is a really strong statement but if you look at the Medical Record you know it’s actually a fact. The focused push to enable EMR in hospitals IS critical and has to occur. The mindset around it, to me, is often concerning.

Somehow the “data” has to evolve back into a “patient” who has to evolve back into a “person”.


As most of you know – my professional passion is the patient, the one who must take up residence within the walls of a hospital for a period of time. However, if we limit ourselves to seeing the “patient” only within those walls then we limit our view of the health continuum.

On Monday I enjoyed a wonderful lunch with Cerner’s Clay Patterson. I wasn’t sure what to expect – Cerner is an enigma – when people ask me about it I say “It’s shiny” meaning it’s very exciting, cool new innovations, amazing technology, thriving business, and flashy interactive gadgets. However, nothing I had seen to date gave me the feeling of heart – innovation, yes – incredible business, absolutely – heart, not so much. The heart I was missing was the patient – the person. Then I met Clay. His passion is getting medical data in a useable format so that a person can better interact with their health. This incredibly engaging and friendly man painted a picture of Cerner unlike any I had seen before – he shared a vision of people not products.

As he spoke, the picture that formed in my head was a giant sphere and inside of it there were stations of a person’s health journey. They include Hospital, Family Doctor, Medications, Tests, and even Diet & Exercise. (which I call DEA - which is a blog for another day) all surrounding the ability to research within the platform. The components within the sphere are interconnected and the data can ride freely between them.

The Sphere is taking information that is generally spaghetti and putting it into waffle format. When it’s in waffle format it can be searched, analyzed, cross referenced, and made into useable information. Think of it like managing your finances. Many of us keep our receipts in a box – or a wallet – or the center console of our car (or for some of us all of those places). You may have to dig them out if you need to return something, but the data of what you bought and when generally goes nowhere. However, if you use an online banking service then it automatically can analyze your spending habits and you can toss your little pieces of dispirit papers. The evaluation can lead to better planning, better habits, and overall better financial wellness. WHY? Because Data itself is not valuable – Data analyzed and applied into information is valuable.

But will adoption of this medium really occur. My prediction is yes – if you look at the slow recovery of our economy, you notice that people are spending less with credit cards and more with cash. Why because when you lose your home due to over spending you must take drastic measures to get things under control. People have had to learn to live within their means. Currently, the US is one of the most unhealthy nations in the world. Out of necessity a time is coming when we are going to have to reclaim our health. Sooner than later change will occur – not because there is some cool gadget but because consumers will realize that managing their health is the same as managing their finances.

The challenge will be education, access, and funding. How are we going to teach masses of people how to engage with their health while using a computer based tool?  Encouraging people to take control of their health is only part of the puzzle.  How are people going to get access to this portal?  This is a really layered portion of the equation including socioeconomic, locations, etc.  Who is going to provide access to this cool portal and who will “own” the data? Remember the data isn’t the value, the value is in the analysis….. when the data becomes information. As with everything else, it all comes back to who is going to pay for it? In a time when socialized healthcare is looming are we going to drive consumers to pay (not likely), employers, payers, ACOs?

If you believe that the patient is the heart of all we do then you must believe that the patient’s ability to interact with their health is critical to our success.

Stay Tuned for an exciting announcement from Cerner in the coming months.

The Walking Gallery

I always wanted to be one of those creative artsy people when I was younger – something about their free spirit draws you into their earthy lifestyle. As my friend Carrie can attest – I did attempt to be “cool like that” but I have settled for just enjoying art and music. So, when I started following @ReginaHolliday I was enamored with her artistic ability, and something about her draws you into her world of colors and words.

I will admit – I didn’t know what to expect traveling to the Walking Gallery. Let’s face it I met her on the internet….squares just don’t do this type of thing….I had no idea what I was in for, and let me say the experience was incredible.

When I arrived at the Kaiser Permanente Center for Total Health – I encountered fellow Walkers @MatthewBrowning and @FairCareMD we were all lost but soon we found our way to the “Gallery”. There were jackets all ready walking…I was challenged to find my own as I began to lose myself in the art. Soon I found myself standing at a table receiving my jacket, but strangely it wasn’t the jacket I sent – the jacket had become a window into my life for all to see. As I stared into the face of my sick baby it was incredible how she captured him – my Noah. I put on my jacket and found @ReginaHolliday. She recognized me immediately and threw her arms around me. It was like seeing an old friend.

As I wandered through the room I met @technicaljones and learned about his mothers fight for life. His jacket with a “SuperMom” who fought through illness to be there for her children. Across the room I spotted @epatientDave, he moved through the room like a rockstar with people reaching out and talking. David Hale incredible Matrix inspired jacket with a red pill representing all data and a blue pill representing us accepting what we are told to be truth from doctors. We marched together walked sharing the challenges of weeding through data with limited budgets. @MatthewBrownings jacket (one of my favorite paintings) showed the harrowing experience he had with his wife and their first child. @tmit beautiful jacket in support of the #caremom movement. The evening went on and my story repeated itself over and over sometimes without my mouth even opening – to people who understood. I didn’t have to prove myself as an expert in my field – I didn’t have to justify how I knew anything since I am not a clinician or doctor. I just got to be a mom with a story about healthcare.

My story – we were in the hospital and Noah vomited – I pressed my button and no one came….my company installed the button years ago – I thought it was broken……it wasn’t…..the difference between my story and most is when I went to the hospital they acted. They didn’t just act – they talked to me and made me part of the solution. I was able to meet other patients they call “frequent fliers” and their parents. I was able to work deeply with the technology team. I took my story and I created because that’s what I do. Talking only will get us so far – words are meaningless without action.

Look at Regina – she is a preschool teacher – she is an artist – who would listen to her? Most artist are seen by business people as creatives who can’t work so they paint….I laugh at the thought when I think of Regina. She uses her powerful medium as a tool to reach the masses – as a method to spread her gospel – as a leader to those of us who don’t know how to define our voice. Let me tell you, some of the most powerful people in healthcare listen to her. If you are in healthcare and you don’t – you are missing the boat.

I have shared with very few people recently how tired I am – fighting to build a startup, being challenged by healthcare to prove it, traveling every week, and night time kisses through video phone – after this event…..I am inspired…..I am energized…..and I know it’s all worth it.

If what I do impacts one life – it’s worth it. Let that be your thought today. Be inspired by the stories – not by your technology.

An Industry in Flux

It strikes me that there are some fascinating industry changes occurring in the “middleware” space and more are on the horizon. Interestingly, its not aggressive competitive behavior - it’s shuffles, buyouts, ReOrgs, partnerships, major players leaving major organizations, and simply surprising business decisions.
Dramatic human capital changes as opposed to dramatic technology change.
But what does it all mean – is it that alarm notification tools are not doing the job they set out to do, is it that the alarm notification tools promised too much and delivered too little, or is it that creativity and design ability was not balanced with well researched deployment on the cause and effect of the disruptive technology.

My thought is well intentioned creative individuals saw an opportunity in the marketplace that allowed the perception of faster communications. (If you haven’t figured it out – I believe most people are well intentioned.) The crux is more than 10 years after Michael McNeals press to market with the game changing Emergin platform – the cluttered market space is starting to relax and mature into a “what’s next” mentality.

Major platform changes are needed to meet the demands of a healthcare ecosystem that has a broader expectation of what information needs to go to which person. The new mantra is not about “alarm notification” it is more about “information distribution” and “decision support”. “Notification” brings with it the thought of disruption while information distribution and decision support bring the picture of well balanced and focused approach to patient care.

The problem is alarm notification has not reached maturity before the next change. What I mean by that is we have started to move to a new thinking without truly looking at the data associated with the “old thinking”. We have no base line comparison to clearly identify how information distribution will affect the ability of the clinicians to serve better. The industry has no clear baseline of information to compare the emerging decision support capabilities of the patient communications platforms (aka Nurse Call) with the old way.

Technologists, ask yourself:

Are we making things more flashy, exciting, techy because we can or because it’s right?

I challenge Nurse Call providers – Middleware developers – and even you EMR players who get in the game to prove it.

Show us how a change to status quo solves….if it doesn’t make the patient’s and caregiver’s lives better in documentable, data backed ways – then don’t waste your development dollars.

My prediction – major change is coming – large players will be motivated to change their focus and new players will be motivated to create better platforms.

A Day with Nurse Sue....

Learning about new products has always been a lot of fun for me, and whenever possible I like to go to the company and experience their product and meet their team in person. Just to be clear I am not a journalist, and everything I blog is my opinion. So, this is the story about my day with Nurse Sue.

As I entered the doors of Capsule Tech I was greeted by a friendly a woman and welcome sign displaying my name and company logo. In the corner was a larger than life cardboard cutout of the Nurse Sue Avatar, and down the hall came the real Susan Niemeier. She is an adorable red head with a bright midwest smile and matched warmth. There was no formality just a friendly hello and then off to get some coffee in the break room.

Our first order of business was a tour of the office. It’s not flashy – but nice – a large space with cubicles and a few conference rooms. Nurse Sue pointed out the large black and white pictures on the walls were their colleagues in Paris, and in Paris they have pictures of their colleagues in the US. Every person seemed busy but happy and frankly excited to be working on challenging projects. A few had Avatars which made me write *add S3 K Avatar to the development list. I internally sighed with relief. I have grown weary of the corporate stodginess and the competitiveness of HIT.

As we settled into the conference room, Nurse Sue delved into her passion for clinicians and how to drive more time at the Point of Care. She bubbled about the product she manages and how she believed it would – make life better. We dove in and vividly she relayed the story of “her” MVP. The Mobile Vitals Plus is really a simple product. It’s a box (isn’t everything ) that takes the vitals collected by almost any mobile vitals device (demonstrated with the GE device) – it automatically collects the data, allows the clinician to confirm, compiles it in a server, and then sends it to the medical record…any medical record.

MVP was created for Nurses by Nurses with influences from – not technologists – but Human Factors Engineers. The device is ergonomically designed to have the most beneficial colors for reduced eye strain to the most beneficial placement for the log on/off button. I was very pleased with the company’s commitment to not just make a product but make one that was easy to use. The presentation ebbed and flowed in and out of conversations of industry, family, business, and baseball (we were in Boston). I ended the day thinking – wow, these are good people trying to make a difference.

It is clear that Capsule is a darling in the industry. But Why?

• It could be their Switzerland Status. They closely align with many EMR companies, but are married to none.
• It could be their well thought out – well researched product. Nurse Sue’s commitment to research to make sure the product truly makes a difference is fed from her history of research on projects such as the Kaiser/ Ascension Time Motion Study and the ever famous Proclamation for Change. This woman gets data like few I have met.
• It could be their people – many who I have termed “the good guys”
• It could be a methodically planned approached to product, implementation, and test…continuously improve. Wash – Rinse – Repeat.
• It could be their culture. Friendliness, Transparency, and a non-smearing attitude. They don’t spread FUD (my favorite new term from @VoalteTrey) Fear Uncertainty and Doubt – they just are who they are.
• It could be that they are small and in small companies ideals and vision are easily disseminated amongst the team. There is no clawing to the top – you just walk down the hall way.

 It “could” be anything – end of the day this will make life better. 

This is my quest - if you have Healthcare IT products that "Make Life Better" I want to know about them.  I am interested in learning and sharing.   If you are a hospital with a process that will "Make Life Better" for other clinicians using HIT - I am intersted in learning and sharing.  

Today.....

If we are honest with ourselves there are times in our career where we grapple with the business verse human aspects of our products. We seek balance. We balance making money with helping people. We balance “marketing messages” and big picture vision with everyday life in the weeds. We balance heart and commitment to being the change with the work that must be done.

On the 3 year anniversary of Sphere3, I find myself evaluating the balance of building a start up and staying true to my commitment to Make Life Better for Patients AND Caregivers. Today – I focus on the Caregiver.


There were two blogs that caught my attention over the past few weeks. One blog was noted by Paul Levy called “Medical Margins” by Josephine Ensign. Josephine tells the story of a RN who had made a medical error – her blog blasts the hospital for the inequality of discipline levels between Docs and Nurses. Really what struck me was Kimberly Hiatt – a veteran RN with all in all good approval ratings – was dismissed for her error of administering a lethal dose of medication to a fragile NICU baby. After which she committed suicide. (Note there is no public information about linking her suicide to her dismissal)

I struggle with the balance – a bad day for me is I publish something on the blog that irritates someone or my team misses an internal development deadline.  (which is really a bad day for them) A bad day for a RN is someone could be seriously harmed or die. Do we expect perfection? Are we being realistic to apply “lean six sigma” principles to a human based profession – patients are not cars and clinicians are not assembly line workers. The patient advocate side of me really wants to drive every ounce of error out of existence. What if that error was my child – what if that “bad day” affected my parent? Aperum™ was created to identify when workload balances are too great. Is it enough? Do we find that self reporting based EMR systems and other gadgets and gizmos really make a difference in the day of the RN?

When my brain went into over drive trying to grapple with it all another great blog was posted – this time by a Nursing Student named Jennifer-Clare Williams of my home state Missouri. Her heartfelt desire to be the super hero that “saves the world one patient at a time” brings back the sovereignty of unadulterated hope. The blog is beautiful – showing her true desire to be a help to those in need.

I replay my mistakes (“No wonder your patient was uncomfortable—you put the bedpan under her backwards!”), I cry more than I ever have in my life, and I continuously wonder how on earth I will ever learn everything I need to know.

But there is good news. I’m surviving. And I’m learning that perfection is unrealistic. That nursing really is a fluid profession: things are constantly changing, and that’s a good thing. That there are very few things that I’m going to master on the first try, or heck, even the 10th try . . . but that’s ok. I’m learning that the patients who are, let’s just say . . . unkind . . . are not launching a personal attack on me, but are facing a difficult set of circumstances and are unhappy with the situation.

The inspirational heart of this young woman pushes me forward that every nugget of information we can provide back in a visual meaningful way can make a difference to improve her ability to provide care. The S3 team has made linkages to reduce readmissions, show documented improvement to patient satisfaction scores, reduce fall rates and errors, and do all the big picture money saving things that we need to do to sell a product. That’s not what drives me – and technologist – EMR person – industry specialist – big picture lingo laden with catch phrases shouldn’t be what drives you either.

What drives me should be the thought that today – we made life better for Jennifer because we were able to identify that her workload was so great that she may make an unintended mistake. What drives me should be that today we were able to provide information to the charge nurse that over stimulation was increasing the propensity for medication error beyond capacity – so she can engage and make sure her clinicians are in an environment where they can care and not run. What is your “today” statement? What did your product, software, service do today to Make Life Better?

For a moment, stop and focus on how you can make life better. Stop thinking about selling the next big deal and start thinking about the people you are affecting.

Thanks to:

Josephine Ensign’s “Medical Margins” Blog
http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/#comments

Off the Charts AJN Notes of a Student Nurse: A Dose of Reality written by Jennifer-Clare Williams http://ajnoffthecharts.com/2011/05/04/notes-of-a-student-nurse-a-dose-of-reality/

Everytime......

It’s funny when people know what you do how the conversation trends towards that topic. One of my dear friends mother has been in the hospital for over a month with kidney failure and infection. Tammy has been the epitome of advocacy. She called me one afternoon to share the trials she was going through.  Pouring her heart out to release the pain of watching her mother suffer.  Before she got off the phone she said “Make sure to tell your friend – the boss here – how great our experience has been – how great these nurses are in making sure we are taken care of every time we need something.” My friend, Damond Boatwright, the CEO of Lee’s Summit Medical Center has done a great job of cultivating a culture of caring staff.

I began to think about that statement “making sure we are taken care of every time we need something.” I know that hospital – I know the technology, the staff, the design, the process, and how they manage their care. Managing by metrics is only part of the equation – the other half is care.

I had a great post written for you all – about metrics and managing by numbers and pushing for results. It was insightful and interesting with recent data from a new hospital.  Exploring Dynamic vs Intuitive responses based on the “need type” and weighting averages. Numbers and the quantification of expectations – it was brilliant……..but listening to Tammy reminds me - it's only part of the solution....have you been reminded today?  If you haven't had a recent hospital encounter - technologist, you need one.  Don't let the math cloud the reality of what we all do.  Don't let the flashy exciting technology be the cetner of your universe.  Don't let competition between bitter rivals reduce the ability for the patient to have the win.  I want to win as bad as the next guy - but I don't want to win at the expense of the patient.

Maybe some of the best things I post have nothing to do with fancy math (or as Steve says "Algorithms")  but have everything to do with the human condition – the patient as a person – the clinician as a giver.

Who would think a geek could feel?

Press Release on APERUM

Kansas City, Missouri (April 18, 2011) -- Sphere3™ Releases Aperum™ targeting patient satisfaction Indicares™ within U.S. Hospitals. Sphere3™ is the first to reach the market in an emerging category of software targeting patient satisfaction and safety during a hospital stay. Since it’s inception in 2009, Sphere3™ has focused on nursing activities that indicate quality of care. Aperum™ uses data found within standard transactions of the hospital’s patient communication platform to provide performance and risk indications.




The Company’s proprietary algorithms dissect the data path and normalize basic elements for analysis related to patient requests and resulting caregiver responses. The resulting Indicares™ within Aperum™ reveal actual caregiver performance against hospital expectations for performance based on patient needs by category. Further analysis within Aperum™ reveals behavioral patterns for patients and peak times for certain patient needs, offering new insights in caregiving and staffing models.



“We are very excited about how Aperum™ can advance the suite of clinical management tools within the hospital,” says Kourtney Govro, Founder and CEO of Sphere3™. “Most CNOs and Directors of Nursing manage staffing and clinical care decisions based on subjective data. Few have access to the necessary technical expertise to evaluate the real and changing patterns of patient needs and caregiver response.”



Hospitals invest heavily in the nurse call systems and clinical alarms found in a patient’s room. These devices are the primary method in which patients can request assistance from hospital staff. In some cases, the systems have advanced to “sense” patient needs based on physiological movement or biometrics and automatically generate a request from the room. Although very technical and advanced in their design, the platform makers are more about devices and less about offering critical management information. Yet, the systems are rich in data and capable of revealing behavioral patterns in patient care.



Govro offers, “Our progress was initially challenged by the lack of understanding for the information available from resident systems. We are bridging the knowledge gap within the hospital by creating a common language for this data and the behavioral patterns revealed within it.”



Govro believes a number of drivers will aggressively move hospitals to using this new category of software. For example, Lean Principles for staffing target more flexible movement of staff as needed throughout the hospital without compromising the level and quality of care. Objective measures of patient needs, priority, wait times and associated risks should assist caregivers and managers in assigning the right staff at the right time to a floor.



“Patient safety is at the heart of this balance,” Govro says. “Patients are in the hospital because of acute needs. The simple act of getting out of a bed unsupervised creates the risk of a fall, which is a costly event for hospitals.”



Govro explains patient falls are closely measured by hospitals. Because the event is considered avoidable, Medicare and insurance companies deny the associated costs of care linked to the fall, including additional days of stay in the hospital. According to a study completed by the Washington University School of Medicine, St. Louis, MO with Barnes Jewish Hospital, St. Louis, MO in 2004, the typical patient fall occurred during activities unassisted by staff (79%) in the patient room (85%)1.



The makers of patient communication platforms place continue to investment heavily in more accurately categorizing and routing the patient needs to caregivers. Sphere3™ has filled the information void by developing the necessary enterprise level management software to manage the aggregate of needs with caregiver availability.



“Although Version 1.0 is a retrospective review of the data,” Govro says, “future versions will move data to real-time and allow for immediate care management decisions.”



1 Characteristics and Circumstances of Falls in a Hospital Setting: A Prospective Analysis. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1492485/)