Welcome to the Cisco Networking Professionals Ask the Expert conversation for small and medium business. For a one-week period, small and medium business and technology leaders and Cisco engineers are available to continue discussing issues and ideas from scheduled live web broadcasts.
This is an opportunity to discuss with experts Matthew Holt, Michael Haymaker and Kacey Carpenter how innovative applications for collaboration are enabling faster, smarter patient care. Matthew is an independent research consultant serving the healthcare industry. He has been in health care for more than 15 years as a researcher, generalist forecaster, and strategist. Michael is a member of the Cisco Healthcare team, with 20 years of healthcare experience. Kacey leads worldwide healthcare marketing for the Cisco commercial marketing organization. He is a core member of Cisco's Connected Health team focused on Medical-Grade Network solutions for healthcare providers.
Remember to use the rating system to let Matthew, Michael and Kacey know if you have received an adequate response.
They might not be able to answer each question due to the volume expected during this event. Our moderators will post many of the unanswered questions in other discussion forums shortly after the event. This event lasts through November 8, 2006. Visit this forum often to view responses to your questions and the questions of other community members.
I'm a nurse in a mid-sized hospital in the mid-west. I see lots of opportunities to automate our patient care processes and I've suggested many of them to IT. However, I'm told that IT is already too busy just keeping the place running, plus there's not budget money to do anything new. Do you have any suggestions on how else to approach this?
That is indeed a tricky one. The answer is that IT is often too busy keeping the wheels falling off to consider new initiatives. The issue that you need to connect your senior management with is the potential gains from automating care processes.
Two technologies I briefly mentioned on the video all improve patient safety, and save nurses' time. They are mobile IP telephony (No more paging), and location tracking for staff and equipment (no more wondering where the cleaning crew is when you're admitting a patient, or where a wheelchair is when you're moving one).
The key is that these technologies are also proven money-savers with very quick pay-offs, and they run over a WiFi network your hospital probably already has.
At least one hospital which has instituted staff and patient tracking in its ED (ChristianaCare in Delaware) claims that its staff are much happier, and they've seen nursing staff turnover go down to virtually zero.
To get these and other opportunities up and running you need to by-pass IT and get to the decision makers in the executive suites who care about labor productivity, staff satisfaction and patient safety. All those have a direct impact on the bottom line.
Our hospital is in a very competitive market and we've been considering the idea of using state of the art IT to help differentiate ourselves. Are there any great examples of hospitals who have successfully taken this approach? How can we do this without taking on a lot of "technology risk"?
This is a great question. Certainly we could look to Mayo or Beth-Israel and marvel at the technology. Truthfully, all the technology in the world really makes no difference if your customers do not perceive a benefit to them. I see advertisements about this MRI and that new heart scanner and if a customer does not use these services, all it does is give them a reason to complain why their bill is high.
I'm a klutz, so in our house the emergency room is speed dial number one, (Popeye's Chicken is number two, but that's another story...) So while my wife and kids are in the waiting room waiting for me to get this bone set or that cut sewn up. Giving them a option other then CNN or outdated Highlights mags, wireless in the waiting room is a great idea so families can surf the web or play games with their favorite handheld devices! Or just offering the web or games thru a commercial grade touch screen panel is just awesome!
For the staff, RFID tracking on wheelchairs, crash carts and other high use items is great way to find stuff and for lost prevention. Fast service always looks good in the patients eyes, so this is a double bonus. I also like the Vocera communicators that allow hospital team members to communicate with each with a touch of a button right over my existing wireless network. Plus it looks like the Star Trek communicators from TNG and how high tech is that! I almost can not wait until my next injury to see them work! Wait is that a Frisbee on my roof...
I agree that patient focus with IT is a very important part of the future of hospital marketing. This will come down to two things. One is improving the "customer experience" by which I mean things like:
a) getting rid of the multiple clipboards, by having patients fill in forms online once only in kiosks or from home and having all staff have access to that information (the way that the Ritz-Carlton knows all about you when you check in)
b) letting patients have access to a view into their medical records and post-visit summaries, the way that Group Health Cooperative in Seattle, or Palo Alto Medical Foundation, or Caregroups in Boston is doing.
The second issue is using IT to improve the care process and patient safety. This is of course much bigger than just adding new technology and baking for 30 minutes. However, at some point there will be real competition between providers not just on the soft stuff like valet parking, but on outcomes. Given that variance between different organizations on process inputs and patient outcomes can be up to three or four-fold, building a base now using IT to improve those measures is probably the best strategic move that a hospital can make for the medium term.
In that respect the best examples to look at are Intermountain Health Care in Utah, and Virginia Mason in Seattle, both of which are ahead of the curve on process change to improve safety and outcomes.
What are the main challenges that the increase in the use of smart phones and other mobile devices create for health care organizations?
Beth -- I'm sure some of the Cisco folk will chime in on the technical side, but the major issue with any new technology deployment is training and process change.
Mobile devices of all types create a change in the way clinicians work. For instance, the new VOIP phones or the Vocera lapel communicators on the inpatient side mean that nursing staff are going to change their work-flow. They'll be responding to requests (including patient requests) and even accessing database information in a new way.
Physicians will be using smart phones for looking up results and ordering tests and drugs. They'll have to understand the impact that has not only on their work-flow, but on that of their staff (in their office) and in the hospital. For example, if smart phones are being used for ePrescribing, the office staff will have to start processing the electronic information flow that will come back and forth from pharmacies and payers, as opposed to using the phone and fax.
All these things will be better solutions than how things are done now, but any change is hard and takes both training and an acceptance of less productivity while people get used to the new system. So your organization will need to build that lag into its schedule while the new technologies are being incorporated. This of course is even more important for major system changes like the installation of EMR or CPOE.
The final challenge is a technical one for hospital IT staff. They will have to make a decision about who can access their network using which devices. Probably they'll want to accommodate admitting physicians who'll only want to carry their own device (and not one for each hospital or clinic they work in). That will mean beefing up their security and access protocols so that they can identify who's where on their network and make sure that all information exchanged is authorized.
What do people mean when they talk about unified communications within health care provider settings? How is that different than what most hospitals are doing today?
How significant will be the impact of new information technologies on the productivity of nursing staff?
That's a tough question to answer. The variables include how the technology is introduced, the training and communication of the introduction, and the culture.
As I said in the video I perceive there to be three main types of technology-based process change. The first, and most pressing in that it's arriving soonest, is the shift to unified VOIP communications which will make it easier for nurses to contact each other, and be contacted by supervisors and patients. That should cut out plenty of waste motion. Related to this communications issue is location tracking for devices and people, which will also allow better understanding of where resources are, and greater uptime for equipment like pumps and monitors. Location tracking for people will have its critics, but many nurses will be glad that their tracking "tags" will come with an emergency help request button -- in case of, say, violent patients in an ED.
Second is the integration of vital sign data automatically into the medical record. This is a longer process, but currently estimates are that up to 25% of a nurse's time is spent recording information. That time should substantially be reduced, allowing for better direct care with patients by getting information directly into the computer from monitoring devices. The bar-coding systems for drug administration are already heading well in this direction.
Third, and furthest in the future is the replacement of nursing time with labor-saving robotics. The most obvious version of this is the Aeron Tug, a robot which is already in use delivering supplies in several hospitals. But soon those types of robots will be delivering supplies to individual patients on an as-needed basis. Those among us keen on science fiction can forsee a time when the robot will refill IV pumps, move patients at risk from bedsores, and do much of the grunt work that's currently done by nurses.
Over time these technologies will radically change what nurses do, freeing them up to be patient advocates and even more central to patient care and education. Of course in some states regulations will restrict nurse to patient ratios, while elsewhere there may be simply fewer nurses. But how that plays out in the complex field of health care industrial relations remains to be seen.