These days, there are few things that get me angry. Life is going well - Voalté continues to flourish, I have great family and friends, and I get to wear the coolest outfit in the industry everyday to work. Let me tell you, these pink pants are comfortable! With the exception of my Florida Gators struggling in football, life is good!

However, on January 9, 2012 Eric Wicklund published the following quote in an mHIMSS article about the SpectraLink 8452:

"Emerson says nurses are often left in the background when hospitals develop communication strategies…the 8452 is ideal for providers who have followed a "just good enough" policy for their nurses".

I don't normally call-out other vendors, but this article INFURIATED me.

"Just good enough" policy for their nurses???

I couldn't believe what I was reading.

Beyond claiming this device was "setting the bar" in any category (this phone probably has the tech spec's of a 1990's cellular phone), this company has the audacity to infer that hospitals should undertake a "just good enough" strategy for their nurses. This is contradictory to everything we stand for at Voalté and we aren't going to let this slide without calling it out.

I know if my friends or family are in the hospital, I don't want a nurse with "just good enough" technology taking care of them. I want a nurse that has the best tools and technology possible to take care of my loved ones. Our nurses have extremely demanding jobs and deserve the best - especially when the cost of the best is about the same as "just good enough".

Settling for "just good enough" isn't going to cut it anymore.

So as we kick off the New Year, I have one simple question for you and your administrative team: Is 2012 another year your hospital settles for "just good enough" or is 2012 the year your hospital steps up and makes sure caregivers have the best tools possible to do their job?

There is no time like the present to make the change… and we at Voalté are ready to help every step of the way.

Cheers to a great 2012!

Remember the “Pass the secret” game we all played as kids? What went in on one side was never what came out the other because each person acted as a filter, misconstruing and warping the original message. You would be lucky if the intent made it all the way through the barrage of improper memory-mapping and malicious intent. We face the same dilemma today in Healthcare I.T., with interoperability and interfaces to and from the Electronic Medical Record (EMR) systems, communication vendors, and various other middle-ware solutions. It amazes me sometimes that it works at all. Mapping back and forth between discrete and non-discrete entry fields, through automated systems, and sometimes by temp analysts, is a recipe for disaster.

All too often, vendors produce mass-marketed solutions that don’t interact friendly with third-party systems. Because of this, inaccurate interfaces are erroneously created by third parties or inside of the hospital by their own IT staff to link these sub-systems together. These interfaces remain the weakest link in a hospital’s IT infrastructure which can lead to patient safety issues by reporting on inaccurate or incomplete patient information.

EMRs see their system as a central repository for all hospital data, and I tend to agree. We already see this complexity just getting data back into the system with back-end lab systems and flubbed interfaces, and the same complexity is seen with data coming out. How does a third-party system display that clinical data in an efficient and effective way? That burden must be on the EMR vendor to provide a more efficient way to display patient data and they must become more draconian about how their data is presented. As third-party vendors, we must start thinking of ourselves as a supplementary applications and a passive consumer of that data.

The same rules apply when duplicating data across systems. Every additional duplication is another failure point in the system. Hospital roles and assignment are a primary example of this problem. Many of our competitors duplicate roles and assignment, already found in the EMR system, into their own database repository. This is an inefficient and error-prone way of pulling information across hospital systems.

In summary, as a hospital IT developer, we need to find a better, more efficient way to reach across boundaries and communicate with a hospital’s EMR vendor. Data should become centralized with as little redundancy as necessary and we should rely on the EMR systems to display patient data, it shouldn’t be cannibalized by other systems.

Welcome to my first blog article, which happens to be written on my new iPhone 4S without a keyboard thanks to the help of Siri and speech to text. No desktop or laptop computer was used in the creation of this article and no apps were harmed in the process. Now for my top five favorite new features:

1. Siri is your new personal digital assistant. Siri is so much more than a speech to text recognition engine. It is the next generation. It is the next dimension. I remember when I got my first smartphone, the Palm Treo, and how complex it was to create something as simple as a new calendar event. I literally wished I could just talk to my phone and tell it to create a new event for tomorrow at 5 PM. Now, Siri does just that.

2. Reminders.app never forget anything again. This is one of my favorite new apps! I once carried a folded sheet of paper and post-it notes in my pocket with all my reminders. Now this app takes it to the next level and will remind me of my task at a certain time or location. The reminders based on location are amazing. For example, I can ask Siri to remind me to take my lunch when I leave the house or when I get to work to call Bob. This is what makes Siri seem so lifelike.

3. iMessage, therefore I am. Apple is now getting into the text messaging game and making it ridiculously easy to use. No configuration required and it works on the iPod touch and iPad. iMessage supports delivery receipts and read receipts, if they are enabled, but the killer feature is group messaging. Also Siri will be happy to read your new text messages aloud and create new ones hands-free (you know where I'm going with this one).

4. Camera and photos. This is the beginning of the end for the point-and-shoot digital camera. The iPhone 4S rivals most digital cameras with its eight megapixels and take 1080p HD video. It will edit your photos and videos, as well as GPS tag and upload them to your favorite social network! What digital camera lets you do all that? RIP digital point-and-shoot you served us well.

5. Speed demon. Every new iPhone gets faster and faster and the iPhone 4S is no exception. It has the new dual core A5 processor, which Apple claims is "up to two times more power and up to seven times faster graphics". I definitely agree, all my apps load faster and feel much more responsive.

My Conclusion: I love my iPhone 4S. When I hear people complaining that the 4S isn't that much different from the iPhone 4, ask them if they can "write" an entire blog article on their phone without using a keyboard? 

No matter where I go when donning the Voalté scrubs, people stare, and often times (while smiling) ask, "What's with the pink pants?"

This is especially true when attending events such as trade shows, networking meetings, conferences, or even vendor fairs. Curious parties from both IT and clinical pass by to see, use, and demo our unique clinical communication tool – Voalté One.

In addition to Voalté, other vendors are in attendance as well, however, the usual suspects are typically in suit and tie, and as always, my colleagues and I stick out like a horse in a herd of ponies in our pink pants.

So, what's with the pink pants you ask?

It’s not only an expression of our quirky personality and the spunk that we bring to the healthcare industry, but also an external view to what differentiates us as a Company. When we first set-off to start Voalté, we turned to our development partners for some guidance. One of the overlying themes was that there wasn’t a Company that provided exceptional customer service. What we quickly recognized was that there was no Disney, Starbucks or Zappos in terms of the service experience provided by traditional healthcare vendors, and knew that this would be Voalte's opportunity to clearly differentiate itself – which we have.

Our mission is to set a new standard in point-of-care communications, and a key component of this mission, if not THE key component, is the user experience. Part of this experience is our company uniform (i.e. the pink pants and black scrub top) so that besides being memorable in events such as the ones above...we’re also easily identifiable and accessible when we’re out at your hospital during each phase of go live, clinical training and support, or when your Voalté Care Specialist comes back in each and every week to make his or her rounds. It’s part of our promise to make sure that your Voalté experience is nothing short than exceptional. 

Are you engaged with your customers? More importantly…are they engaged with you? Gaining and sustaining customer loyalty is becoming more important by the day. It can be your organization’s leading edge. Simply satisfying customers is no longer enough! Satisfaction is only the foundation and the minimum requirement for a continuing relationship with your customer. It should be noted that the term “customer” could refer both to the external customer who purchases goods or services from your company as well as the internal customer, your employees, who deliver these goods or services.

As opposed to satisfaction, engagement is a better indicator of the thoughts a customer has toward your business and its offerings. Customer engagement aims at long-term relationships, encouraging loyalty and passionate advocacy. It implies a higher level of commitment to the health of an organization, while satisfaction encompasses a sequence of events with many variables. Very simply defined:

Engagement = Product X People

Sixty to eighty percent of customers who defect to the competition say they were satisfied on surveys administered just prior to their defection. So why do customers leave a business? According to a study by the American Society for Quality:

9% of customers leave because of competitors

10% of customers leave for other reasons (move away, death, etc.)

14% of customers leave because of their dissatisfaction with the product

67% of customers leave because of an attitude of indifference on the part of an employee

The impact an individual employee has on a business is staggering. I believe we all would agree that we have left a business because of the attitude of an employee, conversely I also think we would agree that we frequent a business because of our relationship with an employee. What brings you back to your favorite restaurant…the food or the individuals who serve you? So then should we focus on the human aspects of business performance?

Customers are not strictly rational. The majority of decisions to purchase a product or service and commit, long-term are purely emotional. In manufacturing companies, value is created on the factory floor. In sales and services organizations value is created through the customer/associate interaction or "moment of truth". The customer/associate encounter is the factory floor for service and sales organizations.

A customer’s degree of engagement with a company lies on a continuum that represents the strength of his investment in that company. Positive experiences with the company strengthen the investment and move the customer to passionate advocate.

A few final thoughts:

Great service is only great if your customers think it is great.

The customer is why you go to work. If they go away, you do to.

The personal relationship and value are remembered long after the price is forgotten.

Customer is King! 

So tell us, is your customer really your King?

Nothing is perfect. Everything has room for improvement. The trick is to work out a way to continually improve. This is not new. There are aphorisms like “pause to sharpen the saw” and “listen to your customers.”

Easy to say, but how do you do it? At Voalté, a significant part of the company is devoted to listening to the customer and most importantly...paying attention! The Services department feeds information from our customers and users to the rest of the company in several ways through product plans for future work, and more immediate problems too.

We see a lot of information come through Engineering...specifically about new feature requests. We make a big effort to make those new features happen too. Like everyone, we have limited resources but try to make the most users happy with our changes. As a software engineer I really like to see people using the software I write to do something good and useful. It’s why I do what I do in the first place.

But that’s first degree listening. We also want to listen at a higher level, at a second degree. Apple and Steve Jobs knew no one was asking for something like the iPhone when they came out with it, but they knew through listening at a higher level that this was what people really wanted. Now, after four models and an installed base pushing 100 million phones, it’s pretty clear they were right.

New ideas are interesting, but lets face it: ideas are cheap. It’s the execution of an idea to make that idea real that’s important. Smartphones existed before Apple created the iPhone. It was how Apple made the iPhone that’s important. Hospital communications already existed before Voalté. We think, and hope you agree, that it’s our approach that is important. We listened at this higher level and combined voice, alarms, and text and we will continue to listen to improve what we have now. But we’ll also pay attention to what you’re not yet saying and practice that higher degree of listening so that we can continue to give you what you really want and need.

It’s no secret that Microsoft has launched a campaign to eliminate IE6. They have been encouraging people and organizations – for quite some time now - to upgrade to an IE7 or newer version. In fact, Microsoft has created a website (www.theie6countdown.com) specifically for convincing people to upgrade to at least IE8, and preferably IE9.

The reasons for upgrading are plentiful. The biggest reasons are centered on security and features. However, it seems as though hospitals in particular are slow to upgrade. I’ll touch on the two most common reasons today.

The most common concern has to do with legacy applications and sites. IT departments are concerned that IE8 won’t work with these applications and may cause an entire chain of “have to upgrade” events. You know…the chain of “I have to upgrade this, that, and the other to support this new software.” We’ve all been there.

However, newer versions of IE include a ‘compatibility mode’ that actually seem to work pretty well. A large number of the sites that many people don’t think will work with IE8 actually work fine, even without the compatibility mode.

The second issue concerns resources, manpower, or staff. Most hospitals have a limited budget for the IT department. Often, projects like “upgrade IE hospital-wide” seems to incur a cost with little perceived reward. Additionally, other projects tend to have a higher priority simply because the rewards are immediately noticeable.

The problem with this is…IE6 is a pretty large limitation. Both for the hospital environment, as well as those companies who provide applications and solutions used by those hospitals.

IE8 supports many new features, such as improved JavaScript engines, better CSS support, HTML5 support, and various other improvements. While it is true that many of these improvements won’t be immediately obvious, or taken advantage of, upgrading your web browser is the first step at enabling your content providers to offer you better solutions. Providers will be able to offer efficient, fuller, faster, stable, and more attractive interfaces.

IE8 can be deployed via group policy, or any of several software management utilities. Many hospitals decide to do a unit-by-unit, or department-by-department rollout. You can first start by testing all of the software that accounting uses, and then rollout to that department. You can test all of the software that ICU uses, and then rollout to that unit. You get the idea. The mass deployment of an updated web browser becomes a series of smaller tasks and projects, and often can gain traction easier within your facility when broken up in this manner.

How much of a life span does your IE6 have left?

Time-division multiplexing (TDM) has been around a long time and is considered to be a legacy protocol. Most public branch exchanges (PBX) will support TDM trunks provisioned as either channel associated signaling (CAS) or common channel signaling (CCS). CCS is often referred to as ISDN PRI. ISDN PRI is normally how most TDM PBX's are now provisioned, as there is a significant amount of intelligence that can be carried across these trunks as compared to a CAS trunk.

Here are my two cents as to why SIP is better than TDM.

Easier Integration: By using a SIP PBX it is so much easier integrating other applications with the PBX. There are a multitude of applications that support SIP, which will easily integrate and interoperate with a SIP PBX.

 

Utilizing a SIP IP PBX also allows you to integrate with other SIP applications such as Voice Mail running on a SIP Voice Mail Server.

 

More Security: SIP can be so much more secure than TDM. Users and trunks can be provisioned with authentication so no one can just plug into the SIP PBX and start making calls. Users and trunks must be provisioned and can include passwords along with user names to authenticate against. TDM must also be provisioned, but is generally not password protected. If you want to get really secure you can even send your signaling and audio path encrypted by using TLS and SRTP. This does require more processing overhead and is typically done in government installations.

 

No Limitations: TDM has hardware limitations limiting you to the amount of simultaneous calls you can make. Here, in the USA, most PBX's support T1 cards which limit the PBX to 23 calls per T1 card. If you need more simultaneous calls you will need to purchase additional cards.

 

With SIP you do not have these hardware limitations. You do not need T1 cards to handle your calls. You are basically limited only by your system configuration such as your CPU speed and memory amount. Your limitations only start after your processor has exceeded what it can handle in call volume, which can be in the hundreds and thousands of calls.

 

You are also less likely to have call issues due to hardware failure since there are no T1 cards required for SIP.

 

More Flexibility: SIP is an industry standard, which most vendors will deploy with. Staying with TDM often requires you to purchase only from your vendor thus limiting you to your vendors pricing. With SIP you can purchase from any vendor, which also supports SIP.

 

I could go on and on but for the sake of brevity let me conclude by saying, "I think SIP ROCKS!"

What are your reasons to using SIP over TDM?

Prior to World War II, physicians, nurses, and specialists staffed hospitals with very few “support” personnel. World War II then brought about massive changes in the staffing of health facilities. These changes were first felt in the late 1930s and forced nurses to perform extra duties. At that time they were simply put in the position to do “desk duties” such as answer the phone, paperwork and going on errands. As time went on, more and more responsibilities expanded and advancement in technology resulted in shifting of many tasks and it soon became clear that this position was so much more than someone who just answered the phone and ran errands. 

In 1980 several educational programs were established across the nation and the first organizational meeting was held in Phoenix, Arizona on Aug. 23rd 1980. This date then became the National Health Unit Coordinating Day to celebrate Health Unit Coordinating as a recognized health profession.

The HUC has now become the centralized hub of the unit and is so many things to so many people. They have the ability to listen when there are a hundred other things to do and give advice to fellow staff and to their patients. They remember that every patient could be their mother, father, sister or brother and offer kind words, a shoulder to cry on and a smile when needed. They act as a liaison and serve as a vital link between the physicians, nursing staff and various departments.

It takes a very special person to perform all of these duties as they must be reliable, dependable, patient and possess a pleasant and professional disposition along with having a big caring heart.

We appreciate each person who serves in this role and so we celebrate our unit coordinators on National HUC day particularly because of the service they provide to our healthcare system.

Let’s show our support to these dedicated men and women, don’t forget to tell them thank you and most of all hug your HUC today. 

Why telephones are the wrong solution for hospital communication.

When you’ve been in the computer software business for as long as I have, some themes tend to come back over and over again. During a recent presentation at a prominent hospital, I was asked, “With what wireless telephones do you compete?” Before I knew it, I time warped back to the 80’s to my Apple days.

I was in charge of Application Software at the time and in talks with a large corporation about the benefits of using an Apple II. The COO, leaned back in his chair and asked,“So Rob, tell me what this Apple II can do that I can’t already do on my Wang Word Processor or my IBM Selectric typewriter.” 

Looking back, I now see that he was asking the wrong question. Apple II computers were not some glorified word processor. They were multi-purpose productivity systems that could type letters, keep the books, prepare proposals and analyze financial statements. He should have asked, “How were desktop computers going to transform my business?”

That’s where the difference between telephones and smartphones come into play. Telephones only do one thing and are slowly becoming a thing of the past. Smart phones are like desktop computers that fit into your pocket. And when you think about it, legacy telephones require that both parties (caller and recipient) be available at the same moment to properly communicate. 

In busy hospitals, this is seldom the case. Caregivers are busy with patients, or family members, or physicians, or pharmacists, or phlebotomists or…a million other things. No one is sitting at a desk waiting for the phone to ring. So buying a telephone, even a wireless telephone, is like buying a Selectric typewriter in 1980 at the dawn of the computer revolution. Do you want to be on the wrong side of the tipping point? Do you think that hot new EMR application is going to run on a telephone?

Popular Mechanics just named the smart phone the number one gadget that changed the world - ahead of television and the bicycle. Smart phones didn’t achieve this because they are better telephones, but because they are changing the meaning of computers…and communication…and business…and education...and…you get my drift. 

Learn to ask the right questions. How are we going to change the meaning of communications among care teams? What amazing things can we expect these highly mobile pocket-sized computers to do and how will it change the patient experience?