I’ve written my last couple of blogs on ISDN vs. SIP and Open Source vs. Proprietary PBX’s. Now I would like to conclude this subject with why Hospitals really should implement the SIP protocol on their PBX rather than remain with their legacy PBX, which could be TDM, or even the earlier signaling protocol H.323.

I would like to go over a couple of problems I have seen in the industry with utilizing these legacy PBX’s. The largest complaint on legacy PBX’s, especially the ones with TDM interfaces, is the lack of bearer channels. Every time you want to increase your capacity, you will need to add another T1 card, which of course only adds 23 more bearer channels, or 24 if you have the capability of running a shared d-channel as in a NFAS configuration. A second common problem is the display name being sent over the TDM trunk via the ISDN protocol. Some ISDN protocols use Information Elements (I.E) in the ISDN Setup Message while others may use Facility Messages to send the Calling Name. Sometimes, if supported at all, this configuration can be cumbersome. A third problem also seen, especially in a Tandem PBX, is the lack of the ability to sometimes send the actual calling number or perform any digit manipulation.

With a SIP PBX, especially Open Source, all of these problems can be easily resolved. There is no 23 bearer channel limitation. If you want the ability to place more calls, you just have to make sure you have the appropriate hardware such as memory and CPU power. As for the Calling Name, it can be taken from the Display Info in the SIP Header. This is pretty much automatic, really little to no configuration. Digit manipulation and the calling number are simple with SIP. The calling number is generally sent in the host part of the SIP from header. The calling number can also be obtained easily from what is referred to as a P-Assert or Remote Party-ID.

As for H.323, it really is an end of life protocol, still used somewhat in the public sector, but not much use in the private sector. Although closer than SIP in relation to ISDN signaling, there is little development being done with it today.

So in conclusion, choose SIP for your hospital.

After having worked for Voalte for six months now people have asked me; “what question do you hear most often in the field?” When explaining what we do to hospital executives the over whelming majority ask, “if Voalte is a smartphone application can we just download it on our personal phones?” 

The simple answer is no, but the underlying importance is the reason why. Nurses all over the country have used different legacy devices ranging from complicated phones to simple single-use pagers. Now days all of the emerging technology is wonderful but we cannot lose focus on the end users. Hospitals are busy places and when a new technology is proposed caregivers are left wondering if they are going to have to learn how to use a new device or system?

This is where, as we say, a full “turn-key” solution is necessary to address the problem. After seeing our solution successfully rolled out at a number of hospitals across the country I have to come to realize that the reason for the success starts with the nurses being receptive and embracing the technology. Our end user training does just that. Our project management team ensures integrations are performed and infrastructure is configured correctly. Our go-live support maintains a successful rollout, while our ongoing supports keeps the solution up and running as it should. Lastly, our “app” in combination with our specialized devices and charging solutions deliver the efficient and effective communication nurses and caregivers need to deliver the best care possible.

It’s more than just about the app…it’s about our people and the overall experience.

As my colleague, Frank Watts, mentioned in his post “Noise and Patient Anxiety,” a cacophony of alarm signals, nurse call equipment sounds, and the like, can wear down a patient’s recuperative efforts and assurance that they are receiving the best possible care. So, too, can a frequency of alarm noises cause anxiety in hospital caregivers, which in turn, can deplete their ability to provide excelled healthcare. This syndrome, known as alarm fatigue, occurs in a clinical scenario when alarms sound so often that responders become desensitized causing them to respond slowly, inaccurately, or not at all. Another issue of “alarm discriminability” arises which affects the clinician’s ability to discern between one or more alarms. Hence the need for a better alarm delivery solution – Voalte One!

In a survey summary published in the MedSun Newsletter #65, October 2011 by The Medical Product Safety Network*, nine of the 350 health care facilities included in the network reported on the most common alarm fatigue challenges in their demanding and time-critical environments. The respondents represented a cross-section of the hospital staff: risk managers, staff nurses, nurse managers and biomedical engineers. Nearly two-thirds of the respondents experienced alarm fatigue daily, while the other one-third were clearly aware the term and the issues involved. Generally, many of the respondents felt that the varying alarm sounds required extra diligence that involved relying on other sources of observation. In order to determine the correct priority of an alarm, many clinicians would check central monitors in the nursing room, search from room-to-room, use split screens in patient rooms, etc.–all requiring invaluable time when seconds really count the most. Even with varying pitch and tone, many alarms in a localized area were still hard to distinguish properly.

Building considerations as to the overall size of the unit, high levels of noise, and closed patient room doors also factored into the ability for proper alarm signal discernment. That particular consideration and other conditions contributed to the survey-wide result that visual alarms faired better than auditory alarms when providing reliable, and rapid, information regarding alarm location and level of urgency.

When the respondents were questioned regarding their recommendations for better technological solutions to alarm fatigue and alarm discriminability, receiving alarm notification text messages on a smartphone was a survey-wide answer. Additionally, the ability to monitor alarm notifications and information portably through an iPad or similar tablet product was also mentioned as another important technology advancement.

*The Medical Product Safety Network (MedSun) improves FDA’s understanding of problems with the use of medical devices so that the FDA, healthcare facilities, clinicians, and manufacturers can better address safety concerns.

Whether you call them a HUC, an NCT, a MST, a UCA, etc., the hospital Unit Secretary is a professional juggler of tasks, Jack of all trades, chief communicator, mission control, and in many cases Mother Hen to everyone with whom they come in contact. Caregivers, Physicians, and patients alike appreciate what they do and reap the benefits from their daily interactions with their Unit Secretaries. Voalte would like to take a moment to recognize these amazing individuals.

The Top 10 Reasons we LOVE our Unit Secretaries:

#10: They work tirelessly

 #9: They are very knowledgeable about the workings of the department
       and are a wealth of information

 #8: They are always willing to lend a helping hand

 #7: They always know where to find everything

 #6: They know who to call in any situation

 #5: They always work hard to help everyone out

 #4: They are in control

 #3: They know how to fix any and all problems

 #2: They keep us organized

 #1: They ROCK!

To all Unit Secretaries all over the world, we acknowledge and value your ongoing commitment to your patients and your team. You make a HUGE impact, one interaction at a time!

Thank you!

Well maybe it’s not perfect, but it’s pretty darn close. Before doing a house wide deployment, many of our sites decide to test run on a single unit. The downfall to just going live with a single unit is that you miss the crucial interaction/communication between units and ancillary departments. The other thing you miss out on is the buy in you get from different groups within the hospital.

The University of Iowa Hospitals & Clinics noticed the importance of including departments outside of nursing. UIHC selected a single nursing unit and then included all the Physicians, Residents, Pharmacists, Dieticians, Social Workers, Physical Therapists, and Nursing Administrators that the unit communicated with. Phase One was hugely successful–probably one of the best I have ever seen!

When we went live, users immediately noticed the value of the Voalte One communication tool. Nurses loved the fact that they could find Pharmacists no matter where they were in the building. Residents loved the ability to text Nurses during rounds. Voalte was an all around win with all of the Hospital groups.

However, there were unintended consequences. Now that a few pharmacists, dieticians, and others had trialed Voalte, everyone else now wanted one. I guess it’s a good problem to have…

I've been thinking a lot about the impact of mobile technology on Healthcare. For the last few months I have been working with a task group with mHIMSS that is attempting to prepare hospital IT staff for the flood of mobile connected devices heading their way and recently released the “What’s Next Work Group Report: Emerging Tech Trends 2012”. Some of the BIG trends that are moving more rapidly than we expect will change everything. In this blog I will take a crack at some of those issues.

Everything is going wireless… EVERYTHING! This is tough because hospitals are traditionally hostile environments for radio waves. They have lots of concrete and steel walls, long hallways, elevators and lots of electrical equipment that radiates interference.

It is time to get serious about your wireless infrastructure. Many hospitals have relied on 3rd party service providers to maintain their wireless networks. These networks may have been designed a decade ago with only data-quality capacity and little concern for fast roaming, packet loss, jitter and a myriad of other considerations needed for today's demands. Access points maybe hidden under ceiling tiles, have poor power settings, or have an obsolete topography and channel settings. When was the last time you had a top-to-bottom, campus wide assessment / audit of your network?

Have you been thinking much about the "Internet of Things"? Maybe you should. The amount of R&D that is pouring into development and use of wireless sensors is mind-boggling. Sensors will soon be arrayed throughout the physical space to detect a variety of adverse conditions…think smart beds, smart rooms, smart gurneys, medical devices. Sensors will be worn in clothing, stuck to the skin (smart band aids and patches), taken internally or embedded under the skin.

All of these sensors will need to be connected into a data network where they can accumulate massive amounts of information. All of these wireless devices and sensors are producing massive amounts of data and that leads me to the topic of Big Data. We will need a way to store, access and analyze petabytes of information. That's right, petabytes… 2,000,000,000,000,000,000,000,000,000,000 (plus 20 more 0's) of data… but who's counting. Hidden in this data will entirely new medical protocols, diagnosis and disease markers just waiting to be discovered. Healthcare institutions will be drowning in data if action is not taken immediately.

The future is roaring down on vendors and providers and we all need to be ready to embrace the change. So…buckle your seat belts and hang on! 

Voalte does “Service” with more care and attention than anyone else in the business, and at the end of the day, our service component is what makes all the difference when it comes to the implementation, adoption, and success of the Voalte solution.

If you ever start to wonder how we do it, all you have to do is look at our people. Our customer focus extends from our Voalte BFFs to our Engineers. It is completely ingrained in our culture, and it is what makes it a point of pride to earn your “Pink Pants”. We develop such a strong relationship with our customers that they cannot help getting involved too:

“I keep meaning to tell you that Belinda is awesome!! The staff loves her, the managers have even commented that she's great and she's been super to work with… How long until she gets some pink pants? :)” –Jen Lassonde, Senior Project Specialist, Massachusetts General Hospital

I’m a project manager at Voalte, which gives me the unique opportunity to take part in every customer interaction from the project kickoff to post-go-live support. A ton of details go into a full implementation, but there is one detail in particular that I believe is critical to our success, and that is training. Training is the first chance we get to make a lasting impression with our customers, the clinicians.

Our trainers have a tiny window, 60 minutes, to make sure that our clinicians are comfortable with the iPhone and the Voalte One application. They help staff who have never touched a smartphone before conquer their fears and discover how they can benefit from this amazing technology. It takes a unique gift to adapt to different environments and people while maintaining the same exceptional level of service. For that reason, these final quotes go out to our team of talented Voalte Trainers:

“Amy has done a fantastic job. She is a wonderful facilitator and is able to manage large classes with ease. She has provided staff with one-on-one help after class to those who need a little extra practice. The class content is exactly what our staff needs.”  –Clinical Educator, Lurie Children’s Hospital

 

“Great class, GiGi!!!” –RN, Cedars-Sinai Medical Center

 

“I just want to recognize Amy Demski for doing an phenomenal job these past 2 weeks with training. Amy has trained over 1,000 users in 12 days. She has accommodated large class sizes and extra impromptu sessions while providing a high quality education.” –Arnold Butiu, Manager of Clinical Applications, Lurie Children’s Hospital.

For those that didn’t read my first blog, I wrote about my transition into healthcare and the anticipation of my first sales trip. In the last month, I have had the opportunity to visit ten hospitals/health systems of different shapes, sizes, and locations. I have met many diverse individuals in various hospital positions. It’s been an eye opening experience to say the least.

To quote our Chief Experience Officer (CEO) Oscar Callejas, “Once you’ve seen one hospital unit, you’ve seen just that…one unit, in one hospital.” To elaborate on this quote, no two hospital units are alike. Hospital units are just as unique as each person is. Sure, there are similar underlying needs for efficient communication, but how those needs are met is where the differences lie.

Take the Emergency Department for example. I think we have all watched episodes of Grey’s Anatomy on TV. The portrayal of craziness and pandemonium in the ER is not far from real life. I visited small, medium, and large sized ER’s. I saw some that were similar in bed/room size but drastically different in footprint size and layout. What this translates to is that different communication barriers are unique to each hospital’s Emergency Department. Installed communications and other technologies also create unique workflows.

However, what they fail to show on TV is how important communication becomes with other areas of the hospital. Patient flow from the Emergency Department becomes critical because hospitals do not want to divert patients to other hospitals simply because they cannot move patients through fast enough. Transporting patients through the hospital is harder than it sounds. Patients need to be transported to departments such as radiology, surgery, and other departments as quickly as possible.

The Emergency Department is just one area I will mention. Technological differences play an important role. Similar units, even inside the same hospital, might have different systems. Therefore, the communication roadblocks become unique, as well as those workflows.

To summarize my travels and experiences, hospital communication problems cannot be solved with a universal approach. Similarly, technology can aid, but will not fix the problems by itself. The uniqueness of every hospital unit creates a challenge and I encourage you to share those challenges with us so that we can find ways to help. 

What can we do to reduce noise? There are many attempts to reduce noise in hospitals. Reducing noise should improve the patient experience and improve HCAHP scores. Just as important and a bi-product of noise is patient anxiety! Patients unexpectedly find themselves in a new setting, away from home, facing the unknown in the form of a health condition, unfamiliar with their surroundings or the routine. Activity going on all around them that they do not understand:

What are all these alarms for? Did someone die? Are they for me?

Why does the nurse keep leaving my room to talk on the phone? Is it my doctor? Why don't they want me to hear?

They are always getting calls when they are treating me and leaving the room.

Are they understaffed? If I need assistance, will it be available?

That's a new alarm sound! What does it mean? I don't see any nurses anywhere? What is going on?

Why is this machine attached to me beeping? What does it mean? Am I taking a turn for the worst? Should I call my nurse? Where are they?

I wish my doctor would call. I asked the nurse to notify him I'm having a new pain. The nurse says they can't do anything without the doctor's approval. When will they contact him? Why hasn't he got back to them? Can't they call him again?

Why didn't the nurse answer her phone when she was in my room? Maybe it was my doctor?

Too often caregivers and the communication tools they are given only add to the anxiety.

Alarms all sounding the same and difficult to differentiate their urgency are heard throughout every hospital unit. Nurses go home exhausted from alarm fatigue. Patients lay in bed awakened at all hours of the day and night with anxiety at what the cacophony of alarms and other noises mean.

Nurses are provided phones as the main tool to communicate with other caregivers, departments, and doctors. Unfortunately HIPAA requires they do not talk of clinical matters in front of a patient. The phone causes numerous interruptions for nurses treating patients requiring they leave the room. If they do not answer the phone alternate strategies of overhead paging, and attempts to find them take over.

Today's technology offers many other solutions:

Alarm management tools can make sense of the numerous disjointed devices producing the cacophony of alarm noise.

Sophisticated nurse text messaging (similar to what is available on smartphones) can eliminate 78% of ringing telephone calls, almost all overhead paging and the potential for missed patient requests.

When looking to reduce noise, consider improving patient anxiety as well. It will more than give you justification and urgency to proceed and result in a better environment for all.

So, we all hate going to the doctor’s office for one reason or another, whether it’s because it’s not fun being sick, you hate needles, or it’s just a pain to take time out of your busy schedule. One of my biggest pet peeves is walking into my doctor’s office, checking in with the receptionist, filling out any necessary paperwork (which is normally about fifteen pages) and then you sit. You sit and wait for what seems like a lifetime, not knowing if you will be next or if the eight people sitting there along with you will be called back before you. No one gives you any idea of a time frame on how long you will be there. Everyone has his or her face buried in a magazine and not much conversation is had.

Well, all of that is about to change. Close your eyes and picture this. You enter through large wooden doors into a beautiful lobby area. Directly in front of you is a peaceful and serene waterfall. To your right is a big screen TV that takes up the entire wall. Right next to this is a cheerful chef making delicious chocolate chip cookies or a healthy chicken salad. A smiling face then greets you and introduces himself or herself as a member of the Life Guide team.

A Life Guide meets patients immediately upon entering the clinic and redirects them to a decentralized check-in area. This private, more intimate area allows patients to feel like their visit is one-on-one. The Life Guide helps with any paperwork and gives a brief tour of the clinic, and when the caregiver is ready, the Life Guide escorts the patient to a procedure room. No longer are patients sitting in a lobby, waiting and wondering how long it will be until they are seen by a caregiver. Sounds like a dream, doesn’t it?

Now open your eyes because this is the reality at one group of forward-thinking clinics. I recently went to a newly opened Mosaic Clinic in Kansas City, Missouri for a site visit, and as I was introducing new Voalte users to the solution, I kept asking myself, “What is this Life Guide position all about?” I learned that Life Guides are there to make patients feel as though they are not just numbers. Life Guides are welcoming, caring, and compassionate, and they help guide patients through the sometimes confusing and frustrating process of obtaining healthcare services. Most traditional clinics can make us feel like we’re trapped in the “hurry up and wait” game. We are checked in and paperwork is pushed through and we are left to wonder whether we will be there for ten minutes, one hour or half a day. In Kansas City, the status quo is no longer good enough. At Mosaic clinics, you, the patient, are the main priority from the moment you walk through those doors, and we all know there is no better feeling in the world than when someone makes you feel special. Inarguably, Life Guides are playing a critical role in solidly establishing Mosaic as a leader in this movement towards more comprehensive, personalized service. Nationwide clinics take note. We’re your patients, your customers, and THIS is what we want!