I’m in San Francisco this week at HealthBeat 2013, a new event that’s exploring “smart hospitals” and “smart practices” to help healthcare decision-makers identify the technologies transforming the industry. Trey Lauderdale moderated a session with Julie Vilardi, RN, MS, Executive Director of Clinical Informatics and Strategic Projects at Kaiser Permanente, and Darren Dworkin, Senior VP and CIO at Cedars-Sinai Medical Center. Here are some highlights:

As a practicing nurse for over 25 years, Julie spoke from experience when she painted a picture of the chaotic environment of hospital nursing.

“When you look at the nursing population, they are very smart and industrious, and used to a disjointed environment,” Julie said. “It takes some study and focus to bring in new technology, because if it doesn’t work they’re going to go back to their manual process. They need one standardized device that can be used for voice and text, that’s reliable and delivers a return on investment.”

Julie went on to discuss the importance of the user experience, and the expectations nurses have for slick consumer devices. “When you get inside the hospital walls,” she said, “those experiences are beginning to be the expectation, and we so don’t deliver it right now.” 

When Trey asked about the trend toward BYOD, Darren acknowledged hospitals worry about the security issues of mobile technology, but emphasized that care providers have come to expect those technologies at work. 

“A lot of our clinicians are using technology in other aspects of their life,” Darren said. “They want to know how come they can’t have a healthcare version of that.”

The answer, he said, is a balance between convenience and security. “If a device is not convenient enough, people will use a personal device that is not secure.”

As EMR begins to be integrated into mobile devices, user interface and security issues will only increase in importance. Both of today’s panel experts pointed to the need for hospitals to introduce nursing technology intelligently, with an end-to-end solution that works across hospital departments.

If you or a family member has ever been admitted to a hospital, you know how important nurses are. They take care of us when we’re most vulnerable, and comfort us with a smile when we’re in an unfamiliar place and facing an uncertain future.

Nurses are the heart of the hospital. They are also at the heart of everything we do here at Voalte. 

When Trey Lauderdale came up with the initial concept for Voalte five years ago, his goal was to make it easier for nurses to communicate with each other. Nurses at our local hospital, Sarasota Memorial Health Care System, were first to use Voalte One smartphones back in 2009. The feedback they provided then and continue to provide today has helped us shape Voalte One into a rich, dynamic solution that’s now used by leading hospitals throughout the country. 

Every year, we pay tribute to our local nurses with a celebration during National Nurses Week. Last Tuesday, we joined our friends at Sarasota Memorial for a Voalte-sponsored game show, where we handed out gift cards from local restaurants and spas, and awarded cash prizes and Voalte goodies to some lucky winners. For us, the prize is always seeing smiles on the nurses’ faces. And those smiles aren’t only reserved for Nurses Week. It may be due to our bright pink pants, but happy nurses are always first to greet us when we visit Voalte hospitals.

While Voalte solutions and our vision have grown beyond bedside communication to include other functions vital to a smooth clinical workflow, nurses know they always come first for us. Whether we’re on-site at Children’s of Alabama, Cedars-Sinai in Los Angeles or here at home at Sarasota Memorial, nurses thank us for making their jobs easier. Considering that nurses have one of the most difficult jobs in the world, we consider it the least we can do. 

Last week, we released the results of our first Special Report: “Top 10 Clinical Communication Trends.” More than 1,000 nurses responded to a national survey sponsored by Voalte and American Nurse Today, the Official Journal of the American Nurses Association. Our goal was to identify the communication pain points that make it difficult for nurses to do their jobs efficiently. Some of the results were shocking; others were reassuring. Be sure to check it out to see what nurses are saying about the struggles they face every day.

At some point, we all may find ourselves being admitted to the hospital. When that time comes, let’s hope the nurse assigned to our care has the tools he or she needs to do their jobs efficiently … and with a smile.

_{Shown above: Voalte Account Manager Nate Levine (center) with Sarasota Memorial Health Care nurses: Kathleen McDonald, RN, Maria Murray, PCT, Sara Campbell, RN, and Karen Van Der Weert, RN.}

Years ago, a wise COO told me, “I can’t help you if I don’t know what you need.” When dealing with a problem or issue, the first step is to understand the nature of the challenge. The same holds true of nursing practice issues or barriers. Speculation or assumptions about the communication, resources and support needs of nurses at the bedside may lead to wasted time, misunderstanding, and even mistrust and loss of engagement.    

In an effort to fully understand the end users of our products, Voalte partnered with American Nurse Today, the Official Journal of the American Nurses Association, to conduct a national survey of nursing leaders and staff nurses. The purpose of the survey was to solicit their perceptions of the work environment related to time available for care coordination and patient needs, devices available for communication, and support for the effective use of technology.  

Now is the time to fully understand the nursing care micro-system and the dynamics of daily communication between stakeholders. Changes in our healthcare arena are challenging hospitals to change their care delivery systems and reevaluate both their basis and paradigm for decisions. The operational strategies that have worked for decades will not necessarily work in this reformed healthcare environment. All previous assumptions must be tested, and rejected if they no longer apply. 

More than 1,000 people responded to our survey. With the assistance of Dr. James Lani and Jeanine Glase, the amazing biostatisticians at Statistic Solutions, we compiled the main findings into a Special Report: “Top 10 Clinical Communication Trends.” For those interested in nursing workflow and communication, this report is a must-read for insight into the clinical communication landscape in the nation’s hospitals. Once you understand the challenges, you can start coming up with solutions.

Are today’s hospitals creating an environment that encourages healing and recovery?

A 2012 study from the University of Chicago found average noise levels in hospital rooms easily exceeded the recommended 30 decibels, and peak noise levels sometimes approached the decibel level of a chain saw.¹

That sure doesn’t sound therapeutic to me!

At Voalte, we believe reducing hospital noise can improve the patient experience and positively impact HCAHPS scores. Now, there’s evidence that lowering noise also affects patient outcomes. 

In another study last year, Orfeu M. Buxton, Ph.D., of Harvard Medical School found a correlation between patient health and noise levels, stating that lowering the noise level in hospitals “would decrease patient stays and improve healing, and perhaps even reduce readmission rates.”²

He also found that some noises are more disruptive than others. In particular, patient heart rates jumped consistently due to the sound of electronic alarms and ringing telephones.

This anxiety makes perfect sense to me. Imagine being a patient in an unfamiliar setting, away from home, and facing the unknown regarding your health. You might wonder:

- Why are all these alarms going off? Did someone die? Are they for me?
- Why does the nurse keep leaving my room to talk on the phone? Is she talking to my doctor? Why don’t they want me to hear?
- Why is this machine attached to me beeping? What does it mean? Am I taking a turn for the worse? 

Too often, caregivers and the communication tools they use only add to the cacophony … and the anxiety. Many nurses are given phones as their main tool to communicate with other caregivers, departments and doctors. Yet HIPAA requires they don’t discuss clinical matters in front of a patient, so every phone call causes an interruption as the nurse leaves the patient’s bedside to answer the call. If the nurse is too busy to answer, other noisy strategies such as overhead paging attempt to locate them.

Fortunately, there is a solution. Secure text messaging via smartphone can eliminate up to 70 percent of ringing telephones and nearly all overhead paging. Alarm management tools can integrate disjointed devices and assign levels so all alarms are not treated equally.

As scientific evidence supports the importance of lowering the noise level in hospitals, old attitudes are changing gradually. Maybe what will truly push the urgency of this issue will be the new policies linking hospital reimbursement to patient satisfaction.

<sub>1. Jordan C. Yoder, BSE; Paul G. Staisiunas, BA; David O. Meltzer, MD, PhD; Kristen L. Knutson, PhD; Vineet M. Arora, MD, MAPP, Arch Intern Med. 2012;172(1):68-70. doi:10.1001/archinternmed.2011.603.

2. Orfeu M. Buxton, Ph.D., assistant professor, Harvard Medical School, and associate neuroscientist, division of sleep medicine, department of medicine, Brigham and Women's Hospital, Boston; Gulshan Sharma, M.D., M.P.H., director, Medical Intensive Care Unit, University of Texas Medical Branch at Galveston; June 12, 2012, Annals of Internal Medicine.</sub>

How long does it take your nurses to respond when a patient pushes the nurse call light? Two minutes? Four minutes? Longer?

If you don’t know the answer, you should, because it influences everything from health outcomes to patient satisfaction to financial results.

Patients use the nurse call light for various reasons, but as you can see in this bar chart from the American Journal of Nursing (AJN), the top three calls are for bathroom assistance, IV problems or alarms, and accidental calls that often involve pushing the call button while turning over in bed or trying to turn the TV channel. While none of these involve life-threatening scenarios, your nurses’ response to them has a major impact.

Consider a call for bathroom assistance. If a nurse doesn’t get to the patient’s room within a couple of minutes, will the patient wait or try to get up from bed on their own? If they get out of bed, in an unfamiliar place and perhaps while taking pain medication, the danger of a fall is significant.  

At one hospital, I heard about a patient breaking her hip in a fall while trying to get to the bathroom. In addition to the suffering of the patient and her negative impression of the care she received, the hospital took a financial loss from the cost of the patient’s resulting surgery and the increased length of her stay.



The AJN study found that each patient averages 4.59 nurse calls per day. It’s simple arithmetic to multiply your number of patients by the number of calls per day to arrive at the potential for such negative consequences.

So what are you doing to make sure your nurses respond to calls in a timely manner? In a typical scenario, when a patient pushes the nurse call light, an alert goes to the unit coordinator, who responds by asking the patient what they need, then tracks down that patient’s nurse to relay the information. Depending on the communication system, that could mean using an overhead paging system, making a phone call that may or may not be answered, or using a one-way communication device. The nurse then needs to respond to the unit coordinator to find out which patient is calling and what their needs are. If the nurse is busy, the unit coordinator needs to locate another nurse or nurse technician using the same process.

With Voalte One, when a patient pushes the nurse call light, an alert goes directly to the nurse, who can proceed to the patient’s room or send a text to a technician asking him or her to go to the room to assist the patient. 

When a nurse responds to a call promptly, the patient not only receives the best possible care but also feels well cared-for.  When delays can have such a high price, a couple minutes makes a difference.


_{Source: Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety, AJN, September 2006, Vol. 106, No. 9. By Christine M. Meade, Ph.D., Amy L. Bursell, Ph.D., Lyn Ketelsen, MBA, R.N.}

“A tipping point is the event of a previously rare phenomenon becoming rapidly and dramatically more common.”

Last year it happened – I can’t put my finger on when it happened – and I am not sure if there was a specific day, week, or month when it occurred, but in 2012, we hit a tipping point.

The tipping point we experienced was the exponential growth of smartphones being used as a communication device at the point-of-care. Nurses, doctors, and hospital administrators have unilaterally proclaimed that legacy VoIP wireless phones, pagers, and voice badges are devices of the past; our caregivers deserve a better communications experience.

We are constantly amazed at what our customers have been able to achieve in the past four years and we are blessed to partner with such an innovative group of healthcare leaders.

So what is in store for 2013– the year past the tipping point? What is the future of smartphones at the point-of-care?

Come check us out at HIMSS13 in New Orleans to see what Voalte has planned for the new year. If you think Voalte was busy last year, just wait and see what we have in store for you in 2013!

As I travel from hospital to hospital as a User Experience Manager for Voalte, caregivers I train frequently ask me, how Voalte will be useful in their particular unit?  Depending on the type of communication device the caregivers have previously been using or the lack thereof, many caregivers just cannot visualize how Voalte could benefit their unit. 

I often respond with a question… "With whom do you communicate on a regular basis?"  The responses from the caregivers vary depending on their unit workflow from Pharmacy to Respiratory to Physicians, Care Techs, etc.  Then I ask, "How have you been communicating with them?"  Their responses are amazing!  Some have been using pagers, which have been obsolete for individuals outside the hospital setting for quite some time.  Others say they have phones that they can use to call the intended party on.  The trouble with this is that both parties must stop what they are doing to speak to one another by phone.  In this scenario, both caregivers must be available at the same moment and caregivers don’t consistently have the same phone number, resulting in the caregiver dialing 4 or 5 extensions before they find someone to answer.  Lastly, many caregivers respond to my question by saying, "We just yell down the hall or go find the person."

When I explain how the Voalte One solution will allow them to text and call other caregivers by tapping on the desired individuals name or unit, they are thrilled!  Being able to text caregivers and other units throughout the hospital excites them, realizing how this form of communication will help them to better manage their requests from other individuals more effectively.  They are relieved when they learn that they will now be able to see which caregivers are at work on a particular shift, thus eliminating the dialing of multiple extensions to find someone to answer their call. 

I am excited to report that it does not take much convincing for Voalte’s caregivers to agree that we have transformed how they do business!

As a young rep starting off in technology and healthcare, I was thrown into a whole new world that I never expected. Immediately, I was given an overwhelming amount of knowledge, talking to some of the best individuals in healthcare. Eight months later and I love every minute of it. I get to develop relationships with the people that make a difference everyday…. Nurses!!!

Tradeshows are nothing new. Almost every b2b company attends a conference of some sort. For me however, the ANCC National Magnet Conference that took place in Los Angeles, California this past month was my very first tradeshow.

The 2012 ANCC National Magnet Conference is where clinicians go to celebrate nursing, let their hair down, and have a good time!! This is the nursing conference to top all nursing conferences. Hospital organizations send their nurses to ANCC to celebrate being designated (or re-designated) as a Magnet Hospital, the highest clinical honor to be had.

What made ANCC so special was that it was a conference dedicated solely to nurses. As a vendor, we were there to show our Voalte solution but we were also there to celebrate clinical excellence. This conference was all about showing nurses a different way to manage the craziness of their daily work lives through our solution, putting a smile on their faces, and making relationships with those that matter most.

The amount of sweat and stress that goes into making this conference happen becomes worth it when you get the chance to speak face-to-face with the nurses. These nurses come from all different backgrounds and environments; each one having a different perspective, but all having the same caring heart that makes them so special. Seeing the a-ha moment after demoing our solution was just icing on the cake.

The take away… The solutions you sell are one thing, but the people you meet and the relationships you make are what really count. ANCC opened my eyes as to why we work hard at doing what we do. It’s a shout out to nurses because they are the ones that matter most!

A lot of people talk about what they want to do or who they want to be. Companies do it too. They talk about their vision or their purpose, but what does it all really mean? To believe in what you are doing, is that vision? What is the purpose of the work I am doing?

These were the types of questions I asked myself when I was sitting in a chair at Sarasota Memorial Hospital. My wife was recovering from complications with her Diabetes, so I had a lot of time to sit, stare blankly at my laptop screen, and ponder the impact our solution has on healthcare and even further, on my life directly, in this moment. I had the same reoccurring thoughts, as I watched nurses come in every thirty to sixty minutes to test her blood sugar levels. This isn’t just marketing; they are really using the product to help my wife recover. This is real.

I did not understand the true importance of the Voalte solution until I saw it in action. I watched as someone triple checked the basal rate of insulin my wife received every hour. The nurse used the product we sold, making sure not to double up on the dosage. It really hit home at that moment, how lucky we were to be in one of the best hospitals in the world, a hospital, which is running Voalte.

You hear sales pitch after sales pitch, involving the vision or purpose of a company, but you don't really understand the reality until you experience it first hand. I understand, now more then ever, what it means to have purpose in my work. It’s not about hitting a sales goal. It's about building something that is capable of impacting the quality of care your child, parent, or spouse receives. I love being a part of something like that... I was sitting in the hospital room while my wife recovered when purpose slapped me in the face.

On Tuesday, October 23, 2012, at 10:00AM PST, Apple released the iPad Mini.

On Tuesday, October 23, 2012, at approximately 10:05AM PST, physicians, nurses, and other caregivers began asking IT when the iPad Mini would be supported by the organization.

Below are three things to consider regarding the iPad Mini’s immediate impact on healthcare:

1. Ease of use. The iPad Mini has the same intuitive user interface and application standards that the iPad and iPhone feature. Users will have no problem picking up the device and using it with little-to-no training. Standardized products and ubiquitous experiences have their advantages.

2. No form factor. The iPad Mini is a dream device for physicians and nurses who are looking for a lightweight, mobile platform that can fit in their lab coat pocket. It’s big enough to enable both reading and writing information in an EHR, yet small enough to easily carry around throughout a shift. When it comes to the deployment of the iPad Mini, the real question will be, how quickly EHR vendors can optimize their applications for the iPad Mini’s new form factor? Epic’s Cantu and Cerner’s PowerChartTouch were both designed for a regular sized iPad. Not all features and functions that have been built into their iPad app will be suitable for a smaller screen size, so expect customization to occur.

3. Enterprise readiness. Right out of the gate, the iPad Mini runs Apple’s iOS, which is accepted by almost all IT organizations in one fashion or another. With the plethora of mobile device management solutions (such as Voalte Connect, powered by Airwatch), the iPad Mini will have no problem receiving the go-ahead from IT in terms of enterprise readiness. (This, of course, is a 180-degree change from the launch of the iPhone in 2008!)

Wondering how the iPad Mini will play into your organization’s mobility strategy? Feel free to give us a call here at Voalte and we will be happy to help guide the way.