Very soon your web browser will become your next telephone!  Surprised.  You should be.  Soon you will be able to make voice and even video calls to anyone running the latest web browser.  No apps to download, no installs and no sign ups.  It’s just you and your web browser.

WebRTC is a free, open project that enables Real-Time Communication (RTC) capabilities to be built right into the web browser without any extra plug-ins or software.  In addition to voice and video calls, it will also be possible to screen share and transfer files. 

What does this mean for you?
Websites will become more interactive “environments” where other users will be able to interact and communicate in real-time, rather than static pages of text and images.  It will also allow for imagine browsing on an online store, being able to chat with other shoppers or even talk with a salesperson or customer support directly and immediately.

What does this mean for healthcare?
This will make telemedicine easier and cheaper to achieve because it won’t require any special hardware or software to setup a videoconference between a patient and a healthcare provider.  It could also change the landscape of medical devices, for example, a nurse could receive a critical alarm that links to the patient monitoring device showing the live waveform or real-time values like heart rate.

What browsers have it? 
WebRTC is not generally available in any web browser yet, but you can try it in early experimental versions of Google Chrome, Mozilla Firefox or Opera.

When will it be generally available? 
I guesstimate that 2013 will be the year of WebRTC and it should be available on all major web browsers.

I am very excited about this new technology because it will take web browsers and communication to the next level.  Telecommunications started with landline telephones that only made voice calls, then wireless smartphones enabled voice, video and data and now the web browser will have the ability to allow easy real-time collaboration between individuals and offer direct access to real-time data.

We have all read the articles on huge amounts of money being raised by hot, new social media software companies. Two twenty-somethings with a great idea, a Stanford pedigree and a freshly minted business plan from the Y Combinator raise $15 million dollars and move into the 18th floor of the Embarcadero Center in San Francisco. Well, that is not the way it works…  at least not in healthcare. In my experience, it involves endless meetings, lots of inane questions, and traditional Venture Capital always seem to end up at the same place:

• How long is your sales cycle? Did you really say six to twelve months?

• You mean your staff actually goes on site to train and support the client? How can that scale?

• Did you really say that you have to integrate with hospital systems and you can't just download an app or subscribe to a cloud service? That sounds way too complicated.

Now don't get me wrong, I have worked with Venture Capitalist for more than 30 years and I know some great ones, Dick Kramlich at NEA, Randy Komisar and John Doer at Kleiner Perkins, to name a few. But the Venture Capitalist landscape has changed. Funds are raising hundreds of millions of dollars, with deal size getting bigger and bigger. Valuations have grown as rapidly as planning horizons have shrunk. Deal velocity is up and patience is down.

We recently closed a Preferred Round with strategic investors, one a major vendor and the other a top-rated healthcare provider. Why would we do this? I think the number one reason is that "they get it". Not just as a financial transaction but as a shared vision for transforming healthcare. We must act and we must have strong partners that can look over the horizon.

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.

My name is Alex Brown and I love reading through release notes, beta testing new software and anxiously watching new product announcements (Dreamforce, AppleKeynotes, etc.). Basically I’m addicted to new features.

I’m in charge of scoping and implementing the IT systems that help Voalte employees work smarter, not harder. Many of our IT vendors are using Agile based development (So are We!), leading to a constant flow of new features. To me new features = new workflows.

For example, this past spring Box.com (our Document Management and Collaboration System) revamped their file comment system to be similar to a facebook-esque newsfeed, including all the relevant history of a file as well as tasks, comments, and revisions. This new feature allowed us to revamp our Travel Authorization Workflow, our Deployment Template Workflow, and our Marketing Collateral Workflow. My challenge is making sure our workflows are the best they can be, utilizing the new available features.

In the world of Voalte a great example of where new features = new workflows is in our VoalteOne 2.0 Release. With the introduction of Read Receipts caregivers no longer have to constantly ping colleagues as to whether or not they read a certain message (i.e. “Can I get ice in Room 205?”). Instead, they can check for a read receipt and if the other party doesn’t read a message in time they can transfer the request to someone else. The challenge for hospitals is having people who re-evaluate workflows actually take into account all the new features available to them.

Who on your staff turns new features into new workflows?

There is no question that the iPhone is the king of smartphones when it comes to clinical communication. No other device has been so widely adopted by nurses, doctors, and other caregivers.

In celebration of the iPhone 5 release, the five improvements listed below ensure that Apple’s latest iPhone continues to be the king of communication devices in the enterprise healthcare space:

1. Larger display with 44% more color saturation. As more applications provide medical document and imaging features, the richer and better display continues the iPhone’s dominance as the essential medical device for accessing patient information.

2. 802.11N support. The iPhone 5 supports 802.11 a/b/g/n on 2.4Ghz and 5Ghz. This is a HUGE, HUGE win for future VoIP support on the iPhone. It also supports secure information downloading on an enterprise’s wireless network.

3. 4G LTE connectivity. The future of mHealth depends on ultra fast connectivity in locations outside the walls of the hospital. Furthermore, 4G LTE support from iPhone promotes video and other telehealth focused applications.

4. A6 CPU – faster performance, better battery life. Having the iPhone survive through a 12-15 hour shift is critical for point-of-care communication. The iPhone 4S was easily able to make this mark – with a new and improved battery, we can expect the iPhone 5 to last even longer at the point-of-care.

5. 20% lighter, 18% thinner. Caregivers have to carry around many tools to do their job. A lighter, thinner iPhone is just icing on the cake.

Apple continues to amaze and dominate the smartphone market with the design and functionality of their products. It’s incredible to see the improvement from the first iPhone 3 to the new iPhone 5. One can only imagine what the iPhone 10 will look like in 5 years…

Long live the king of mHealth!

When I joined Voalte six months ago, I was already a fan of the iPhone. I had read about this fantastic company providing a revolutionary healthcare communication solution via the iPhone. Needless to say, I was eager to join the team. I love providing excellent customer service and I love the iPhone, but providing support to those who care for others is especially rewarding. 

As a Voalte BFF, I provide Voalte support to caregivers at the point-of-care in real time. I’m there with our users throughout the course of a busy day to answer questions or provide other assistance that enables them to get back to their patients quickly. At any moment users can reach out to me by sending feedback at the touch of a button and I am able to respond just as quickly.  We BFFs do this all day, every day. It’s really all we think about.

Now caregivers are smart people. They’re well trained professionals and the work they do is complex and demanding. They’re dealing with changes in healthcare and responding to those who are in their care. They’re really amazing people. On top of everything they have to do, they’re navigating a technology leap from a patchwork of communication methods (personal pagers, overhead paging, call lights, patient monitoring systems, landline phones, and etc.) to Voalte, the one solution that allows for comprehensive communication from the palm of their hand. Suddenly, communication can travel effortlessly to and from your handheld smartphone at the tap of the screen. Voalte is an amazing and powerful solution for critical hospital communications.

So how do our users make the leap to the next level in communication technology? First, by being a caregiver at one of the best hospitals in the country! And while smartphones may seem to be ubiquitous, they are new to some of our users. The idea of using a smartphone may at first seem intimidating to some, but Voalte is built for comfort! Those who are new to smartphones sometimes need a bit of coaching on the phone itself. I’m the friend they can rely on to help them get over that little bump in the road. I’m their BFF, and our BFF team is there pretty much whenever we’re needed so that caregivers can get back to doing what they do best. Their transition to the Voalte solution is often an exhilarating experience because the user interface is so intuitive that they’re able to enjoy the benefits of improved communication immediately.

For me, it’s all a matter of perspective. You don’t need to know how to rebuild an engine in order to drive a car, and you don’t need to know every detail of how smartphones work in order to use one successfully. The Voalte solution makes it easy! Have a suggestion, comment, or question? Reach out and let us know. You’ll find my team listed under Voalte BFF in the directory.

Better communication means better caregivers.

Better caregivers mean better patient outcomes.

 

Fresh faces and excitement fill the room before each training class begins. Users chitchat amongst themselves thinking “what in the world is this lady going to train us on today?” They discuss what’s going on with their patients, their team dynamics, and their life in general. Often times, people come into class with preconceived notions from past in-service trainings and possible knowledge of iPhone or smartphone use. They may even discuss how Voalte will be perceived among their coworkers.

Now fast forward to the day of the unit’s “go-live”. Users may be a bit nervous about using Voalte. But there will be two major differences between those that attended training and those that did not: adoption and usability.

Users that attended training leave class excited about Voalte and how it will improve communication. Those that did not attend may feel obligated to use something they hardly know anything about. Adoption is key to the success of the Voalte implementation – or any other technology for that matter. Training class attendees know how to “Add to Favorites”, send feedback, find their extension, add contacts to the directory, and so much more. Also during training, users are given a user guide that provides step-by-step instructions on the Voalte application. If you do not attend training you are given a phone and left to ask questions that could have been answered. That person will only be able to use the basic functions of the application and are ultimately left at the mercy of their colleagues.

Attending training allows users to sit down and think about how they will use the application in real time, as they get the opportunity to practice operating the phones in class. As various features are explained, it is amazing seeing the       “ah-ha” moments people have about what the application can do and how Voalte will help with communication among colleagues in their unit, as well as throughout the entire hospital. They will now be able to receive information in a faster and more efficient manner. Training is usually the first point of contact we have with end users and is so critical to the success of the project.

See you in the next training class….

In my travels working with customers and partners I have the pleasure of talking with hospital management teams and end users about Voalte. Frequently our conversations gravitate to the lack of modern wireless communication solutions in healthcare and the truly unique capabilities Voalte brings to the market.

1. Convenience – Voalte eliminates the need for the nurse's "tool belt" of multiple devices and applications. Text messaging, alarms/notifications, and voice communications all flow naturally to a single smartphone application.

 

2. Ease of Use – Why is Apple selling 350,000+ iPhones Per DAY? It's intuitive and simple to use. Voalte leverages the advantages of the robust iPhone hardware and a software application that provides all of a caregiver's communications needs on a shared device with a single sign-on.

 

3. Functionality – I tried text messaging on my old Nokia cell phone. Remember pushing each button 1,2, or 3 times to get the letter you wanted? Forget it. The advent of full keyboards made text messaging a mainstay of communication in the modern world. The non-smartphone handsets currently used in most hospitals today provide the same functionality you abandoned 10 years ago in your personal life.

 

4. Efficiency – The workload of nurses and physicians is astounding. Few jobs require keeping multiple "balls in the air" quite like the hospital environment. A study shows that communication with team members, or other departments, accounts for 20.6% of nurse's time. Providing more streamlined communications leads to happier more effective caregivers. The result is more time spent at the bedside with patients and fewer mistakes. Voalte provides better outcomes and happier patients. This all leads to higher reimbursement and lower cost to the hospital and our over burdened healthcare system.

 

5. Flexibility – The typical process for replacing broken wireless phones in the hospital is for the telecom team to order the same proprietary phones they have been using for decades. The "new" handsets may be a different color or shape, but provide the same limited functionality and user interface they've always had. Why replace a dead-end phone with another dead-end phone?

 

Voalte can custom provision iPhones tailored to the hospital system's needs or even customize by department. Voice, alarms, and text are just the beginning. Voalte puts the power of 50,000+ medical applications in your hands at the bedside – drug reference, med math calculators, language translation – the options are endless and growing every day. Shouldn't your wireless hardware and software solution have the flexibility to grow and change with your communication needs?

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.