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.

I am thrilled to have joined Voalte as VP of Product and Alliance Management. As the leader of the Product Management team, my primary role is to make sure we build the right product, to be available at the right time, and designed in the right way to deliver a cost-effective, compelling communication solution for caregivers and support staff. Just as mathematicians can’t live without a calculator, we want clinicians to feel the Voalte empowered smartphone is the best tool to help them deliver a high level of patient safety and quality of care. Of course, no one piece of equipment is a silver bullet that solves every problem, but ultimately we want to deliver an increasingly valuable and powerful tool that is reliable, efficient and – most importantly – effective. 

At Voalte, we understand that to be successful at meeting that lofty objective, the product and alliance/partner teams must go out and talk with nurses and physicians inside and outside the hospital. The participation and guidance of actual users is the foundation of everything we do at Voalte. Based on our users’ proactive input and constant feedback, Voalte has built a solid reputation for designing apps with the functionality and usability that has resulted in a quantum leap in solving the communication challenges of today’s healthcare personnel.

We’re also dedicated to building compelling alliances with companies that make related best-in-class healthcare products that are ideally suited to co-reside on the smartphone with Voalte apps. In certain cases, it makes sense for such products to be tightly integrated with Voalte applications, and in other cases to be more loosely coupled, as in basic interoperability. While the majority of such partnerships will be in software applications, we are actively building alliances with hardware vendors to deliver even more effective uses for our compatible and complementary products. 

Done right, the integration of barcode medication administration (BCMA) and radio frequency identification (RFID), integrated with the smartphone hardware and our leading voice, alarms and text messaging capabilities, will demonstrate our commitment to delivering what nurses and doctors need to provide safe, efficient and effective patient care. Naturally, Voalte is fully engaged with the leading EMR vendors to create clinically compelling applications built on the Voalte communication platform … and is open to many more alliances and uses.

Communication is well recognized as a huge challenge for hospitals. The dynamic environment requires the exchange of a plethora of communication types, such as voice, alarms and text, but also is evolving rapidly to include images, video streaming and voice dictation. Add to this the requirement for managing all communication based on work schedules, real-time availability and roles, responsibilities and certification/licensing levels, and before you know it you’re talking about a truly complex communication challenge.  

In my new role at Voalte, I’m looking forward to helping caregivers do what they do best – saving lives and creating positive patient outcomes. At Voalte, we believe that arming hospital staff and caregivers with a single, versatile communication tool is one of the most significant ways to make a positive difference in healthcare for the 21st century.

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.}

It seems like almost every day a new vendor announces a HIPAA-compliant text application. Here at Voalte, we consider it our business to know who’s entering the market, and we’re impressed by the steady stream of new vendors. But does the development of an effective clinical communication solution require more than writing an app, labeling it “HIPAA-compliant” and posting it to the App Store?

The short answer is yes. To be a complete clinical solution provider, you need to offer more than text, and you need to venture outside of the App Store and the Google Apps Marketplace. To offer a complete solution, you need the staff, expertise and technology to support on-site integrations with key hospital systems like PBXs, Wi-Fi networks and alarm systems. And after you’ve integrated the systems, you’ll need to be on-site to add real value by consulting on new workflows, training users and supporting the staff when the solution goes live. Finally, you have to keep those hundreds of smartphones you just deployed running smoothly with a continued on-site presence.  

For many industry newcomers, these requirements are expensive, messy and don’t fit into a Facebook-style business model.

In the quest to implement “voice, alarms and text” in hospitals large and small, Voalte has managed successful integrations to:

- Middleware products from four vendors
- PBXs from six manufacturers
- Nurse call systems from four manufacturers
- Wi-Fi networks from three vendors

The result is in an easy-to-use communication solution that reduces noise, improves clinician satisfaction, and allows healthcare providers to focus on what originally led them to their calling.

Things will get even more exciting with our next app, which lets people run Voalte on their personal devices and connect to other Voalte users anywhere, any time. But more on that in my next blog. 

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.

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.

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….