Recently I had the privilege of attending User Interface Conference 17 over in Boston where I met some really interesting and talented people. I attended some outstanding sessions and workshops to help us improve and innovate our design process over here at Voalte. One session that resonated with me was Luke Wroblewski's talk on 1st person user interfaces where he spoke about the current trend in touch-based interfaces and how augmented reality and the use of sensors in everyday items will become the interfaces of tomorrow, paving the way for natural interaction interfaces over learned voice or esoteric device specific commands (swipe to delete anyone?).

Being part of such a saturated market, where the new buzz word 'HIPAA-compliant text messaging' is being slapped on everything like a 'Gluten-free'' label, means we constantly have to keep one eye on the goal and one toward the future. This talk got me thinking about some of the cool new ideas we could use to improve healthcare communications in the future.

Imagine being able to use your phone's altimeter (or interpolated location based on WiFi access points) to trace a nurse's route throughout the hospital. You could automatically set them as 'busy' when they enter the cafeteria or the break room and forward alarms to their backup.

There is also the concept of wearables, where users affix an unobtrusive device to their clothing which records information from a built-in GPS, altimeter, pedometer, gyroscope, accelerometer, temperature sensors, and more! We would be able to tell if a physician is sleeping, driving their car, or out on a hike, and look through their backup list to try and not disturb them if another physician is readily available.

New tools and paradigms like this will allow us to gather information about a user's surroundings and let the software work for you, naturally, as you would expect it to. As a software developer and user interface designer, it is a very exciting time to be in the healthcare communication market. 

You may have heard about cloud computing, but what is it and where did it come from? If you’re a Voalte user, you are already using the cloud. Congratulations, you’re on the cutting edge of technology! 

Cloud computing got its name from engineers' practice of drawing networks as clouds on whiteboards. Drawing a cloud is easier than drawing a bunch boxes and lines for the connections between the client and server. Over time it also became an easier way to talk about server computers too.

The term is used to describe various ways of sending data across a network from one computer (like your iPhone) to another (like the Voalte server). The server then processes your data for you. In this case, it’s the Voalte cloud! Think of it as an assistant doing your bidding. Or think about it like an iceberg. The software running on the iPhone or on the desktop is the tip, but underneath there’s big chunk of software in the network doing its job. That software is running on the server computer.

When you send a message on your Voalte phone, despite what you might think, you’re not sending it directly to your co-worker. Your message goes through the hospital’s WiFi network to a computer called a server. This is a computer in an equipment rack somewhere in your hospital’s IT department. The software on that computer then looks at your text, figures out if your co-worker is logged in and can be reached on WiFi, then relays that text. Otherwise it waits until it can reach your co-worker and sends that message later.

As a Voalte engineer, my co-workers and I create features by writing code on the server, on the iPhone, and on the desktop clients. That software has to communicate across the network. We also define the network protocol that our software uses to talk across that network.

When we find problems, we have to figure out if the problem is on the iPhone, desktop, or the server. Or, maybe there’s a network communication problem in the middle? We don’t like WiFi problems any more than you do!

Writing networked software can be challenging, but it’s also rewarding. I enjoy writing our Voalte software and seeing it used for an important purpose: taking care of patients.

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!

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?

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!

I’ve often been asked if a proprietary SIP PBX or an open source PBX should be utilized in my environment. Well, the answer to this question can be rather complex, depending upon your needs. There are reasons one may be beneficial over the other, as I have explained below.

An open source SIP PBX will normally interoperate with any PBX, proprietary or open, as long as it supports the SIP RFC 3261, the IETF SIP standard. The great thing about an open PBX is you can customize the software to suit your needs. There is also plenty of online help to get you going and even to help you once you have started. The only negative thing about the open PBX is it may be more difficult to get paid support.

A proprietary SIP PBX may not interoperate with another proprietary SIP PBX. Many times companies add proprietary SIP extensions to their code, which prohibits some interoperability with other proprietary SIP PBX’s. Proprietary PBX’s may not completely follow the IETF standard either, which also adds to interoperability issues, especially with other proprietary PBX’s. A proprietary PBX will often limit you to purchase other peripheral hardware just from that one vendor. The nice thing about proprietary PBX’s though, is they normally have a paid support staff to aid you when you need assistance.

In conclusion, the open source SIP PBX will be much less in expense compared to the proprietary PBX. There are no licensing fees and you do not have to sign contracts for support. As long as you have a knowledgeable staff and want to save on costs, the open source SIP PBX is certainly the way to go. A proprietary PBX is just that, proprietary, and often keeps your selection down to just the one vendor.

I had the opportunity to attend and exhibit Voalté at the Smith Seckman Reid (SSR) Mobile Healthcare Technology Summit in Houston, Texas in May. 

The Summit was a two-hour panel discussion that explored how mobile technology including smart phones, the iPad, and various available applications are impacting the future of healthcare. SSR's Vice President of Communications and Technology Planning Scott Johnson and Project Manager Velma Jackman lead the event. 

When I received the invite and saw the list of esteemed panelists, attendees, and exhibitors I could not help but think we must be on to something here. 

“With mobile device technology and applications rapidly advancing in healthcare, we thought it was important to start a dialogue about the issues and opportunities with industry leaders from different perspectives,” stated Johnson as the reason for the Summit. He continued, “We hope to gain insight about the guidelines needed for best practices, legal implications, and maximizing impact on patient safety and staff efficiencies.” 

The panel tackled critical topics and questions including:   

- Clinicians are embracing mobile healthcare technology. Is technology ahead of practice transformation? 

- Will mobile technology improve efficiency and quality of care? 

- Is FDA approval required on applications for clinician liability and patient safety? 

- Will this emerging technology redesign care delivery? 

Towards the end of the session Scott walked up to our table and stopped to scope out the crowd. I asked him, “Scott…do you think we're on to something here...with healthcare and smart phone technology?” He just looked at me, smiled with all teeth showing, and jokingly said, “Nah, these things are going away soon”. 

For me, the Mobile Technology Summit cemented my conviction in what I do as a healthcare technology consultant, why I do it, and why we all proudly wear the pink pants on this quest to redefine point of care communication. 

It also rooted my belief that while what we are doing here at Voalté is still ahead of today’s healthcare technology adoption curve. We need to stay the course and keep educating Nurse and IT Executives on the growth opportunity and the gap they have to bridge between where they are today and where they need to be tomorrow by leveraging mobile devices at the point of care. 

Most importantly, for me, this summit reinforced a concept that I already knew, but was nice to see confirmed unanimously by my peers and colleagues. By providing an easy and unified solution for voice, alarms and text messaging on an iPhone platform, today's clinicians and physicians find value in using these devices to help them reduce the “clinical chaos factor”, resulting in better outcomes and performance results and greater job satisfaction. 

Do you think we’re on to something here?