Talking HealthTech: 294 – Strategies to optimise the value of digital technologies and improve organisational resiliency in a smart, connected hospital. Dr Benjamin Kanter, Vocera – now part of Stryker

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We’ve been digitising healthcare for years. We’re taking regular, plain old healthcare, and turning digital. But it’s not really the final destination, though, is it? Because when you think about it, just being digital doesn’t solve many of the big problems in healthcare alone. Sure, better infrastructure, hardware, and software can make things faster, more reliable, and more powerful… but that’s the enabler, for something more. Something smarter.

Dr Benjamin Kanter, Chief Medical Information Officer at Vocera, now part of Stryker, joins Pete in this episode to discuss strategies for maximising the value of digital technologies in a smart, connected hospital.

About Dr Benjamin Kanter

Dr Ben Kanter is the Chief Medical Information Officer at Vocera, now part of Stryker. In this role, he works closely with clinicians and engineers to co-design the next generation of real-time communication and collaboration solutions for hospitals and health systems around the globe. 

Ben is a physician specialising in pulmonary critical care. He got involved in the technology side of healthcare nearly 20 years ago and for the past 15 years has focused his efforts on critical event notifications and communications in healthcare. 

Ben has been with Vocera for about five years and has two major roles. The first is on the product team, where he helps disrupt by pushing the product team into areas where they may be not comfortable to solve real clinical problems. The other role is to support sales worldwide and educate about communications, infrastructure, and so on.

The importance of a clinician doing the disrupting

A physician involved in the product team provides the clinical voice that the engineers need. You can have all the user-centred design you want, but it helps to have internal clinicians. Fortunately, at Vocera, they have ex-nurses, physicians, and other healthcare professionals working within the team. That is extremely beneficial, given their role is to provide clinically relevant tools. They may be telecommunications, devices, or collaboration software platforms, but at the end of the day, these are used by clinicians in patient care, so, they’re really clinical tools. Clinical personnel should be involved in the design process.

Digital hospitals and the role that communication tools play

For the past 20 to 30 years, hospitals have been replacing analogue and paper systems with digital ones. The reality is that we have been transitioning from analogue to digital; however, who is to say that digital is actually superior to analogue?

Digital is a tool. Although digitisation makes it easier to obtain data, it is not the solution. It has to do with what you do with digital. That is what determines whether a healthcare system succeeds or fails, and being able to truly leverage digital technology is the key to success.

How the concept of doing things smarter appears in hospital health systems

When it comes to healthcare communications, it is referred to as event-driven communications. An event has taken place—it could be a new pathology result or a change in a patient’s vitals. In healthcare, like in so many other businesses, the question is how quickly you can convert that into useable, actionable data, and truly close the loop. How quickly can you solve those issues? So, to be able to harness your digital technology, break down the silos of the many streams of data, and act on it more swiftly, is the ultimate goal. For example, how rapidly can you respond to a sepsis alert? Minutes matter a lot when it comes to patient outcomes. In the event of a COVID surge, how quickly can you boost throughput to bring in additional people? These are typical examples of hospitals that can work smarter by maximising the use of their digital technologies. It’s about time efficiency.

Moreover, it’s not just about working faster. Every single one of these digital systems that a health system puts in place now can send out an alarm which is a clinical decision support message. It’s another interruption and it may have tremendous value. However, let’s say you put in 10 new systems; you now have 10 new systems that are sending information. One of the unintended consequences is that as you start to put smart devices in the hands of your nurses, and if you start sending all this information to them without any kind of workflow orchestration, you’re going to hammer them. They’re going to flood them with information and it may all be important information, but the reality is that the nurses have to take care of patients. Physicians have to take care of patients and you can’t keep interrupting them. The models of how these are done best are still evolving but the data streams aren’t going to go away. Thus, you’ve got to have systems in place that can help sift through the data, make sense of it, and help orchestrate those workflows.

Advice for health systems aiming to upgrade their infrastructure and become smart

Consider medical emergency teams, a concept that originated in Australia, as an excellent model. If you look at that model, you’re attempting to spot the deteriorating patient early. However, many people do not pay attention. It’s not just about finding patients who are deteriorating; it’s also about communicating it to individuals who can take action. This is frequently where things go wrong. Similarly, you may have the best infrastructure in the world for converting all of your data streams into information, but if that information is locked in place, if you can’t guarantee delivery to the people who are accountable for acting on it, you won’t be able to become smarter. To get all of this information out, you must be able to combine your communications technology with your information processing so that your team members are kept up to date. To make sound decisions, you must be aware of your surroundings. If information is delayed, the situation you believe you are dealing with may no longer exist. So, the closer to real-time you can get it, the better, but there’s this tug of war because you could be bombarded with information indefinitely. It’s like if someone tried to give you a suggestion every time you used your computer and gave you a useful hint, you’d do it. Caution must be exercised when it comes to what to send to the staff members.

If you focus on nursing efficiency, you’re concentrating on the wrong thing. Nurses are incredibly efficient at what they do, to the point of exhaustion. We must alleviate their burden in some way. It’s as much about knowing when not to message someone, when not to communicate, and when not to interrupt. That is just as important as knowing when to interrupt because you must be extremely cautious if you have multiple systems running. They might interrupt for the best of reasons. It’s a perfect storm of good intentions—everything is being sent directly to the nurse so that he or she can take action, but the reality is that they are simply overwhelmed by this stuff.

A nursing informaticist who is part of the rollout of a system like this is required so that they have the trust of the nursing staff, who are usually the first responders. They are the ones who are getting things sent directly to them if they start carrying smartphones or other devices.

One good thing to always do if you’re installing a system and intend to send alarms from that system to the nurse, turn it on and begin measuring how many alarms will be sent to your nurse per hour before you begin doing so in real-time. Figure out ahead of time what the volume is going to be, as you may need to reduce it.

Implementation of technology within healthcare settings

 

When attempting to fully build a smart hospital, you must first build your IT infrastructure and then break down the silos of your various digital streams of information. You must decide whether you want to use this in an algorithm to detect or predict whether a patient is deteriorating, as there is a distinction between the two. Then you must consider how you will get it to the staff members who require it. As a result, an increasing number of hospitals are putting devices in the hands of their nurses, typically enterprise-provisioned smart badges. That’s a significant shift for the nurse on the floor. You must proceed cautiously if they have never used these systems before, and if the nurses on the floor have never received direct information from these systems. It truly is “crawl, walk, run.” You must give your people time to adjust because it alters how they work. Healthcare workers dislike changing the way they work not because they dislike technology, but because they are accustomed to doing things a certain way as they know it is safe and that is how they have always done it. Attempting to break some of those antiquated workflows must be done with caution. We’re at a point now where we need to be in sync with our doctors and nurses due to burnout. So, it’s more important than ever. You have to involve your end users. As previously stated, these are all clinical tools at the end of the day. 

The Concept of Presence 

One of the most important aspects of developing a communication system is presence. There are two critical aspects to presence: how it is used internally and what it means externally. If there is a system, such as what Vocera can do, Vocera can take information from multiple systems and aggregate it. They can break down those silos. They have logic in place to convert that into actionable data, but they must know what to do with it. They can only know what to do with it if they know who is working—their roles, licences, and the patients they are caring for. They need to know as much as they can about the end users because they need to figure out where this is going. What happens if that person does not answer the phone? Because this information must be delivered promptly and they must guarantee delivery. Thus, internal presence is required to ensure proper delivery. Otherwise, it would be like a post office without any addresses. It is accomplished by taking information from any type of care team, assignment, process, or whatever the hospitals use, regardless of their mix, and normalising it into a standard database. As a result, it is always known, in real-time, who is working and what their roles are. The second aspect is how transparently the presence information is displayed so that when a healthcare provider is reached, it is clear if the correct person is reached, or if someone else needs to be contacted if the situation is critical.

A growing number of hospitals are moving to some kind of digital scheduling system for their medical staff. More and more of the electronic health records include scheduling and staff assignment; almost every major electronic health record now includes staff assignment, as do bed nurse call systems. So, basically, at the start of each shift, the nurses assign which nurses are working on a certain day, what their role is, and which patients they have. The key point is that you only want them to have to do it. That is something you only want to do once. This is something that Vocera excels at, regardless of where you do it. It doesn’t matter if their system is used for that kind of staff management and care team assignment. They will grab the information and normalise all of it so that they have an up-to-date, centralised database of all of that information.

What to expect from Vocera in the future

Vocera was recently acquired by Stryker. Historically, they have produced hands-free and nurse communication badges. They’ve moved on to a smart badge with a larger screen and the ability to text more easily, and they’ve just released a mini badge, a small lapel badge that also connects to a phone via Bluetooth and can work in either tethered or untethered mode. 

They will continue to work on device integrations with workflows, but more importantly, they will work on improving the way their systems interact with voice. They’re shifting to a more conversational vocabulary, similar to how people are accustomed to using things like Alexa and Siri, where you have more freedom because the systems understand intent. They have a little more understanding of what you’re trying to say and accomplish in medicine; there are many different ways to say the same thing. They are significantly updating their voice front-end interface, which will be extremely important. 

Another area of focus is their workflow engine, which is improving the way they allow customers and partners who have their systems, and they have them all over the world, to create their own new workflows using their system. They’re focusing on workflow, communication technologies, and hardware, and integrating more with Stryker products like beds and OR solutions. Essentially, they are building it with the help of customers. This is a very user-centred design process.

_{Source talkinghealthtech.com}