A relatively small number of patients – often older or chronically ill people – account for a large portion of all medical costs. These include frequent hospital readmissions and managing the consequences of obesity and uncontrolled diabetes. SOURCE HENRY J. KAISER FAMILY FOUNDATION One in five Medicare patients discharged from the hospital will return within a month; half won’t have seen a doctor before their return. More than 50% of all discharged Medicare patients will be back within a year. Healthcare Realities A Few People Cost a Lot
Healthcare Reform Timeline Oct. 1, st Qualification Date for MU Stage 1 Jan 1, 2011 Accounting of Disclosures if EHR after 1/1/11 Jan 1, 2014 Accounting of Disclosures if EHR before 1/1//09 Dec 31, Internal Testing Complete Dec 31, External Testing Complete Jan 1, Compliance July 3, 2011 Last day to start 90 qualification for FY 2011 Oct. 14, 2014 / 15? ICD-10 Compliance June 1, 2010 Red Flag Rule Compliance Oct. 1, 2012 Unique Health Plan Identifier Jan 1, 2013 Claims Status & Eligibility Jan 1, 2014 EFT and Payment/Remittance Jan 1, 2016 All other HIPAA Transactions Jan 1, 2016 All other HIPAA Transactions Jan 1, 2016 Claims Attachments Oct. 1, st Qualification Date for MU Stage 2 Oct. 1, 2014 Qualification Date for MU Stage 3 Feb 18, 2010 Breach Notification Rules Compliance When Industries become digital Major Things Happen! Disruptive Innovation will occur! ??
Healthcare Reform Realities Race to the Bottom (Payment Reform) – Those who can achieve high patient satisfaction and high clinical quality at the lowest cost will survive. – Radical Focus on Performance Management & Quality 1.Clinical / Business Discovery tools will dominate – Tableau, Qlikview, etc Enable Discovery from multiple data sets without complex normalization 2.Ubiquitous Access & Medical Device Integration Become Paramount to = High Quality w/Lower Cost – Improving Safety, Quality & Efficiency, Wireless a necessary component!
Interoperability The ability to integrate devices & systems such that they truly act as one. Literally to operate one from inside another. Graphic Courtesy of
Background / History
Requirements (2007) Desire to Eliminate Central Monitoring Room Need for Information at the Nurses Fingertips Alerts based on specific requirements Visual Indicator, Room and Wave Form (more than just a pager) Automated Escalation Capabilities Speed and Reliability An Engine that would enable the connecting of people and devices.
Clinical / Business Needs Applications / Solutions Infrastructure Usability and Adaptability Governance Security Architectural Concepts
Connexall integrated with Draeger/RIM Monitoring Solution Wifi only devices (RIM Initially / Cincinnati Bell, Latest) Policies on Device Extensive WI/FI network AM Shift Set / PM Shift Set Allows one set to be charging at all times Provides spares in case of failure Alerts for all Critical Alarms & SPO2 Alarms Escalation to House Resource / Charge Nurse Solution
Lessons Learned from BB Most issues were either ; Education Issues (Alarm type/Escalation Rules) Wi/Fi Turned Off Failed Units (Zombie) Drove Need to verify units in working order before each shift starts Acknowledgment sent to all shift units at 7:00 a.m./7 p.m. (House Resource for each unit verifies all devices operational prior to placing them in Service). Report Generated from Logs Daily Reviewed daily w/ follow-up
Status report (a.m./p.m.) Report Generated at 7 a.m. and 7 p.m. Initially the report showed the entire week and every devices status
Status report (a.m./p.m.) Later Redesigned / Revised Report to only show “Exceptions”
In-Place for 8+ Years Near Real-time Alerts Delivered to Nurses carrying Blackberry SmartPhones using; Connexall App integrated w/ Drager Patient Monitoring Wifi only devices (RIM/Blackberry ) Eliminated Need for Monitoring room! - $$$ Fingertip Access w/ Alerts Configured to our requirements Automated Escalation, Speed and Reliability Allows Nurses More time with Patients Decreased Noise and Alarm Atrophy Fast Forward Connexall Solution Drives Simplicity… Order out of Complexity
Journey to the iPhone
Aging Condition of Blackberry’s Issues / difficulty of procurement of Wi-Fi only version Desire to Expand uses of Nurse Carried Device Need / desire to continue to use a Wi-Fi only device Usability! Drivers
Columbia Obstruction Device Electric grid Hungry rodent Cheese Goals are to: Maximize the reward Minimize the pain User Doing a Job Pain of using the tools Work Completed ShockCheese size No go Go Intersection of Technology & Psychology User-centered approach Empirical wherever possible Performance not Preference *Courtesy Human Factors International What is Usability Engineering? A usable product… Is easy to learn Is hard to forget
2013 – Evaluation / Pilot (Blackberry Replacement) Existing Cisco 8945 Wi-Fi Phone vs. IOS (iTouch, iPhone, Ipad mini) Nurse Managers felt need to separate phone from alerting device (may reconsider in future) – (Read and Talk) Usability was best on Apple Devices Nurses liked the ability to see previous messages on the iphone Eliminated iTouch/iPad due to; Voice capability. Future Uses of TouchID (5s) Pilot
iPhone Selected Best Usability and Platform for Future Solution
5 Year Cost Analysis (U.S. Dollars) ** Note OPEX Option Includes Overnight Exchange, Config, & 1 Upgrade to next device version in 5 Year Period Procurement Options
5 Year Cost Comparison Purchase 100 Devices From Carrier (AT&T, Verizon, Sprint, etc) iPhone 5s 16gb without voice/data plan Included the Cost of 1 Std Case and 3 belt clips per year per device Included AppleCare and Cost of upgrading the device to latest model 100 Phones with Accessories for 5 Years = $723,480 Purchase 100 Devices From Cerner iPhone 5s 16gb without voice/data plan Included the Cost of 1 Std Case and 3 belt clips per year per device Includes Overnight Exchange, Pre-config to MDM/Apps, and 1 upgrade 100 Phones with Accessories & Service for 5 Years = $354,980 Basically $55 per month per device
Accessories for Consideration Basic Protective Case (with Hospital Logo) Third Party Sled / Extended Battery & Scanner Consider if Using Phones for more than receiving alerts. We found if just using phone for Alerts Battery was fine for 12 hour shift (no texting, internet, voice, etc.) Bluetooth Scanner + Could be used for Meds Administration, Supplies, etc.
Complete Production Implementation / BB Replacement Evaluate Options for Wider Alerting Labs Medications IV’s Bed Management Assignments Housekeeping Evaluate use of iPhone as wi-fi voice device Evaluate Possible Replacement of Other internal Systems with Connexall Nurse Call, Server Monitoring, etc. Next Steps
Mobile Device Management & Wi-Fi Lessons Learned
Have a “Wired Backup Strategy” Ensure Switches on Emergency Power POE Switch / AP’s Deny Wireless “b” (a/g/n) Support Voice First Dedicated VLAN’s / SSID’s Improves Power Consumption Wireless Lessons Learned
AP Placement Avoid Too Many or Not Enough Cover all Patient Areas Get Third Party Survey / Certification “Outside-In” Layout for best results Best For Location and Coverage Redundant, Embedded / Distributed Controllers Consider Future (Wireless “ac”) Don’t Forget Security! Wireless Lessons Learned
Summary / Closing
Healthcare Reform Drives Organizations who can; Achieve High Quality & Satisfaction at Lowest Cost Wireless and Interoperability can be an Enabler for; Improved Quality, Safety, Efficiency = $$ The Hard and Soft Economics of Wireless are Real You will be supporting Wi-Fi Regardless Design it right with medical grade redundancy OHH Saved saved nearly $2 million in Capital by implementing Wi-Fi Patient Monitoring over WMTS (2 Campuses) The Flywheel Theory holds true for Wireless (Jim Collins) Build a Solid and Secure Wi-Fi Infrastructure to support your future! Wireless Capabilities drive Innovation Summary The Economic Case for Wireless
Mobile Evolution Applications versus Devices Wireless & Interoperable Wired & Interfaces Standalone Devices Embedded Apps & Wearable
Look For, Select, & Empower, Power Users at all levels (Physicians, Nurses, Pharmacists, Network Engineers and Architects etc..) Partnership is Key (Physicians, Nursing, Lab, Pharmacy, Biomed, IT, Vendors) Innovate for the best experience, improve processes & systems for patients…clinician…all team members Usability Engineering & Service Focus can be major difference makers (Consider the Human Factors!) Mobility & Wireless is here to stay – Plan & Design For it! Get Advice / Ask for Help! Final Thoughts Don’t be an IT/Clinical Engineering Department of NO, be one of KNOW-HOW!!!
Thank you Steve Miller Chief Technology Officer Coordinated Care of Oklahoma