Medical Connectivity Consulting Improving Patient Flow through Technology Point of Care (PoC) Technology Planning Prepared for Cardinal Health.

Medical Connectivity ConsultingImproving Patient Flow through Technology

Point of Care (PoC) Technology Planning

Prepared for Cardinal Health

External Hospital Pressures

Patient safety – JCAHO, Leapfrog, etc. Publicly available outcomes data Adoption of mandated nurse to patient

ratios Continued nursing shortage and skill gaps Patient satisfaction – Press Gainey scores Evolving technologies and new vendors EMR/EHR adoption pressures

Resulting Health Care Trends

Most patient flow bottlenecks occur in critical care areas – ICU and telemetry – ED overcrowding and ambulance diversions continue

Patient monitoring and ventilators are moving to general care units to off-load critical care areas

New care delivery strategies – variable acuity units, house-wide monitoring, medical emergency teams

Renovation and building trends – private rooms, decentralized nursing stations, “universal rooms”

Technology Evolution

Medical devices and IT systems are blurring Device data integration with EMRs Central station proliferation (telemetry,

pumps, ventilators) Alarm notification systems

Increasing PoC software adoption (meds admin, EMR, CPOE, etc.)

Proliferation of PoC computing devices RFID adoption (patient, staff, asset

tracking)

Changes at the Point of Care

Enterprise solutions are needed for what was once considered stand-alone Various medical devices integrated with

information systems (e.g., EMR, remote care)

House-wide access to surveillance and therapy delivery data – management and alarms

Wireless communications with phones, nurse call, and medical devices

What’s Your Situation? How many different nurse call systems do you

have? How many individual medical device networks are

installed? How many vendors provide your monitors, pumps

and ventilators? How many central stations will you have on nursing

units in 5 years? How many point of care computing devices do your

nurses really need? How many will they accept? What would it cost to “upgrade” all your nurse call,

patient monitoring and IV pumps to support connectivity and IT integration?

Medical Staff

Access to resources

Patient satisfaction

Productiveenvironment

Clinicalarms race

Organizational SilosIT

Project mgtMission-critical infrastructure

PoC computingdevices

Enterprise solutions

Point of Care

Admissions criteria

NursingStaffing models

Care delivery methods

Policies & proceduresNursing unit design

BiomedsPatient safety

Device evaluations

Direct clinicalsupport Patient satisfaction

AdministrationOutcomes

Bed utilization

Patientmonitors

Telemetry packs

IV pumps

Ventilators

Spot vital signsmonitors

PoC diagnostics

MedicalDevices

Alarms

Patient assessments

Medsadministration

Coordinating care

Patient education

Patient care

Documentation

Tasks

Nurse call

Overhead pages

Phones Pagers

Communications

Computerson wheels

PDAs

The Point of Care

Patientmonitors

Telemetry packs

IV pumps

Ventilators

Spot vital signsmonitors

PoC diagnostics

MedicalDevices

Alarms

Patient assessments

Medsadministration

Coordinating care

Patient education

Patient care

Documentation

Tasks

Nurse call

Overhead pages

Phones Pagers

Communications

Computerson wheels

PDAsVariable workload by patient

Direct care vs. facilitating careOpen nursing positions

Nursing skill levels

Interrupt-driven environmentDirect care sometimes lags

Delays in care deliveryTasks poorly aligned with devices,

and information systems

Disparate alarmsDifferent alarm annunciationDifferent alarm classifications

Alarms at device or central station

Alarm fatigueFailure to rescue

No single vendor solutionVendor standardization difficult to

achieve

Two-way phone tagUnheard calls or pages

Delayed or undelivered pagesProliferation of devices

Noise and confusionUnreliable communications

Delays in care deliveryPatient safety impact

Point Solution Limitations

Vendor’s PoC solutions fail to cross vendor and device categories – they only solve part of the problem

Unnecessary and expensive upgrades Proprietary tech that creates lock-in

through high changing costs Proliferation of computing devices at

point of care

Emergin Integration Suite

A foundational integration platform that drives process improvement – standardization, interoperability and automation

Open, vendor-neutral, device independent Orchestrates over 200 best-of-breed systems

using plug-and-play technology Modular and scalable, begin with a single

system and add service components incrementally

Zero-Defect Communications

Enterprise Architecture

Point-of-CareSystems

InformationSystems

BuildingSystems

EMR

Dashboards

EmerginOrchestrator

Client

CommunicationSystems

Enterprise Service Bus

AdapterAdapterAdapter

Adapter

StaffDirectory

PatientDirectory

LocationServices

Universal Assignments

White Board

Command Center

Patient Safety Indicators

Quality Metrics

InfrastructureSystems

Available AdaptersA4 Health SystemsAdaptiveAeroscoutAlcatelAmtelcoAarmarkAscomBMCCanamexCardinal HealthCare TechnologyCernerCingularCiscoComtech WirelessDatascopeDraeger MedicalDukaneEclipsysEkahauELOEXI

FrontrangeGE HealthcareGE SecurityGet Well NetworkHewlett PackardHill-RomHome FreeJohnson ControlsLife LineMcKessonMeditechMicrosoftMotorolaMultitoneNECNextelNotifierNortelNote PagePCSC

Philips MedicalPicisPremisePremiseRadianseRaulandRF TechnologiesSBCSDCSiemensSkytelSimplexGrinnellSpacelabsSpectraLinkSprintStartelSurguardSwisslogSymbolTAC Americas

TektoneTeletrackingTMA SystemsTOATycoUSA MobilityVaratronicsVasonaVeriChipVerizonVersusVisionLinkVisiplexVoceraWavewareWescomWest-CallXTendZetron

Performance ManagementPatient Safety Officer

Nursing Reports provide the following to evaluate staff-patient ratios and nurse vigilance:

Total Alarms Per VendorTotal Alerts Per VendorAlarms Per LocationAlarms Per Sensitivity

IT/Communication QoS Reports provide the following to monitor IT Quality of Service:

System MalfunctionsTotal Successes/Failures Per VendorTotal Messages Per System TypeTotal Messages Per CarrierTotal Messages Per Recipient

A Patient Safety Officer can review a root cause analysis transcript of activity to trace errors and omissions to the second:

Alarm SetDelivered to Communication SystemDelivered to Communication DeviceDelivered to RecipientRead by RecipientAcknowledged by RecipientAlarm Reset

Nursing Leadership IT/Communications

Operational Efficiencies A Service-Oriented Architecture unites

departments and drives teamwork across the healthcare enterprise

Leverages and extends the life of legacy system investments

Drives standardization & interoperability across multiple silos

Enables healthcare organizations the flexibility to pick-and-choose any combination of disparate technologies; enables best-of-breed selections

Produces score cards that monitor progress of event activity and dashboards the measure operational performance

Staff Productivity

Creates teamwork by enabling communications across multi-disciplinary departments

Automatically populates patient and staff directories; no more manual data entry

Standardize the way that clinicians enter staff assignments; perform this task globally, not locally

Location services - Quickly and efficiently find objects and people

Failure Mode & Effects Analysis

Proactively identifies system malfunctions and alerts supervisors to take immediate action

Reduces, if not eliminates, human mistakes by proactively monitoring common errors and omissions

Helps healthcare organizations move away from timely and anecdotal investigations; produces a root cause analysis transcript that can quickly and efficiently identify errors

Adds checks and balances to identify patient and staff location during a critical alarm situation

Can assist in reducing mortality rates by adding the necessary ‘safety net’ required for improved patient safety

Cardinal Alaris Gateway

Alarms Management

Server

EMRStaff

DirectoryPatient

DirectoryLocationServices

DashboardsEmergin

OrchestratorClient

CommunicationSystems

CommunicationSystems

CommunicationSystems

Point-of-CareSystem

Point-of-CareSystem

Enterprise S

ervice Bus

Gateway Features

Pump alarms transmitted from Alaris to Emergin Pump, Syringe, PCA Occlusion, PCA-pause, Air-in-line, etc.

Monitoring alarms supported SpO2, EtCO2 EtCO2 – no breath, disposable

disconnected, etc.

Gateway Benefits

Improved Communications Faster Response Times Improved Workflow “Root Cause” Analyses

Return on Investment Summary

Leverage existing technologies -- not ‘rip-and-replace’

Enterprise workflow automation -- assignments, management reports, communication systems

Nurse Productivity Gains – 51% improvement in completing patient tasks, $37,700 per care unit per year (see U of Maryland study)

Patient Safety – root cause analysis transcripts for adverse events, including sentinel events/ supervisory alerts

Patient Satisfaction – raise scores by improving response time

Staff Satisfaction/Retention – improve the clinical processes to reduce workload

Quantitative ROI

Qualitative ROI

Some Key Questions

How long does a root cause analysis take now?

How can you maximize communications for disaster readiness?

What facilities alerts need to be managed? How is that done today?

Medical Connectivity ConsultingImproving Patient Flow through Technology

www.emergin.com

www.cardinal.com

Tim GeePrincipal

[email protected]