UNIFYING HOSPITAL COMMUNICATIONS PRESENTED BY: ARNAZ ALAVI, DARYL WIELAND, ANDREW O'HARA, AND JAMES TESSIER Board of Directors Presentation March 2013.

UNIFYING HOSPITAL COMMUNICATIONSPRESENTED BY: ARNAZ ALAVI, DARYL WIELAND, ANDREW O'HARA, AND JAMES TESSIER

Board of Directors Presentation

March 2013

Memorial Hospital

Introduction

Patient care involves many different individuals and support services–all of whom need to share and discuss patient information in a timely manner

Critical need to connect and communicate with the right clinician at the right time about the right patient

Better communication means better care–both in terms of patient safety and quality

Problems with Current Communications

Healthcare industry has been using outdated methods of communication for decades (pagers, stationary phones, etc.)

Both productivity and patient safety are impacted by poor communication between clinicians

Communication inefficiencies cost hospitals more then $10 billion annually (Sands, 2008)

“Ineffective communication is the most frequently cited root cause for sentinel events”

-The Joint Commission

Current State of Communications at Memorial Hospital

Technology: Avaya PBX phone system Rauland Responder 5 nurse call system Proprietary text and overhead paging system Separate paging system for critical patient alarms

Problems: Difficult for clinicians and support staff to connect with each

other in real-time (leading to delays in care) Clinicians texting on personal phones (HIPAA violations) Frequent noise from alarms and overhead paging (affecting

patient satisfaction) Alert fatigue from alarm pagers and beeping devices (patient

safety concerns)

Proposed Solution

Unify Memorial Hospital’s communication system Eliminate legacy system, including call

bells, numeric and overhead paging Implement integrated voice, two-way text,

and alert system on a single communication device

Integrate new system with existing phone and nurse call systems which will run on existing 802.11n Wi-Fi network

Advantages

Clinicians will be able to… Immediately connect with other clinicians

and support staff and improve timeliness of notifications

Send HIPAA-compliant text messages to other clinicians and support staff

Receive relevant patient alarms that auto-escalate to other clinicians if necessary

Advantages

Memorial Hospital will… Have a unified hospital-wide

communication infrastructure Experience a significant reduction in

overhead paging Have a reliable record of all hospital

communications and alarm receipts

Disadvantages

System is heavily network and Wi-Fi dependent

Clinicians and support staff will have to adapt to a new technology

Perceived disruptions of use of smartphones and weakened interpersonal relationships by decreased direct communication

Individual devices are fairly expensive – loss and theft could be an issue

Available Systems

Vocera Utilizes proprietary, wearable devices for voice

communication and uses iOS, Android, and Blackberry for voice and secure messaging

Voalte Utilizes iOS for voice, secure messaging, and

patient alarmsTiger Text

Utilizes iOS and Android for secure messaging and notification (no voice capability–excluded from further analysis)

Vocera

Lead offering is voice-activated hands-free badge allowing instant communication with clinicians and support staff (however, primarily used by nurses)

Offers smartphone app for voice, secure messaging, and alarms systems, but not widely used today (limited opportunity for site visits)

Estimated cost*: Initial investment: $1.0 million Present value of 10-year costs:

$2.1 million

*Financial model available in Appendix 1

Voalte

Lead offering is iPhone-based voice, secure messaging, and alarm system

Commonly used by both physicians and nurses

Also offers desktop-based messaging app that communicates with all mobile devices

Estimated cost*: Initial investment: $1.1

million Present value of 10-year

costs: $1.5 million*Financial model available in Appendix 2

Metrics for Communications Systems Upgrade

Objective Provide safe, patient centered, timely, and efficient care

through improved communications Goals

Decrease time spent finding the most efficient way to communicate to other healthcare team members

Facilitate more efficient and safe patient hand-offs Expedite room turnovers

Measures Track the amount of time spent connecting to the correct person Track the time spent from initiation of communication to end of

communication for patient hand-offs Track the time lapsed between calling for room turnover and room

being ready for the next patient

Implementation

Propose a staged deployment:1. Emergency Department (initial trial area)

Uses: contact between triage, main desk, and staff location

2. Operating room suite Uses: turnover teams, front desk contact, minimizing

overhead paging, anesthesia/surgeon notification

3. Intensive care units Uses: emergency response notification, staff location

4. Roll out to all nursing floors Uses: notification and paging between nursing staff and

clinicians, eventual integration with call lights and network connected devices

5. Eventual roll-out to outpatient clinics Uses: clinician paging, notification, and alerts

Request to Proceed

Allocate manpower, draft RFP, conduct site visits, choose vendor (with input from clinical leadership), and enter negotiations;

Conduct ED pilot; and, if successful, Continue with purchase and implementation

of full system in FY14

Other considerations: May need to expand Wi-Fi infrastructure to

handle increased load on the network

Questions

Appendix 1 – Vocera 10-year Plan

Back to Vocera slide

0 1 2 3 4 5 6 7 8 9 10 Total

Devices:New devices 1,000 10 10 10 10 10 10 11 11 11 11 1,104 Replacement devices - 100 100 101 102 103 104 105 106 107 108 1,037 Total devices 1,000 1,010 1,010 1,020 1,030 1,041 1,051 1,062 1,072 1,083 1,094 1,094

Replacement rate 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% Device growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%

Cost per device $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 Total device cost $ 425,000 $ 4,250 $ 4,250 $ 4,293 $ 4,335 $ 4,379 $ 4,423 $ 4,467 $ 4,511 $ 4,557 $ 4,602 $ 469,066

Licenses:New licenses 1,500 15 15 15 15 16 16 16 16 16 16 1,657 Total licenses 1,500 1,515 1,530 1,545 1,561 1,576 1,592 1,608 1,624 1,640 1,657 1,657

License growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%

Cost per license $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 Total license cost $ 375,000 $ 3,750 $ 3,750 $ 3,788 $ 3,863 $ 3,902 $ 3,941 $ 3,980 $ 4,020 $ 4,060 $ 4,101 $ 414,152

Cumulative license cost $ 375,000 $ 378,750 $ 378,750 $ 382,538 $ 386,400 $ 390,302 $ 394,242 $ 398,222 $ 402,242 $ 406,302 $ 410,402 $ 410,402

Maintenance:% of cumulative license cost 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%

Annual maintenance expense $ 113,625 $ 113,625 $ 114,761 $ 115,920 $ 117,091 $ 118,273 $ 119,467 $ 120,673 $ 121,891 $ 123,121 $ 1,178,445

Implementation / professional services $ 200,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 400,000

Total cost $ 1,000,000 $ 141,625 $ 141,625 $ 142,841 $ 144,118 $ 145,371 $ 146,636 $ 147,913 $ 149,204 $ 150,507 $ 151,823 $ 2,461,664

Cost of capital 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%

Present value $ 1,000,000 $ 133,608 $ 126,046 $ 119,932 $ 114,155 $ 108,630 $ 103,372 $ 98,371 $ 93,612 $ 89,085 $ 84,777 $ 2,071,589

Appendix 2 – Voalte10-year Plan

Back to Voalte slide

0 1 2 3 4 5 6 7 8 9 10 Total

Devices:New devices 1,000 10 10 10 10 10 10 11 11 11 11 1,104 Replacement devices - 100 100 101 102 103 104 105 106 107 108 1,037 Total devices 1,000 1,010 1,010 1,020 1,030 1,041 1,051 1,062 1,072 1,083 1,094 1,094

Replacement rate 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% Device growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%

Cost per device $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 Total device cost $ 800,000 $ 8,000 $ 8,000 $ 8,080 $ 8,161 $ 8,242 $ 8,325 $ 8,408 $ 8,492 $ 8,577 $ 8,663 $ 882,948

Licenses:New licenses 1,500 15 15 15 15 16 16 16 16 16 16 1,657 Total licenses 1,500 1,515 1,530 1,545 1,561 1,576 1,592 1,608 1,624 1,640 1,657 1,657

License growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%

Cost per license $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 Total license cost $ 225,000 $ 2,250 $ 2,250 $ 2,273 $ 2,318 $ 2,341 $ 2,364 $ 2,388 $ 2,412 $ 2,436 $ 2,460 $ 248,491

Cumulative license cost $ 225,000 $ 227,250 $ 227,250 $ 229,523 $ 231,840 $ 234,181 $ 236,545 $ 238,933 $ 241,345 $ 243,781 $ 246,241 $ 246,241

Maintenance:% of cumulative license cost 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20%

Annual maintenance expense $ 45,450 $ 45,450 $ 45,905 $ 46,368 $ 46,836 $ 47,309 $ 47,787 $ 48,269 $ 48,756 $ 49,248 $ 471,378

Implementation / professional services $ 50,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 100,000

Total cost $ 1,075,000 $ 60,700 $ 60,700 $ 61,257 $ 61,847 $ 62,420 $ 62,998 $ 63,583 $ 64,173 $ 64,769 $ 65,371 $ 1,702,818

Cost of capital 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%

Present value $ 1,075,000 $ 57,264 $ 54,023 $ 51,433 $ 48,988 $ 46,644 $ 44,411 $ 42,286 $ 40,263 $ 38,337 $ 36,503 $ 1,535,152

References

Horwitz, L. Detsky, A. Physician Communication in the 21st Century: To Talk or to Text? JAMA. 2011;305(11):1128-1129

Wu,R et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res. 2011; 13(3): e59.

Wu, RC, et al. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. JAMIA. 2013 Jan 25. ePub.

Daniel Z. Sands. Challenges in Healthcare Communications. How Technology Can Increase Efficiency, Safety, and satisfaction. July 2008