TPC Healthcare today announced a partnership with Patient Care Technology Systems (PCTS), a subsidiary of Consulier Engineering, Inc. (NASDAQ: CSLR). The partnership brings PCTS’ location-enabled workflow applications to TPC Healthcare’s growing portfolio of healthcare solutions. Under the agreement TPC will market PCTS’ automatic tracking and workflow automation solutions for healthcare with specific focus in New England, the New York Metropolitan area and the Mid-Atlantic.

With over a decade of experience in healthcare specific workflow application, PCTS’s platform gives TPC the opportunity to bring high performing, location-enabled workflow applications to new and existing customer alike. PCTS comprehensive Amelior 360 degrees Enterprise Visibility Platform™ includes products for hospital emergency, perioperative, interventional cardiology and diagnostic imaging departments, as well as facility-wide asset and patient tracking.

“In these times, results matter. As we looked to bring the right location-based solutions to our customers, PCTS’ proven ability to deliver measurable financial and operational impact to hospitals in the ED, OR, and across the enterprise really caught our attention,” says Kenny Schiff, founder and President of TPC Healthcare. “PCTS is our kind of solution. They are focused on providing the right applications to deliver customer success and not on any one specific RFID infrastructure,” he says.

“PCTS and TPC Healthcare have a similar solution-oriented approach to healthcare,” says Tony Marsico, President and CEO of PCTS. “All too often these types of solutions are not given the upfront or aftermarket attention they require. TPC Healthcare has a reputation of truly delivering what the customer needs, from pre-sale to implementation and beyond.”

About TPC Healthcare
Headquartered in Wilton, Connecticut, TPC Healthcare provides mobile point-of-care communication technologies, such as RTLS/RFID, wireless voice, alarm notification, and workflow automation to hospitals and healthcare organizations in the New England and Mid-Atlantic regions. TPC Healthcare’s unique blend of technology expertise, exceptional service, and years of experience successfully delivering point-of-care solutions help hospitals and healthcare organizations improve clinical workflow, increase patient safety, and provide better utilization of patient care equipment. For more information about TPC Healthcare and/or its services, call 888.427.2215 or visit www.tpchealthcare.com.

About Patient Care Technology Systems
Patient Care Technology Systems, a subsidiary of Consulier Engineering, Inc. (NASDAQ: CSLR), helps health care providers to improve patient flow, increase capacity and improve patient and staff safety by visualizing the real-time location and status of people and equipment throughout their facility. Each year PCTS solutions support over 2 million patient visits managed through its various solutions and has shown a proven return on investment in high turnover, high-acuity units such as the emergency department and perioperative suites. The Amelior Enterprise Visibility Suite™ is interoperable with all leading locating technologies, including active-RFID, infrared, ultrasound, ultra-wideband, Wi-Fi and ZigBee. PCTS customers have been recognized nationally for improvements in efficiency and clinical excellence. For more information, visit www.pcts.com.

Here are some key points to consider from my recent article in EnterpriseMobileToday.com.

1. Usability matters. A NICU nurse whose hands are busy diapering a baby has very different needs than someone dispatching code teams, or an anesthesiologist. In pointing out the difference between purpose-built healthcare devices like those from Ascom, Vocera or Cisco (and say a BlackBerry or an iPhone), Emergin often talks about “buttonology.” Visualize code team members fumbling for the Chiclet-sized keys on a BlackBerry Bold when needing to respond to an emergency situation. When seconds matter, better to have a single button push on a Vocera badge, or a simple soft key on an Ascom Medic handset.

2. Where are the applications? Healthcare-specific applications do exist for the BlackBerry, and Palm and Windows mobile smartphones, but they are far from perfect, often without true device/application integration. And mobile healthcare professionals require devices with deeper and tighter integration between hardware and applications.

While software providers like Globestar have smartphone-ready, hospital-friendly applications for alarm notification, escalation and dispatch, they lack tight device integration, making them imperfect. Again, the purpose-built applications, like Ascom phones or Vocera badges, currently have the leg up on the competition, though this may not last for long.

3. It’s the Network. If you don’t have a reliable network that can handle mobile communications, you’re going to run into problems. And in a world where medical professionals traverse from office to hospital to home, that network may really be a network of networks. While it may be okay to drop a call mid-conversation when chatting out on the street with your buddy, it’s not okay when a nurse misses a critical alarm from a fetal monitor.

In spite of significant efforts, the medical grade network (even purely at the building level) is not a reality yet. And while fixed mobile convergence (FMC) vendors like DiVitas (or the big PBX players like Nortel, Siemens and Avaya) have solutions that manage the transitions between networks for multi-mode devices (e.g., in-building wireless’3G), they can’t really fix the network of networks problem. And even if they could, the purpose-built, multi-mode device with true application integration has yet to appear.

4. What about workflow? Spend time in an Emergency Department or Operating Room suite recently? This incredibly fast moving world doesn’t lend itself well to ad-hoc asynchronous communications like email or text messaging that is de rigueur with normal consumer smartphones, especially given all the possible sending and receiving points. Reliable communication starts first with designed workflow and an understanding of the journey information must take from inception to delivery, to acknowledgement and response. Once you have a workable flow, then software applications and devices can be considered.

For more information, see In Healthcare Communications, One Device Does Not Fit All … Yet

Kenny Schiff is a contributor to Internet.com’s EnterpriseMobileToday.com. He is founder and President of TPC Healthcare, a specialty provider of real-time location and point-of-care communication technologies to hospitals and healthcare organizations.

So indeed it is an unusual thing to get competitors together respectfully, and that’s what Intelligent InSites did at their first annual partner summit last week in Fargo, ND. And while Aeroscout was conspicuously absent from the proceedings, the four other key players in the sensory network/RFID/RTLS infrastructure space (I realize that’s a mouthful): Centrak, Ekahau, Sonitor, & Awarepoint were there in full force. No insults, put downs, or barbs. It was refreshingly civil.

A More Open Sandbox

As a relative newcomer to the RTLS space, InSites is taking a decidedly open approach to location enablement (or “Enterprise Visibility” as they like to refer to it). With so many potential applications in the healthcare enterprise that can benefit from location intelligence, InSites’ true differentiation is the platform, and not just a collection of their own applications. This is a more open sandbox than you would typically see in healthcare (traditionally a rats nest from an interoperability perspecttve) and this bodes well for customers who realize that technology tribalism is counterproductive. Their vision is one of location smarts, inbound and outbound, framed by business intelligence: not only good data, but the tools to make sense of that data. And indeed that’s why it made sense for all the infrastructure players to be there together.

Hmm… Beta, VHS, Blue Ray

The summit provided a very well-rounded look at a relatively new industry. Maybe it’s the sports fandom that’s in us, but we looked forward to having a chance to see the infrastructure players all together at the same time. To that end, Vi Shaffer, Gartner’s Research Vice President and Global Industry Services Director for Healthcare, led a lively roundtable with Ekahau’s Tuomo Rutanen, Centrak’s Mark Nowakowski, Awarepoint’s Matt Perkins, and Sonitor’s Terry Aasen. This was followed up on Day 2 by each of the player sharing the unique aspects of their product.

What was very striking to us as we listened to the pitches was how widely different each of these companies’ approaches to providing precise location information is. Nothing apples to apples about it. It’s rare to see key infrastructure players approaches so radically different in approach (this is more than Beta vs. VHS). One does wonder how this shakes out as the industry matures.

And while as a business TPC Healthcare has its own preferences, as a technologist, I was jazzed about what they are all doing for different reasons:

• Ekahau for continuing to refine what’s doable with Wi-Fi
• Centrak for their ability to provide great precision using a very practical and simple architecture
• Awarepoint’z ZigBee based solution for thinking big regarding reaching beyond just the healthcare institution and into the home (and small with their convenient wall socket plug-in readers)
• Sonitor for the promise of 1 meter accuracy, 2D or 3D (kudos to Terry for being brave enough to demonstrate USID in front of a potentially rough crowd)

An interesting to note is that  we are beginning to see the some degree of the competitive vendors applying aspects of each other’s technologies in the effort of meeting the market needs (e.g. Ekahau’s introduction of IR-based room level beacon). Perhaps this is an indication of some future consolidation/collaboration on the horizon.

RTLS Infrastructure Now Poised to Really Deliver Anticipated Benefits

Keynoter Vi Shaffer’s lunchtime presentation was careful to give context to the state of RTLS in healthcare. The good news is that Gartner’s view of RTLS is very bullish, and places it clearly in their hype cycle chart on the upswing from the trough of disillusionment (where technologies fail to meet expectations and quickly become unfashionable) and moving towards the “plateau of productivity” (a technology’s benefits become widely demonstrated and accepted).

The timing of InSites summit was not accidental, as much is finally coming together that is making RTLS actionable (including platforms like Intelligent InSites that recognize the diversity of potential location consumers). Real, measurable, and game changing productivity is practical in ways that were never before possible. While the true results will no doubt be the sum of the parts, the backbone of the productivity end game will be the practical, affordable, and accurate location infrastructure that Ekahau, Centrak, Awarepoint, and Sonitor are driving towards.

Some takeaways from the event… it seems that there are enough forces to motivate the market away from WiFi solutions. Second, creative funding models are really what are helping the adoption of enterprise solutions along with managed services. The shift away from capitalized purchases for RTLS and RFID systems may be what moves deployments of these solutions out of the early adopter realm.

The other take away is that passive RFID definitely has a place in healthcare. We heard some compelling case studies regarding high impact, yet lower tech applications of more traditional (if there is such a thing) passive RFID. So even thought there are massive initiatives for enterprise RFID based on active technologies, customers are getting great return from less pervasive and more specific passive technologies. UMass Memorial has such an initiative in the Cath and EP labs. Also, Ray Lowe, the IS Director of Providence Health (a major west coast hospital group) talked about how he will be using Reva Systems (make applications to manage and integrate RFID readers) and ThingMagic (makes readers) as part of workflow in a new facility that will have a WiFi-based RTLS system.

The real story here is that no one auto-ID or location-based solution is going to fit all needs within the enterprise. And that’s not a bad thing. Continued innovation and product maturity, along with more open systems are making this all doable. For hospitals, there are opportunities small and large to take advantage of RFID and RTLS to immediately impact productivity and the bottom line.

I’m not always a great fan of white papers as I often find them manipulative point of view wise, but I think this piece (except for a couple of paragraphs at the end) gives a very impartial read on the whys and hows of RTLS/RFID in healthcare. While it details eloquently the short-comings of WiFi and zonal “good enough” approaches, it more importantly couches them properly against the larger more practical business cases for RTLS in healthcare. David’s piece is less a condemnation of WiFi, and more of a call to making this about business not technology.

Hoglund developed this whitepaper for AwarePoint (whose RTLS technology uses ZigBee), but the conclusions could have just as easily pointed to Sonitor (Ultrasound), or Centrak (IR/RF).

The good news is that customers have some solid choices in powering the critical applications that are so desperately needed to help improve healthcare business performance.

Q: What is the total investment associated with Healthcare IT Stimulus?
A: There are two categories of approved funding through American Recovery and Reinvestment Act of 2009 (ARRA)

• $2B to discretionary health IT through Office of the National Coordinator for Health Information Technology (ONCHIT)- earmarked for studies, creating regulatory bodies and even creating IT systems.
• $18B in investments & incentives to Medicare/Medicaid to implement “meaningful use” of EHR technology. This funding will provide payments to physicians between $44K-$64K over five years to implement certified EHR technology

Q: What is “meaningful use” of EHR technology?
A: Meaningful use is vaguely described in legislation as:

• Includes electronic prescribing
• Allows exchange of information to promote care coordination
• Reports clinical quality measures (TBD)

Q: How will information be exchanged between providers?
A: ARRA provides the creation and expansion of Health Information Exchanges (HIE) that lay the groundwork where EHR’s are shared in a regional and community basis.

Q: Do the physician incentives apply to hospital-based physicians?
A: No. Hospital based physicians (ED, OR, Pathologist, etc.) will still need to collect and report quality measures. The hospital will have access to incentive payments and not these physicians.

Q: What are some of the current barriers to EHR adoption for physician practices?
A: The following barriers may potentially impede adoption:

• Solutions must not only meet the need of the practice, but also need to support data exchange.
• Tremendous change in the EHR vendor environment as players are changing to meet the changes in the market. Physicians need to do significant due diligence.
• Focus on EHR is different from traditional offerings as it transforms from a system that supports data capture for code capture to a model that demonstrates value, outcomes and quality.
• Security that is HIPPA-driven has led to many early solutions that are installed locally within the physician’s office. The ASP model will evolve with greater security and lower cost.

Q: How does ARRA impact point of care communications?
A: Nursing documentation in an acute care setting must ultimatley be part of the patient EHR. The Department of Health and Human Services is defining the specification of “meaningful use” by the end of the year. Many feel that this evolving definition meaning  must include “use by nurses” in the final draft.  If this is the case, more focus will go into automating (less paperwork) the nursing care documentation which today is often a hybrid paper/electronic process.

Also, the ability for a hospital to efficiently measure and collect quality of care data will become important for reimbursements and financial survival. Effectively applying technologies that support quality and safety will become critical pieces.

Q: What are some of the issues behind improved systems for nursing documentation?
A: Issues  are as follows:

• Vendors have historically focused on areas where there is greater perceived benefit – CPOE and physician progress notes. Implementation is also slowed due to poor quality software (Software doesn’t support efficient processes and clinical workflow)
• Problems with data entry devices- COWS, tablets, voice-recognition
• Wireless connectivity issues
• Training and support issues

Q: What impact will Healthcare Stimulus have on IT purchases in 2009 and early 2010?

A: Given that the majority of hospitals won’t see any direct benefit of Stimulus for some time, the healthcare market will continue to evaluate technology investments on those projects that improve top-line revenues or can have a measurable cost-savings impact.  Unlike in recent years, it will be very uncommon to have  clinical leadership sponsor an initiative and get funding for any technology that can’t pass these financial tests.

TPC Healthcare today announced that it has signed an agreement with CenTrak Inc., to provide integrated tracking and workflow automation solutions to healthcare facilities. TPC Healthcare will utilize CenTrak’s patented InTouchCare™, a hybrid technology that combines a new generation of Infrared and Radio Frequency Identification (RFID) to track people and equipment to a room and individual bay. CenTrak developed InTouchCare™ technology to provide a “location-certainty” by overcoming the inaccuracies of “location-estimation” hindered by issues of RF penetration of walls, ceilings and floors.

Room and sub-room level Accuracy with Certainty
CenTrak patient and equipment tags use Gen2IR™ infrared light signals which cannot penetrate walls to accurately locate people and movable medical equipment to a specific room. The active-RFID component is used to communicate the location information back to the network for maximum tag capacity and a fast response time. In this way, CenTrak provides room and sub-room level accuracy with certainty, not based on an estimate. Installation of a CenTrak InTouchCare network is simplified by using battery-powered components which eliminate wiring and offer plug-and-play installation functionality. With RF and Infrared operating simultaneously, the sensors can operate continuously for up to five years on a set of batteries.

CenTrak developed InTouchCare™ technology to provide a “location-certainty” by overcoming the inaccuracies of “location-estimation” hindered by issues of RF penetration of walls, ceilings and floors. CenTrak patient and equipment tags use Gen2IR™ infrared light signals which cannot penetrate walls to accurately locate people and movable medical equipment to a specific room. The active-RFID component is used to communicate the location information back to the network for maximum tag capacity and a fast response time. In this way, CenTrak provides room and sub-room level accuracy with certainty, not based on an estimate.

High-level precision, Excellent battery life and Low cost of Installation
TPC Healthcare will integrate the Centrak infrastructure with software applications that meet the specific needs of the customer. “Centrak has hit the value intersection in RTLS by providing an infrastructure the combines high-level precision, excellent battery life and low cost of installation. Used in combination with the right application software, TPC Healthcare can offer healthcare customers a software platform that can start as a simple tracking solution and grow into a sophisticated location-aware workflow automation solution,” states Kenny Schiff, TPC Healthcare Managing Director.

About CenTrak
CenTrak is a leading provider of precise, adaptable, and cost-effective tracking solutions for healthcare facilities. The patented InTouchCare™ Real Time Location System (RTLS) infrastructure uniquely combines Gen2IR and active RFID technologies to deliver certainty-based or error free data, a requirement for workflow and other important applications. As the only predominantly battery-powered RTLS network, CenTrak has attained an ease and cost effective level of installation previously unattainable. InTouchCare is currently operating in millions of square feet at several world-class healthcare sites in the United States. For more information about CenTrak, please visit www.centrak.com.

About TPC Healthcare
Headquartered in Stratford, Connecticut, TPC Healthcare provides point-of-care communication technologies, such as wireless voice, alarm notification, and workflow automation, to hospitals and healthcare organizations in the New England and Mid-Atlantic regions. TPC Healthcare’s unique blend of technology expertise, exceptional service, and years of experience successfully delivering point-of-care solutions help hospitals and healthcare organizations improve clinical workflow, increase patient safety, and provide better utilization of patient care equipment. For more information about TPC Healthcare and/or its services, call 888.427.2215 or visit www.tpchealthcare.com.

In his 05/01/09 post Tim reports on case studies shared by three Canadian hospitals who are using Globestar’s ConnexALL® to meet their respective workflow and alarm management requirements. And while these case studies will be of great interest to hospitals attacking similar requirements, Tim’s posts from Portugal makes some important commentary regarding the “middleware” space as a whole that go beyond ConnexALL.

In his closing comments, Tim notes that “automating workflow through improved messaging is a need that spans the enterprise. Consequently, manufacturers in this market segment have enhanced their products and repositioned them as enterprise wide solutions.” He goes on to say that, “an enterprise architecture is more cost effective and is easier to manage than a series of disparate messaging products.”

These are very well taken points, and there is no doubt that a coordinated organizational effort that adheres to enterprise standards will yield the most impacting results. And in as much as the stories told at WorldConnex are wonderful representations of what can be done by creative folks working across departmental lines, the actual state of the products on the ground often tells a different story.

Let me explore this a bit here…

Middleware Politics
Because of the specific “point” needs that have driven organizations to adopt middleware implementation (e.g. nursecall or patient monitoring), middleware applications have quietly crept into hospitals for over 10 years, often with very little visibility. In many cases, the players involved with fulfilling the immediate need didn’t even think to consider larger organizational collaboration or standards at all (e.g. a nursecall middleware project may have been bundled into a construction budget).

In the last few years, this has started to change, especially since the middleware applications increasingly require IP network connectivity that requires IT involvement. But while this connectivity is a welcome move forward, it has quickly changed what was once a much simpler “acceptance” dynamic.

Today, when one of these solutions becomes necessary for a project, middleware can become a battleground between BioMed, Clinical Engineering, IT, Telecom, and various other enterprise stakeholders. Throw in middleware vendors hungry to keep their competitors out, and those on the input/output side (devices and end points) not especially eager to cooperate for their own selfish reasons, and nasty turf wars can beak out that can grind these projects to an absolute halt, the enterprise be damned.

As an example of how this can play out, I was recently involved with a project where the nursecall integrator simply refused to allow connectivity to their system in spite of the fact that the customer had already purchased the middleware application. And having been involved in this space for 6 years, I can assure you that this is not an isolated incident.

Enterprise Positioning Yes. Enterprise Implementation, Not Ready for Prime Time
But it’s not just organizational and vendor politics that make the enterprise middleware vision a difficult goal to achieve. As I’ve observed (and worked with) the key players in this space (Emergin, Globestar and Ascom), enterprise thinking has absolutely crept into the feature set and marketing materials, but there are still large gaps here in respect to enterprise-readiness when it comes to product and system implementation.

Despite the fact that these solutions are becoming more common, this is such a small niche that you won’t see technical reviews or evaluations that explore these issues. Customers are truly left in the dark for lack of available information.

Without going into a deep technical comparison regarding enterprise features, let me share some examples of of enterprise weakeness that maybe useful to an organization working through alarm managment middleware adoption:

• Many customers are forced to employ more than one middleware application (from different vendors) to achieve their desired results, often because of technical reasons, but sometimes because of inter-vendor issues. This can lead to crafty (and potentially shaky) workarounds by customers or their integrators looking for messaging to traverse systems
• These systems maintain their own directories and security models that live outside the enterprise
• Middleware application often prefer their own local databases (sometimes proprietary or sealed to the outside world). Yes there are options for other type of connectivity,  but may systems in production weren’t built from the ground up for enterprise database management or connectivity
• Redundancy and high availability are an after thought. Like the database limitations, there are methods for providing some resiliency, but these are not natural parts of the application
• The listener components that evaluate incoming messages prior to delivery to output devices may exist as discrete applications, rather than system services, creating unnecessary failure points and security vulnerabilities. (Note: We have several situations, where the restarting the application because of a system change, literally requires a human being to relogin to get the application going again.)
• The user experience is a low priority. When these applications lived primarily in data closets, the UI was a reasonable place to cut corners. As these applications grow to have visibility at the nursing unit level, there is need for cleaner more contemporary UI standards

Once You Open the Alarm Floodgate, it’s hard to control
To be fair to the middleware vendors, keeping pace with rapid changes in the input and output devices is a dizzying effort. The demands on their respective engines for the delivery of an increasing amount of traffic has forced attention on bolstering a core framework that was never built to anticipate the current demands. Throw the likely tide of regulatory attention into the mix, and you can understand why we haven’t seen entirely new platforms built to contemporary specifications.

In as much as I may be poking holes in the current state middleware applications, the promise of applications of this technology that cross departmental boundaries outweighs whatever weaknesses I point out. The technology is far improved and the potential for an enterprise future state is within reach. Indeed, as was pointed out to me by an insider close to Globestar, the soon to released ConnexALL® V4 will have a high availability and database connectivity features not seen in earlier versions of the product.

Some Potential Solutions
As we talk to customers regarding alarm management initiatives, we advise to not rush to conclusions or assume that any one product can magically bring devices, users, and alarms together in a cohesive fashion. Great gains can be had here; however, one needs to start first with the business issues that are driving adoption, rather than the technology platform.

Not only will this require process engineering, but change management that’s difficult to manage within healthcare. It’s easy to quickly assume that “enterprise” is a hard technology concept, where we would argue that it’s a systems principle whereby the components (not just technical) are intended to serve the larger organization. The manufacturers have struggled with participating with this process from a distance, and this is a place where systems integrators like TPC Healthcare can help (shameless plug). It’s not easy to fly in a swat team to work through the type of complex re-engineering that’s likely to be required.

The manufacturers need to get closer to customer requirements (especially the end-users) to understand what they need to do with alarms, escalations, notifications, and the resulting data trail left behind. If they observe closely, they will see that interfaces need to be simpler, and that changes to workflow and reporting shouldn’t always require deep technical intervention (especially from the manufacturer’s HQ).  I would also argue to that there needs to an openness at the application level that we’ve yet to see. Today this is all way too hard to prone to error because of lack of standardization.

Closing Thoughts
As the Globestar global user conference case studies clearly show, compelling business issues (that involved alarm notification and workflow) can be solved by smart folks with good enabling technologies. Globestar, Emergin, Ascom, Amcom/Commtech (and others like Radianta) have a great opportunity to step up and see past their own platforms and create better tools that are truly aligned with customer’s enterprise needs.

Kenny Schiff (www.tpchealthcare.com) is founder and President of TPC Healthcare, a specialty provider of point-of-care communication technologies, such as wireless voice, alarm notification, and workflow automation, to hospitals and healthcare organizations.

Communication needs and preferences are very different for different clinical roles, and hospitalists are no exception. The following illustrates a Vocera workflow for hospitalists that accommodate their preferred communication style. It’s a great example of how incredibly creative one can be with Vocera, without being technically burdensome.

Too Much Communication Can Be Counter Productive
Seeing the success that other staff has had using Vocera, the hospitalists at one of our customers believed that wearing Vocera badges would boost productivity for their role. As we worked through designing a Vocera workflow for them, they voiced concern that receiving direct voice calls would be counterproductive.

Instant communication is great thing. Too much communication can seriously impact efficiency and focus. They hospitalists felt they were getting paged too often about trivial matters that can wait. Their preference would be to use Vocera and always be on DND (do not disturb). This way nurses will leave them messages which they can get to when they are available. The hospitalists can call the nurses back from their Vocera badge when they are free.

But, of course, there’s a catch.

Work Teams
Hospitalists often work in teams. So, for instance, Dr. Hass and Dr. Dantz are a team. Since they are not at the hospital at the same time, if one doctor should get called while they are not at the hospital, they want the call to roll over to the other.

Initially a call forwarding scheme was attempted. What they discovered was that if Dr. Hass is called (and he is not logged in), the call forwards to Dr. Dantz (who is on DND), the subsequent message left would be for Dr. Hass not Dr. Dantz. To solve this, we needed to think out of the box.

Solution: Use Alternative Names
We created alternative user names for the hospitalists which are the opposite of their real names (Susan Hass logs in as “Hass Susan”, Victor Dantz logs in as “Dantz Victor”). We created a group called Doctor Hass, with an alternate spoken name of Susan Hass) and made the group sequential with the user Hass Susan the first name in the group and the user Dantz Victor as the second name in the group. I also created a group called Doctor Dantz with Dantz Victor as the first person in the group and Hass Susan as the second name. Now when either doctor is called, the caller will leave a message for the doctor that is logged in.

There are three teams. We created six groups.

But the plot thickens…

At night, when neither hospitalist is at the hospital, there is a nocturnist that will wear Vocera on DND. If neither Dr. Hass nor Dr. Dantz are logged in they want the call (message) to go to the nocturnist.

Solution: Use Groups
We created a group called “Nocturnist.” The doctors who are always nocturnists are entered into Vocera “first name, last name” as well as Dr. Last Name. They are also added to the nocturnist group. The group nocturnist is added to each of the six hospitalists groups as the third name in the sequence, and voila!

Note: Recording Greetings is Important to Making this Solution Work

For each group we recorded a greeting so the caller will hear, “You’ve reached the Hass/Dantz group. Please leave a message and one of us will return your call shortly.” To make this work transparently to the calling party, we had to record the same greeting for both the Doctor Hass group and the Doctor Dantz group–same process for the other groups. We also recorded one for the Nocturnist group so it is heard when that group is called directly.

The thing I find intriguing from this blog is that there is no clear winner in the category. There are many various suggestions and comments on why technology hasn’t worked. I agree with the notion that the people and the process are often overlooked and promising technologies fail. However, in my years of visiting EDs, there is one key need that is beginning to be met with technology. That is in the area of communication. Bridging the time (and effort) gap between need for information and getting that information can have a tremendous impact on an ED’s operations.

A bedside nurse in an ED can contact a physician, get lab results, and summon help in an instant in a form factor from 2 ounces (e.g. Vocera badge) to a little over 4 ounces (e.g. Ascom handset). Most ED’s I visit today are using some form of mobile communication, but haven’t look at how to lower the barriers of the physical nature of these devices (remembering phone numbers, getting dial tone, leaving a voicemail, etc…). Early versions of mobile phones mimicked a cell phone experience and although it was a step in the right direction, it still had some shortcomings. Today’s solutions are much closer to seamlessly summoning and delivering information to the caregiver without these traditional barriers.

It’s time to think out of the box and design a solution that works for you. Chances are there’s a combination of technology solutions out there that planned well can make a big difference in your overall ED workflow.