There were some earlier explorations with Sprint and Blackberries, but nothing that has taken hold to date. While hospital customers are not necessarily doing widespread enterprise adoptions of iPhones, physicians and executives are either showing up with their own devices, or pushing their IT organizations to allow them, in essence forcing the issue. The Vocera iPhone app is a further disrupter, especially because it begins to tear down the walls communication wise between home, office, and hospital facility. This is an especially interesting development in light of the work that Voalte has done in bringing voice and alarm notification to the iPhone,  iPad, and Blackberry. Whereas Voalte first took and alarm notification starting place, then added in voice, Vocera has come at this from the other way around. Alarm notification is likely not far behind.

We are in line for some messiness as enterprise IT tries to work through the management of these new multi-modal devices; however, given widespread consumer adoption of smartphones, this is precisely the competitive innovation the market is hungry for.

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.

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.

I made a mental note to come back and chat with her regarding how we could make some modifications to Vocera’s calling behavior and workflow to help her in this type of situation.

She later had time to meet with me. I spent a few minutes discussing the concepts of “Urgent Call’ and “Urgent Broadcast,” and we also explored what the differences are:

• immediate connectivity to the recipient of the call without the opportunity to say “NO”
• the ability to break through a pre-existing call, and
• the ability to break through a Do Not Disturb)

As part of recent efforts to refine how Vocera is being used by this customer, I let her know that unit secretaries, RNs and aides now have the ability to Broadcast, Urgent Broadcast, and Urgent Call. After further discussion with Kathy, I gave all nurse managers the ability to locate users as well (which I also trained her how to do). I then gave all nurse managers VIP status, so they may do a soft break through of DND too (the Genie will announce “Here is…”).

We then discussed the advantages of having floating nurses, aides, etc. be members of the “Flex Team” group in Vocera, thus giving them the ability to add and remove themselves from the various nursing units and the ED.

• They will receive Broadcasts to the department they are working in
• They will not receive Broadcasts to their regular department
• All members of the present department will automatically be added to their Inner Circle (frequently called list)
• All members of the regular department will be removed from their Inner Circle
• They can be reached by the command “Call first name in present department”

With these minor Vocera profile modifications, a little bit of additional training, and some follow up reinforcement, we were able to empower Kathy to leverage Vocera’s roles-based calling features to reach the people she needs to efficiently.