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Vocera Aims For More Intelligent Hospital Interventions

Posted on November 14, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Everyday scenes that Vocera Communications would like to eliminate from hospitals:

  • A nurse responds to an urgent change in the patient’s condition. While the nurse is caring for the patient, monitors continue to go off with alerts about the situation, distracting her and increasing the stress for both herself and the patient.

  • A monitor beeps in response to a dangerous change in a patient’s condition. A nurse pages the physician in charge. The physician calls back to the nurse’s station, but the nurse is off on another task. They play telephone tag while patient needs go unmet around the floor.

  • A nurse is engaged in a delicate operation when her mobile device goes off, distracting her at a crucial moment. Neither the patient she is currently working with nor the one whose condition triggered the alert gets the attention he needs.

  • A nurse describes a change in a patient’s condition to a physician, who promises to order a new medication. The nurse then checks the medical record every few minutes in the hope of seeing when the order went through. (This is similar to a common computing problem called “polling”, where a software or hardware component wakes up regularly just to see whether data has come in for it to handle.)

Wasteful, nerve-racking situations such as these have caught the attention of Vocera over the past several years as it has rolled out communications devices and services for hospital staff, and have just been driven forward by its purchase of the software firm Extension Healthcare.

Vocera Communications’ and Extension Healthcare’s solutions blend to take pressures off clinicians in hospitals and improve their responses to patient needs. According to Brent Lang, President and CEO of Vocera Communications, the two companies partnered together on 40 customers before the acquisition. They take data from multiple sources–such as patient monitors and electronic health records–to make intelligent decisions about “when to send alarms, whom to send them to, and what information to include” so the responding nurse or doctor has the information needed to make a quick and effective intervention.

Hospitals are gradually adopting technological solutions that other parts of society got used to long ago. People are gradually moving away from setting their lights and thermostats by hand to Internet-of-Things systems that can adjust the lights and thermostats according to who is in the house. The combination of Vocera and Extension Healthcare should be able to do the same for patient care.

One simple example concerns the first scenario with which I started this article. Vocera can integrate with the hospital’s location monitoring (through devices worn by health personnel) that the system can consult to see whether the nurse is in the same room as the patient for whom the alert is generated. The system can then stop forwarding alarms about that patient to the nurse.

The nurse can also inform the system when she is busy, and alerts from other patients can be sent to a back-up nurse.

Extension Healthcare can deliver messages to a range of devices, but the Vocera badge and smartphone app work particularly well with it because they can deliver contextual information instead of just an alert. Hospitals can define protocols stating that when certain types of devices deliver certain types of alerts, they should be accompanied by particular types of data (such as relevant vital signs). Extension Healthcare can gather and deliver the data, which the Vocera badge or smartphone app can then display.

Lang hopes the integrated systems can help the professionals prioritize their interventions. Nurses are interrupt-driven, and it’s hard for them to keep the most important tasks in mind–a situation that leads to burn-out. The solutions Vocera is putting together may significantly change workflows and improve care.

Patient Alert Fatigue

Posted on April 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On this blog we’ve often covered the concept of physician alert fatigue. It’s a major challenge for EMR software providers to balance the alerts a doctor gets so they don’t just ignore the alerts all together. What makes this even more challenging is that every doctor reaches alert fatigue at a different point. One doctor might get fatigued and stop looking at the alerts very quickly while another doctor can handle a massive number of alerts and not get tired of looking at them.

I’m certain that physician alert fatigue battle will never stop. Although, I recently was introduced to another alert fatigue in healthcare. It is patient alert fatigue. With the growing number of smart phone apps in healthcare, this is going to become an ever growing problem. Soon patients will be getting health alerts from every angle. I expect that most patients are going to get fatigued very quickly.

Plus, like doctors, patients become fatigued at very different points. In fact, the variety of patients that are out there is much more complex than the physician community. This variety makes the challenge of adjusting the patient alert barometer that much harder.

As more and more healthcare institutions start leveraging patient alerts, they’re each going to need to be keenly aware of patient alert fatigue. If the alerts aren’t providing value to the patients quickly, then it won’t matter if you send the alert or not since many patients will stop reading them.

Communication With Providers, Patient Alert Fatigue, and #HealthIT — #HITsm Chat Highlights

Posted on April 6, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

#HITsm T1: How do you WANT to communicate with your healthcare provider? How does it differ from what’s available?

 

#HITsm T2: How can we avoid patient alert fatigue as we move toward engaged care and #mHealth acceptance?

 

#HITsm T3: Will the shortage of qualified #healthIT professionals to fill openings force a delay in meeting Meaningful Use requirements?

 

#HITsm T4: Open Forum> What #healthIT topic has interested you most this week?

Medispan Clinical Expands CDS Offerings by Wolters Kluwer Health

Posted on March 1, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Since I know I have a number of EMR vendors that read this blog, I know they’ll be interested to learn the news coming out of Wolters Kluwer Health about a new clinical decision support (CDS) offering called Medi-Span Clinical. Here’s a part of the press release announcement:

Wolters Kluwer Health, a leading global provider of information for healthcare professionals and students, today unveiled Medi-Span® Clinical, a robust clinical decision support (CDS) platform that delivers the functionality, interoperability and medication-related CDS necessary to advance the practice of evidence-based medicine and to achieve meaningful use of health IT.

From the looks of their website page about Medi-Span Clinical, this looks like it’s the announcement of the features that they have listed nicely as “launching in 2010.”

APIs OFFERING CLINICAL DECISION SUPPORT
SCREENING INFORMATION LAUNCHING IN 2010
Drug Interactions™ API
Route Contraindications™ API
Drug Allergy™ API
Duplicate Therapy™ API
Dose Screening and Drug Orders™ API
Drug Disease Contraindications™ API
Pregnancy, Lactation, Age and Gender™ API

APIs OFFERING CLINICAL DECISION SUPPORT
REFERENCE INFORMATION
Trissel’s IV-CHEK™ API
Integrated MedFacts Module™ API
Integrated Drug Facts and Comparisons™ API
Drug Image and Imprint™ API

That’s quite a robust offering of services that can really benefit an EMR. I tried really hard to get our EMR to implement Medispan since that’s what our pharmacy uses. Unfortunately, they chose to integrate a different drug database mostly because of cost of Medi-Span I believe. We’ll see if they are regretting that after announcements like this.

I know there are a number of interesting API services like this out there. I’d be interested to hear more about EMR vendor and users experiences with the other people in the industry.

One other interesting piece from the press release:

“In addition to unprecedented interoperability, Medi-Span Clinical delivers advanced end-user controls over alerts and warnings that reduce the risk of ‘alert fatigue’ and drive adoption at the point-of-care,” said Subramanian. “By deploying Medi-Span Clinical within their EMRs, providers and vendors alike are able to advance the meaningful use of health IT and provide clinicians with the advanced point-of-care CDS they will actively embrace.”

I think that a third party service offering like this can really help an EMR vendor. It kind of makes sense to have it separated, but tightly integrated through an API. I’m sure it’s all a bit technical for many readers of my blog, but let’s just say it’s a good thing for the EMR industry for these capabilities to continue to improve.

Also, it should help an EMR vendor meet some of the meaningful use guidelines. Although, it does seem a bit gratuitous to use the buzzword meaningful use like this. I wonder if I’ll get any press releases that won’t include that term somewhere.

Alert Fatigue and Clinical Decision Support

Posted on May 10, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Clinical Decision Support has been called out as an important part of an EMR system. You’ll get no argument from me on this. What I have been thinking a lot about is what people call “Alert Fatigue.” For those unfamiliar with the term, it basically means that a doctor gets so many alerts that they grow numb to the alerts and stop looking at them. For those that are married, it’s like your wife’s nagging. It happens so much that you stop listening (ok, that was a joke. I hope none of us do that or have reached that point. I’m just lucky to have a wife who doesn’t nag).

I think this concept of “alert fatigue” is really important and I think it will be impossible to create an EMR that strikes the perfect balance. Some EMR offer too many alerts and some probably offer too few. So, my question for you is which side should we adopt? Is it better to have too many alerts which doctors then might ignore or is it better to have too few alerts and not be alerted to something important?

There’s some real challenging issues associated with both. Liability unfortunately being a major part of each. Where do you stand on this issue?