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Evolving Message Systems Learn To Filter And Route Alerts For Health Care Providers

Posted on December 11, 2017 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 ( 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.

Because health care is a collaborative endeavor, patients can suffer if caretakers don’t get timely notifications. At the same time, the caretakers suffer when they are overloaded with alerts. Threading one’s way through this minefield (“Communications are complicated,” Vocera CMIO, Dr. Benjamin Kanter told me) was the theme of November’s Healthcare Messaging Conference and Exhibition at the Harvard Medical School. Like HIMSS, the major conference in health IT, something of a disconnect existed here between the conference and the exhibition. The speakers in the sessions implicitly criticized what the vendors were offering, information overload being the basic accusation.

Conference speakers told story after story of well-meaning installations of messaging systems that almost literally assaulted the staff with dozens of messages an hour. Kenny Schiff of CareSight reported seeing boxes full of expensive devices stuffed into closets in many hospitals. Dr. Trey Dobson reported research suggesting that 85% of standard hospital alarms require no intervention at all. He speculated that messaging has similar wasteful effects. In his facility, the Southwestern Vermont Medical Center at Dartmouth, they determined which lab results need to be delivered to the physician immediately and which could wait. They greatly reduced the number of messages sent about labs, which in turn decreased delivery time for important messages from an average of 50 minutes to only 7 minutes. These stories show both the benefits and drawbacks of current messaging systems.

State of the science
We all remember the first generations of pagers. Modern messaging systems, as represented by the vendors at the Healthcare Messaging Exhibition, offer a much sleeker experience, including:

  • Knowledge about who is responsible for a patient. No longer should messages be delivered to the nurse who left his shift an hour ago. The technical mechanism for tracking the role played by each clinician is group membership, familiar from the world of security. All clinicians who share a responsibility–such as working on a particular ward or caring for a particular patient–are assigned to a group. The status of each clinician is updated as he or she logs into the system, so that the message is delivered to the doctor or nurse currently on duty. A clinician dealing with one urgent situation should also not be interrupted by messages about another situation.

  • Full tracking of a message throughout its lifetime. The system records not only when a message was sent, but whether and when it was read. A message that goes ignored after a certain period of time can be escalated to the next level, and be sent to more and more people until someone addresses it.

  • Flexibility in delivery medium: mobile device, pager, computer, WiFi link, cellular network.

  • Sophisticated auditing. If a hospital needs to prove that a message was read (or that it was never read), the logs have to support that. This is important for both quality control and responses to legal or regulatory actions.

  • Integration with electronic health record systems, which allows systems to include information about the patient in messages.

  • HIPAA compliance. This essentially requires just garden-variety modern encryption, but it’s disturbing to learn how many physicians are breaking the law and risking their patients’ confidentiality by resorting casually to non-compliant messaging services instead of the ones offered at this exhibtion, which are designed specifically for health care use.

  • Cloud services. Instead of keeping information on devices, which can lead to it becoming lost or unavailable, it is stored on the vendor’s servers. This allows more flexible delivery options.

Although some of these advances generate more informative and useful messages, none of them reduce the number of messages. In fact, they encourage a vast expansion of the number of messsages sent. But some companies do offer enhancements over the common traits just cited.

  • Vocera has been connecting health care staff for many years. The company formed the subject of my first article on health IT in 2003, and of course its technology has evolved tremendously since then. Their services extend beyond the hospital to the primary care physician, skilled nursing facilities, and patients themselves. Dr. Kanter told me that they conceive of their service not simply as messaging, but as a form of clinical decision support. Their acquisition of Extension Healthcare in 2016 allowed them to add a new dimension of intelligence to the generation of messages. For instance, the patient’s health record can be consulted to determine the degree of risk presented by an event such as getting out of bed: if the patient has a low risk of falling, only the patient’s nurse may be alerted. Location information can also be incorporated into the logic, so that for instance a nurse who is already in the patient’s room will not receive an alert for that patient. Vocera has a rules engine and works with hospitals to develop customized rules.

  • HipLink has a particularly broad range of both input and delivery devices. In addition to all the common devices used by clinicians, HipLink can convert text to voice to call a plain telephone with a message. CEO Pamela LaPine told me it also accepts input not only from medical sensors, but from sensors embedded in fire alarms, doors, and other common props of medical environments.

  • OnPage helps coordinate secure communications through the use of schedules, individual and group messaging, and message tracking. For instance, the end of an operation may generate a message to the nursing staff to prepare for the arrival of a post-op patient. A message to the cleaning staff might be generated in order to prepare a room. All the necessary messages are presented to a dispatcher on a console.

  • 1Call, which provides a suite of innovative and integrated scheduling and communication applications, includes prompts to call center staff, a service they call Intuitive Call Flow Navigation. For a given situation, the service can help the staff give the information needed at the right point in each call. The same logic applies to the automated processes carried out with 1Call’s integration engine and automated notification software, which can also consolidate messaging based on rules, be customized to each organization’s needs, and improve efficiency throughout the organization.

Michael Detjen, Chief Strategy Officer of Mobile Heartbeat, laid out the pressures on messaging companies to evolve and become more like other cutting-edge high-tech companies. As messaging become universal through a health care institution, workflows come to depend on it, and thus, patient lives depend on it too. Taking the system down for an upgrade–or even worse, having it fail–is not acceptable, even at 2:00 in the morning. Both delivery and successful logging must be guaranteed, both for quality purposes and for compliance. To achieve this kind of reliability, developers must adopt the advanced development techniques popular among the most savvy software companies, such as DevOps and continuous testing and integration.

Looking toward the future
In his presentation, Schiff described some of the physical and logistical requirements for messaging devices. Clinicians should be able to switch devices quickly in case one is lost. They should be able simply to run their ID card through a reader, pick up a new device, and have it recognize them along with their message history (which means storing the messages securely in the cloud). Login requirements should be minimized, and one-hand operation should be possible. Schiff also looks forware to biometric identification of users.

Shahid Shah pointed out that the burden current messaging places on caregivers amounts to a form of uncompensated care. If messages are sent just to reassure patients, doctors and nurses will treat them as annoyances to be avoided. However, if the messages improve productivity, staff will accept them. And if they improve patient outcomes, so much the better–as long as fee-for-value reimbursements allow the health care provider to profit from improved outcomes.

To introduce the intelligence that would make messaging beneficial, Shah suggests more workflow analysis and the automation of common responses. A number of questions regarding patients could be answered automatically by bots, leaving only the more difficult ones for human clinicians.

The message regarding messaging was fairly consistent at the Healthcare Messaging Conference. Messaging has only begun to reap the benefits it can provide, and requires more analytics, more workflow analysis, and more integration with health care sites to become a boon to health care staff. The topic was a rather narrow one for a two-day conference, perhaps the reason it did not attract a large audience in its first iteration. But perhaps the conference will help drive messaging to new levels of sophistication, and become true life-savers while reducing burdens on clinicians.

Healthcare messaging and communication is also one of the focuses of our conference Health IT Expo happening May 30-June 1, 2018 in New Orleans. If you’re in charge of your hospital messaging systems, join us in New Orleans for an in depth look at best practices, hacks, and strategies for hospital messaging and communication.

This article is also available in a Portuguese translation by homeyou.

The Subtle Signs of Sepsis Infographic

Posted on September 27, 2017 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Sepsis has been a major challenge in healthcare for a long time. This was highlighted really well on the Wolters Kluwer Nursing Center website:

Throughout my experience in health care over the past 30 plus years, the diagnosis of sepsis has been one of the most challenging. Sepsis affects millions of people worldwide and one in four of the people affected will die. The way we recognize and treat sepsis has changed over the years, and in January 2017, the International Guidelines for Management of Sepsis and Septic Shock: 2016 was published. This update to the 2012 guidelines, emphasizes that patients with sepsis should be viewed as having a medical emergency, necessitating urgent assessment and treatment.

According to the Advisory Board, the average direct cost per case for a primary sepsis diagnosis is $18,700, yet the typical Medicare reimbursement for sepsis and sepsis with complications is just $7,100-12,000. It’s no wonder so many hospitals are worried about sepsis.

I’ve been impressed with the way technology has been used to address the problem of Sepsis. I’ve seen a lot of companies working to use analytics to predict sepsis or identify it in real time as it’s happening. I recently saw where Wolters Kluwer partnered with Vocera to be able to connect the Sepsis risk analysis data with the providers, carrying Vocera badges, who can make the proper diagnosis and start treatment in the early stages when Sepsis is most treatable.

This kind of collaboration between healthcare IT vendors is the only way we’re going to make a dent in major healthcare problems like Sepsis. So, I applaud these two companies for working together.

For those that don’t know, September is Sepsis Awareness Month. As part of this month long recognition of Sepsis, Wolters Kluwer put together an infographic that shows the subtle signs of sepsis. While technology can certainly help with Sepsis identification and treatment, there’s still an important human element as well. This infographic highlights the signs that healthcare providers can and should look for and methods of treatment.

What efforts have you seen effective in identifying and treating sepsis in your healthcare organization?

Healthcare Scene #HIMSS15 Guide

Posted on April 9, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you read this and any of the other Healthcare Scene blogs or follow us on social media, you know that #HIMSSSanity is upon us. Yes, it’s the Thursday before the big HIMSS Annual conference in Chicago.

I’ve often described my visits to the HIMSS annual conference like a kid in a candy store. As a blogger the model is pretty simple. I need: content, readers, and advertisers. Everywhere I look at HIMSS you can find potentially all three of those things. That’s why I’ll be there all week enjoying time meeting with lots of really interesting people and companies.

My HIMSS schedule is packed with meetings. I think when all is said and done I’ll have about 30 must attend meetings and hundreds of casual meetings and networking with people. I always love meeting readers in person at HIMSS, so please find me and come say hi. Luckily, in our HIMSS 2015 guide we have a number of options where you can find me. Plus, I’m listing a number of other talks/sessions/features at HIMSS that have caught my eye. Here we go:

HIMSS Opening Reception
I’ve had mixed experiences at the HIMSS opening reception. I usually like to check it out and see what HIMSS has done. Plus, it’s a great place to meet random people. One challenge I have with social media is that it now facilitates me meeting a lot of the same people. That’s a great thing, but does sometimes limit meeting new people. I love the HIMSS Speakeasy theme for the opening reception. I heard that the live music will make for the perfect #HIMSS15DanceOff setting.

If you’re interested in “What comes after MU? Real digital attention to your patients” then you’re going to want to join Shahid Shah at the iPatientCare Booth #2941 on Monday 4/13 at 2:30 PM CT. They’ll be discussing the questions: What are you doing to manage chronic care in your organization? Is your approach to interoperability bad for patients? What are you doing to manage chronic care in your organization? Changing reimbursement is going to require true patient engagement (not just MU required engagement). In this talk at the iPatientCare booth, Shahid will dive deep into what true patient engagement looks like.

Social Media and Influence Meetup
This meetup will be hosted by myself and my partner Shahid Shah at the HIMSS Spot (North Hall – B Lobby) on Tuesday 4/14 at 12:30 CT. This will be one of the best places to come and find me. Plus, we always have a great crowd and an even better discussion with those that attend. In some ways this will be a small preview into the larger 2 day healthcare IT marketing and PR conference. We hope to see lots of the #HITMC community there.

SAP Healthcare
The famous Shahid Shah together with Dr. David Delaney, SAP’s CMO, will be leading a great discussion at SAP Booth #2656 on Tuesday 4/14 at 2PM CT. The discussion will be around the topic “Driving Clinical Value and ROI Out of Your Data” and will cover questions like: Is data really generating clinical value? Is anyone really driving clinical value from data? Do we have the resources we need to generate ROI from our healthcare data? These are some really important questions for healthcare and I’m sure the discussion will be great.

New Media Meetup Sponsored by Stericycle
We posted about the New Media Meetup before and so hopefully you’ve registered to attend. If you haven’t, there are only a very few number of slots left and then we’re at capacity. This really is a who’s who of healthcare IT social media influencers. I’m proud to host the event and have loved working with Stericycle and Patient Prompt to plan it. We’ve got a lot of fun things and great giveaways planned for the event. Can’t wait to see everyone there.

Vocera has a whole schedule of talks to choose from. The one by Rhonda Collins, CNO at Vocera called “Navigate the Storm without Creating Your Own Twister” caught my eye. I think we can all relate to the storm of healthcare IT priorities and challenges. Although, the Sue Murphy, Exec. Dir. of Patient Experience & Engagement at University of Chicago Medicine, session on Transforming Patient Experience Using Care Rounding also looks interesting.

#iHeartHIT Meetup
I really wanted to make this meetup, but it looks like I’m booked other places. Doesn’t mean you can’t enjoy it. I believe the HIMSS social media ambassadors will be there. Luckily, I think I’ll see them at some of the other events. It also means that it will likely generate a lot of tweets so I can kind of experience the event later.

#HITsm at #HIMSS15
This year, #HITsm is mixing it up with their meetup. They’re basically having a panel discussion with Keith Boone, Rasu Shrestha, MD, David Muntz, and Douglas Fridsma, MD. I believe that Mandi Bishop is moderating. Seems like the topic du jour is going to be interoperability given the panelists. Should be a great panel for that topic. I’ll be the heckler in the back or maybe I’ll just save my heckling for Twitter.

Bush Keynote
The keynotes this year are pretty disappointing for me. I think Bush’s keynote will likely be the most interesting. Although, I always love hearing people like Jeremy Gutsche as well. Of course, I think you’re crazy to actually attend the keynote. Why do I want to watch a little small person up on stage? I’ll be watching the keynotes from the comfort of the press room (plus, they have internet and power).

HIMSS Block Party – This is similar to the opening reception. The block party idea is pretty cool. I’m quite sure you’ll find me in the Little Italy area. #ItalianFoodAddict

I’m always intrigued by the unique tracks that HIMSS puts together. This year it’s called HX360. This consists of a bunch of programming and also a section of the exhibit hall. Looking at what this area has to offer gives you a good idea of what HIMSS is thinking about the future of healthcare IT.

So many more things could be listed like the CHIME Fall Forum at HIMSS15 on Saturday and Sunday. Of course, there are a lot of evening events including the popular Encore/Next Wave Connect Pub Nights, athenahealth Cloud Party, HIStalkapalooza, Anthelio Casino Night, Divurgent’s summHIT, and AEGIS Odyssey (yes, it’s a massively beautiful yacht) to just name a few.

I personally fly in on Saturday and out on Friday. I’m still looking for something great to do on Wednesday and Thursday evening. If some people are going to be there Wednesday and Thursday evening, maybe we could do something fun together. I’d love to hear people’s ideas if you’re around.

Healthcare IT Marketing and PR on the Mind

Posted on April 2, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Healthcare IT marketing and PR have been on my mind lately as I’ve been preparing for the Healthcare IT Marketing and PR Conference (HITMC) and for HIMSS. We’ve published the full HITMC program if you haven’t seen it yet. It’s going to be a really amazing 2 days of learning for me and everyone who attends. Hopefully many EMR and HIPAA readers can make it. There’s only 5 days left to register for the event, so do so now if you’d like to attend.

We’ve certainly seen the evolution of marketing here on EMR and HIPAA. At first people mostly wanted to buy a link to their site from us since we were on the first page of Google for the term “EMR”. (Side note: Don’t buy links. That’s a bad strategy today.) Then, we started doing banner ads and those have always performed really well for our advertisers since we have such a targeted, niche audience. Recently we’ve been expanding our email marketing, event marketing and sponsored content packages. They’ve really become fully integrated marketing packages that touch on email, social media, blogs, and display advertising. It’s exciting what we’re able to deliver sponsors of our site.

10 years later it’s amazing to think back on the 2239 posts we’ve published, the 9743 comments that readers have contributed and the 10,689,418 pageviews for EMR and HIPAA. I wonder how many emails we’ve sent out with our content over the years, but I don’t have a good way to track it. Just last year I estimate that this blog has sent out 1.25 million emails. Wow! Thanks to all of you who read and contribute.

Every 6 months or so I like to highlight the companies who support the work we do here at EMR and HIPAA. Without them, I wouldn’t be able to be a full time blogger and provide you the content I do. Take a second to look through the list and see if one of them might be able to help you solve a problem you’re working on in your job.

Vocera – Vocera is an interesting story for me, since they acquired a secure messaging company I advised (docBeat). Since that acquisition, I’ve been lucky to advise them on some marketing and they’ve also been sponsoring a number of Healthcare Scene email campaigns. They offer a pretty compelling set of secure, real-time communication solutions for healthcare. Plus, they have a good announcement coming out at HIMSS that I think will set them apart from the other secure messaging solutions out there. Although, I’m not allowed to talk about the announcement yet. You can see Vocera’s HIMSS 2015 plans if you want to meet with them in person and learn about the announcement.

Iron Mountain – It was fun working with Iron Mountain on their Healthcare Information Governance Predictions and Perspectives series. You can find all the entries in that series here and my entry here. Plus, I was able to participate in their #InfoTalk Twitter chat which was really well done as well. I hope they continue the discussion, because it’s an important one.

ClinicSpectrum – Regular readers should be familiar with ClinicSpectrum. They’ve been contributing some great content in our Cost Effective Healthcare Workflow Series. I love how they’re interested in taking the discussion beyond just EHR and meaningful use into how a practice or hospital can optimize their use of technology. Plus, they’re really passionate about the hybrid workflow which mixes technology and people to find the optimal solution. We need more of this optimization in healthcare.

The Breakaway Group (A Xerox Company) – You’ll also likely be familiar with The Breakaway Group and their Breakaway Thinking Series. I’ve always loved the researched based perspective that they provide to the challenges that face healthcare IT. Plus, they offer some unique perspectives on training and learning in healthcare. One of the biggest challenges with any healthcare IT implementation is getting the training right. The Breakaway Group is dead set on solving that problem.

Ambir – Ambir’s been supporting the work we do here since January of 2010. Amazing that they’ve been with us for 5 years. I think that was before I even quit my day job. Most people know them as a scanner company, but word on the street is that at HIMSS 2015 they’ll be announcing a new tablet based product. I’ve heard the concept and I think it’s a really creative approach to solving healthcare’s workflow challenges.

HIPAA Secure Now! – We’re seeing a big wave of healthcare organizations and business associates finally starting to do something about HIPAA. Much of this has been pushed by meaningful use’s risk assessment requirement, but it’s also been driven by all the breaches. HIPAA Secure Now! is offering our readers Free HIPAA Security Training.

Colocation America – Colocation America has been supporting us for 2 years. It’s no surprise that more and more companies are looking to outsource their hosting to a HIPAA compliant hosting solution. Healthcare companies don’t want to be in the hosting business. They want to be in the healthcare business. So, working with a company like Colocation America for their HIPAA compliant hosting needs just makes sense.

A massive thank you to all the companies that support the work we do. We look forward to seeing many from the EMR and HIPAA community at HIMSS in Chicago and then at the Health IT Marketing and PR conference in Vegas.