Information Week
Sarasota Memorial Healthcare System, a hospital in Florida, plans to deploy iPhones to its nurses, to replace audible alarms and alerts, bringing peace and quiet-- and improved performance--to the healthcare provider.
"One of the biggest problems in any complex environment, particularly healthcare, is communication," CIO Denis Baker said. "It's a nightmare to get a hold of someone, even people on the same floor, as they go about their tasks."
So Baker's ears perked up when he was approached by Voalte about piloting a project. Voalte is a startup developing point-of-care communications using mobile technology. Its application uses iPods to send pages and alerts.
For the 60-day pilot, Sarasota Memorial handed out 25 iPod Touches to nurses on a single floor in June. The decision was made to use the iPod Touch because it's less expensive than the iPhone, does not require a cell-phone service contract, and basically has all the capabilities of the iPhone exclusive of phone functionality.
Also, the hospital wanted to move from text messaging to VoIP telephony, and it anticipated that the Touch would become VoIP-ready in its next version.
A major objective of the project was to reduce the amount of noise and inefficiency involved in calling nurses where they're needed, Baker said.
He explained, "If a patient is in bed and needs assistance with something -- they might be in pain -- they now push a button on the bedside, that goes to the nursing desk, and someone has to hunt down a nurse and make an overhead page. That's inefficient, because it doesn't go to the right person, and it also makes for too many overhead pages." At any given point in the hospital, you can hear an overhead page every three minutes. Noise is a huge complaint in any hospital -- equipment moving, staff conversations, and especially overhead pages. The noise prevents patients from getting the rest they need to heal.
On the floor where the iPods were deployed, the hospital reduced overhead pages from 172 in eight hours to 38. The 25 deployed iPods were receiving 4,000 messages per day. "Nurses were getting comment form patients on how quiet it was," Baker said.
After a successful conclusion to the pilot, hospital senior management early this month approved the deployment of 100 additional devices to a second nursing floor and the critical care environment. The hospital is also looking into giving devices to anesthesiologists for communications between the hospital's 26 emergency rooms.
For this phase of deployment, the hospital is using iPhones rather than iPods. They'd used iPods initially because they anticipated that the iPod would soon support VoIP, but that did not materialize, so the hospital is switching devices, Baker said.
Sarasota Memorial had prior experience with VoIP phones, and found dedicated VoIP handsets unsatisfactory. Dedicated VoIP phones lacked device management, so nurses could not check out a device at the beginning of a shift and check it back in again afterwards. The VoIP handsets are about the same price as iPhones, $500-$700, and they do less.
The Apple devices permit a greater level of physical security. When the hospital tried deploying VoIP handsets, they had no way of getting nurses to sign the devices in or out.
When the devices broke down or wore out due to normal wear and tear, nurses would simply abandon the devices. "People thought they'd have to pay for them. So they would use them, and if a device stopped working, they'd put it in a drawer and walk away, rather than give us an opportunity to have it repaired," Baker said. And the devices did wear out--battery clips broke, and they had to be taped together. "I can't say the device was designed for the long haul," He said. He declined to identify the brand of device that was used.
The iPods and iPhones, when not in use, live on a 12-bay charging station, under lock and key. A single individual is charged with making sure each nurse signs each device in and out again.
Another reason for choosing the iPhone is third-party application support. Sarasota Memorial eventually wants to roll out electronic medical records (EMR) apps and other enterprise e-health apps on the iPhone, Baker said.
Nurses are happy with the iPods, Baker said. The IT department asked nurses to judge the effectiveness of their current communications. Before deployment, they rated effectiveness at 2.5 out of a possible four. After using the iPods, the nurses rated communications at 3.4.
"Another key component was difficulty in figuring out who was taking care of patients on a busy nursing floor," he said. Nurses gauged their ability to find peers at 2.2 out of 4 before the iPod deployment, 3.4 afterward.
Some 84% of nurses said they would recommend the iPod app for wider adoption.
Upgrading from the iPod Touch to the iPhone was a little tricky, as the hospital plans to use VoIP over its internal Wi-Fi network, and isn't interested in a phone company service plan. Sarasota Memorial hadn't planned at first to switch to the iPhone. When they deployed the iPod Touch in the spring, they anticipated that the new model Touches released later this year would support VoIP. When the new iPods came out in early September without business VoIP services, it left ther hospital scrambling, and it turned to Voalte, the vendor that supplied the application, for help.
"Voalte asked us to go to AT&T, buy the phones, and cancel the cell phone plans. We said no to that, you need to come up with some easy way to supply the devices. Somehow they worked that out -- I have no idea how. Frankly, I don't care," Baker said.
Voalte declined to comment on how it managed to find de-activated iPhones for Sarasota Memorial.
Sarasota Memorial expects to get the new iPhones later this month, and to deploy them by December.
The project cost Sarasota Memorial about $300,000. While it has improved patient care and operating efficiency, the hospital is still working out metrics for financial savings resulting from the application, Baker said.
Voalte, the vendor, is a startup specializing in developing medical apps for the iPhone. The vision is to develop a single application for all types of alarms in hospitals and other healthcare providers, whether they're pages, or automatically generated by devices, with doctors and other caregivers able to check in to the application at the beginning of the shift and check it out at the end, said Trey Lauderdale, vice president of innovation and co-founder of the company.
Voalte plans to support the app on Google Android, the BlackBerry, Palm Pre and Windows Mobile.
Right now, a multitude of EMR and other health technology vendors are building iPhone apps, without coordinating all the different alarms and messages that they send. "You're going to end up with a toolbelt problem, a nurse carrying four or five pagers, a virtual toolbelt on the iPhone," Lauderdale said. Also, without coordination, more important alerts, where a patient's life is in danger, might get superseded by less important ones, because of the way iPhone handles notifications.
"We see ourselves providing VoIP, integration with the back-end PBX, and capability to enable caregivers to log in and log out of the device. We'll provide the infrastructure to work with other applications and vendors to make sure their communications with devices are orchestrated," Lauderdale said.
One limitation of the iPhone is that it doesn't support multitasking for third-party apps. Third-party apps shut down when you switch away from them, you can't leave them running in background. Voalte solves that problem by locating the application intelligence on the server, which sends out alerts using the iPhone's built-in push notification service. When the recipient clicks the button to view the notification, it calls up the local app.
Another limitation on the iPhone is its short battery life. Voalte now uses external battery packs, the Mophie Juice Pack.
In the next generation, Voalte is working with several vendors to develop an external battery pack made of anti-microbial resistance.
Doctors and nurses wipe down the devices with antibacterial wipes between shifts. The iPhone is great for infection protection because it has very few buttons and crevices for bacteria to hide in, Lauderdale said.
Since the notifications are just text-based, why not just use old-fashioned pagers? Lauderdale said they're unacceptable for several reasons. First, Voalte is looking to deploy VoIP call management on the devices for voice calls.
Still, most of the communications with nurses doesn't require voice, it's just small snippets of information that need to get passed to one operson or a team of people--"Please come to the nursing station," "need witness for meds in 305." "These lend themselves perfectly to text messaging," he said. Even there, the iPhone is better than pagers because the iPhone permits two-way communications.
Also, the iPhone apps permit using different ringtones for different-priority messages. "Nurses are constantly doing something," Lauderdale said. If they hear the tone for a low-priority message, they can get to it when they're ready; but if a nurse hears a tone for a critical message, the nurse can jump on it right away (if they're not already doing something else that's also critical). And nurses use notifications as a task list. When they finish something, they delete it from the list, and then look down the list of accumulated messages to see what needs to be done next.
The CEO of Voalte is Rob Campbell, who founded PowerPoint and sold it to Microsoft, and Filemaker, which is now owned by Apple.
"One of the biggest problems in any complex environment, particularly healthcare, is communication," CIO Denis Baker said. "It's a nightmare to get a hold of someone, even people on the same floor, as they go about their tasks."
So Baker's ears perked up when he was approached by Voalte about piloting a project. Voalte is a startup developing point-of-care communications using mobile technology. Its application uses iPods to send pages and alerts.
For the 60-day pilot, Sarasota Memorial handed out 25 iPod Touches to nurses on a single floor in June. The decision was made to use the iPod Touch because it's less expensive than the iPhone, does not require a cell-phone service contract, and basically has all the capabilities of the iPhone exclusive of phone functionality.
Also, the hospital wanted to move from text messaging to VoIP telephony, and it anticipated that the Touch would become VoIP-ready in its next version.
A major objective of the project was to reduce the amount of noise and inefficiency involved in calling nurses where they're needed, Baker said.
He explained, "If a patient is in bed and needs assistance with something -- they might be in pain -- they now push a button on the bedside, that goes to the nursing desk, and someone has to hunt down a nurse and make an overhead page. That's inefficient, because it doesn't go to the right person, and it also makes for too many overhead pages." At any given point in the hospital, you can hear an overhead page every three minutes. Noise is a huge complaint in any hospital -- equipment moving, staff conversations, and especially overhead pages. The noise prevents patients from getting the rest they need to heal.
On the floor where the iPods were deployed, the hospital reduced overhead pages from 172 in eight hours to 38. The 25 deployed iPods were receiving 4,000 messages per day. "Nurses were getting comment form patients on how quiet it was," Baker said.
After a successful conclusion to the pilot, hospital senior management early this month approved the deployment of 100 additional devices to a second nursing floor and the critical care environment. The hospital is also looking into giving devices to anesthesiologists for communications between the hospital's 26 emergency rooms.
For this phase of deployment, the hospital is using iPhones rather than iPods. They'd used iPods initially because they anticipated that the iPod would soon support VoIP, but that did not materialize, so the hospital is switching devices, Baker said.
Sarasota Memorial had prior experience with VoIP phones, and found dedicated VoIP handsets unsatisfactory. Dedicated VoIP phones lacked device management, so nurses could not check out a device at the beginning of a shift and check it back in again afterwards. The VoIP handsets are about the same price as iPhones, $500-$700, and they do less.
The Apple devices permit a greater level of physical security. When the hospital tried deploying VoIP handsets, they had no way of getting nurses to sign the devices in or out.
When the devices broke down or wore out due to normal wear and tear, nurses would simply abandon the devices. "People thought they'd have to pay for them. So they would use them, and if a device stopped working, they'd put it in a drawer and walk away, rather than give us an opportunity to have it repaired," Baker said. And the devices did wear out--battery clips broke, and they had to be taped together. "I can't say the device was designed for the long haul," He said. He declined to identify the brand of device that was used.
The iPods and iPhones, when not in use, live on a 12-bay charging station, under lock and key. A single individual is charged with making sure each nurse signs each device in and out again.
Another reason for choosing the iPhone is third-party application support. Sarasota Memorial eventually wants to roll out electronic medical records (EMR) apps and other enterprise e-health apps on the iPhone, Baker said.
Nurses are happy with the iPods, Baker said. The IT department asked nurses to judge the effectiveness of their current communications. Before deployment, they rated effectiveness at 2.5 out of a possible four. After using the iPods, the nurses rated communications at 3.4.
"Another key component was difficulty in figuring out who was taking care of patients on a busy nursing floor," he said. Nurses gauged their ability to find peers at 2.2 out of 4 before the iPod deployment, 3.4 afterward.
Some 84% of nurses said they would recommend the iPod app for wider adoption.
Upgrading from the iPod Touch to the iPhone was a little tricky, as the hospital plans to use VoIP over its internal Wi-Fi network, and isn't interested in a phone company service plan. Sarasota Memorial hadn't planned at first to switch to the iPhone. When they deployed the iPod Touch in the spring, they anticipated that the new model Touches released later this year would support VoIP. When the new iPods came out in early September without business VoIP services, it left ther hospital scrambling, and it turned to Voalte, the vendor that supplied the application, for help.
"Voalte asked us to go to AT&T, buy the phones, and cancel the cell phone plans. We said no to that, you need to come up with some easy way to supply the devices. Somehow they worked that out -- I have no idea how. Frankly, I don't care," Baker said.
Voalte declined to comment on how it managed to find de-activated iPhones for Sarasota Memorial.
Sarasota Memorial expects to get the new iPhones later this month, and to deploy them by December.
The project cost Sarasota Memorial about $300,000. While it has improved patient care and operating efficiency, the hospital is still working out metrics for financial savings resulting from the application, Baker said.
Voalte, the vendor, is a startup specializing in developing medical apps for the iPhone. The vision is to develop a single application for all types of alarms in hospitals and other healthcare providers, whether they're pages, or automatically generated by devices, with doctors and other caregivers able to check in to the application at the beginning of the shift and check it out at the end, said Trey Lauderdale, vice president of innovation and co-founder of the company.
Voalte plans to support the app on Google Android, the BlackBerry, Palm Pre and Windows Mobile.
Right now, a multitude of EMR and other health technology vendors are building iPhone apps, without coordinating all the different alarms and messages that they send. "You're going to end up with a toolbelt problem, a nurse carrying four or five pagers, a virtual toolbelt on the iPhone," Lauderdale said. Also, without coordination, more important alerts, where a patient's life is in danger, might get superseded by less important ones, because of the way iPhone handles notifications.
"We see ourselves providing VoIP, integration with the back-end PBX, and capability to enable caregivers to log in and log out of the device. We'll provide the infrastructure to work with other applications and vendors to make sure their communications with devices are orchestrated," Lauderdale said.
One limitation of the iPhone is that it doesn't support multitasking for third-party apps. Third-party apps shut down when you switch away from them, you can't leave them running in background. Voalte solves that problem by locating the application intelligence on the server, which sends out alerts using the iPhone's built-in push notification service. When the recipient clicks the button to view the notification, it calls up the local app.
Another limitation on the iPhone is its short battery life. Voalte now uses external battery packs, the Mophie Juice Pack.
In the next generation, Voalte is working with several vendors to develop an external battery pack made of anti-microbial resistance.
Doctors and nurses wipe down the devices with antibacterial wipes between shifts. The iPhone is great for infection protection because it has very few buttons and crevices for bacteria to hide in, Lauderdale said.
Since the notifications are just text-based, why not just use old-fashioned pagers? Lauderdale said they're unacceptable for several reasons. First, Voalte is looking to deploy VoIP call management on the devices for voice calls.
Still, most of the communications with nurses doesn't require voice, it's just small snippets of information that need to get passed to one operson or a team of people--"Please come to the nursing station," "need witness for meds in 305." "These lend themselves perfectly to text messaging," he said. Even there, the iPhone is better than pagers because the iPhone permits two-way communications.
Also, the iPhone apps permit using different ringtones for different-priority messages. "Nurses are constantly doing something," Lauderdale said. If they hear the tone for a low-priority message, they can get to it when they're ready; but if a nurse hears a tone for a critical message, the nurse can jump on it right away (if they're not already doing something else that's also critical). And nurses use notifications as a task list. When they finish something, they delete it from the list, and then look down the list of accumulated messages to see what needs to be done next.
The CEO of Voalte is Rob Campbell, who founded PowerPoint and sold it to Microsoft, and Filemaker, which is now owned by Apple.
