Transcript The Journey from Blackberry to iPhone Steve Miller

The Journey from Blackberry to
iPhone
Steve Miller, CTO
Coordinated Care of Oklahoma
Presentation Overview
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Healthcare Realities
Background (Solution History)
Lessons Learned
iPhone Pilot Results
Device Sourcing Options
Summary
Healthcare Realities
A Few People Cost a Lot
A relatively small number of patients –
often older or chronically ill people –
account for a large portion of all medical
costs.
SOURCE HENRY J. KAISER FAMILY FOUNDATION
These include frequent hospital
readmissions and managing the
consequences of obesity and
uncontrolled diabetes.
One in five Medicare patients
discharged from the hospital
will return within a month;
half won’t have seen a doctor
before their return. More
than 50% of all discharged
Medicare patients will be back
within a year.
Healthcare Reform Timeline
Feb 18, 2010
Dec 31, 2010
Oct. 1, 2010
Breach Notification 1st Qualification Date
Rules Compliance for MU Stage 1
Oct. 1, 2012
Jan 1, 2014
Jan 1, 2016
Unique Health Plan
Identifier
EFT and
Payment/Remittance
All other HIPAA
Transactions
Dec 31, 2011
5010 Internal Testing5010 External
Complete
Testing Complete
??
Oct. 14, 2014 / 15?
ICD-10 Compliance
Jan 1, 2012
5010 Compliance
June 1, 2010
Red Flag Rule
Compliance
Jan 1, 2011
July 3, 2011
Accounting of
Last day to start 90
Disclosures if EHR after qualification for FY
1/1/11
2011
Jan 1, 2013
Claims Status &
Eligibility
Oct. 1, 2012
Jan 1, 2016
Claims Attachments
Jan 1, 2014
Accounting of
Qualification
Date for MU Stage 2 Disclosures
if EHR before 1/1//09
1st
When Industries become digital
Oct. 1, 2014
Major Things Happen!
Qualification Date for
Disruptive Innovation will occur!MU Stage 3
Healthcare Reform Realities
• Race to the Bottom (Payment Reform) – Those who can
achieve high patient satisfaction and high clinical quality at the
lowest cost will survive.
– Radical Focus on Performance Management & Quality
1. Clinical / Business Discovery tools will dominate
– Tableau, Qlikview, etc Enable Discovery from multiple
data sets without complex normalization
2. Ubiquitous Access & Medical Device Integration
Paramount to = High Quality w/Lower Cost
– Improving Safety, Quality & Efficiency, Wireless a necessary
component!
Become
Interoperability
The ability to integrate devices & systems such
that they truly act as one.
Literally to operate one from inside another.
Graphic Courtesy of
Background / History
Background / History
Requirements (2007)
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Desire to Eliminate Central Monitoring Room
Need for Information at the Nurses Fingertips
Alerts based on specific requirements
Visual Indicator, Room and Wave Form (more than
just a pager)
 Automated Escalation Capabilities
 Speed and Reliability
 An Engine that would enable the connecting of
people and devices.
Architectural Concepts
Clinical / Business
Needs
Governance
Applications /
Solutions
Infrastructure
Usability and Adaptability
Security
Solution
• Connexall integrated with Draeger/RIM
Monitoring Solution
• Wifi only devices
(RIM Initially / Cincinnati Bell, Latest)
Policies on Device
• Extensive WI/FI network
• AM Shift Set / PM Shift Set
Allows one set to be charging at all times
Provides spares in case of failure
• Alerts for all Critical Alarms & SPO2 Alarms
• Escalation to House Resource / Charge Nurse
Lessons Learned from BB
• Most issues were either ;
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Education Issues (Alarm type/Escalation Rules)
Wi/Fi Turned Off
Failed Units (Zombie)
• Drove Need to verify units in working order before each
shift starts
• Acknowledgment sent to all shift units at 7:00 a.m./7 p.m.
(House Resource for each unit verifies all devices
operational prior to placing them in Service).
• Report Generated from Logs Daily
• Reviewed daily w/ follow-up
Acknowledgements
Status report (a.m./p.m.)
• Report Generated at 7 a.m. and 7 p.m.
• Initially the report showed the entire week and
every devices status
Status report (a.m./p.m.)
• Later Redesigned / Revised Report to only show
“Exceptions”
Fast Forward
In-Place for 8+ Years
 Near Real-time Alerts Delivered to Nurses
carrying Blackberry SmartPhones using;
 Connexall App integrated w/ Drager Patient Monitoring
 Wifi only devices
 (RIM/Blackberry 2007-2013)
 Eliminated Need for Monitoring room! - $$$
 Fingertip Access w/ Alerts Configured to our requirements
 Automated Escalation, Speed and Reliability
 Allows Nurses More time with Patients
 Decreased Noise and Alarm Atrophy
Connexall Solution Drives Simplicity… Order out of Complexity
Journey to the iPhone
Drivers
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Aging Condition of Blackberry’s
Issues / difficulty of procurement of Wi-Fi only version
Desire to Expand uses of Nurse Carried Device
Need / desire to continue to use a Wi-Fi only device
Usability!
What is Usability Engineering?
A usable product…
Columbia Obstruction Device
User Doing
a Job
Goals are to:
• Maximize the reward
• Minimize the pain
Shock
 Is easy to learn
 Is hard to forget
Hungry
rodent
Cheese size
Cheese
Electric grid
Pain of using
the tools
Work
Completed
Intersection of Technology & Psychology
No go
Go
• User-centered approach
• Empirical wherever possible
• Performance not Preference
*Courtesy Human Factors International
Pilot
 2013 – Evaluation / Pilot (Blackberry Replacement)
 Existing Cisco 8945 Wi-Fi Phone vs. IOS
 (iTouch, iPhone, Ipad mini)
 Nurse Managers felt need to separate phone from alerting
device (may reconsider in future) – (Read and Talk)
 Usability was best on Apple Devices
 Nurses liked the ability to see previous messages on the
iphone
 Eliminated iTouch/iPad due to;
 Voice capability.
 Future Uses of TouchID (5s)
Solution
 iPhone Selected
 Best Usability and Platform for Future
Procurement Options
 5 Year Cost Analysis (U.S. Dollars)
 ** Note OPEX Option Includes Overnight Exchange, Config,
& 1 Upgrade to next device version in 5 Year Period
Items
Costs
iphone w/plan
$199
iphone w/out plan
$649
Applecare
$99
Protective Case
$20
Belt Clip
$10
Data/Voice Service
$50
Canceltion Penalty
-$200
All inclusive Package
$660
1 Year Per Phone
5 Year Per Phone
100 Phones 5 Years
From
Carrier
w/Plan
Qty
2
0
1
1
3
60
0
0
From
Carrier
w/Plan
Extended
$398
$0
$99
$20
$30
$3,000
$0
$0
$3,547
$17,735
$1,773,480
From
Carrier
No Plan
Qty
0
2
1
1
3
0
0
0
From
Carrier No
Plan
Extended
$0
$1,298
$99
$20
$30
$0
$0
$0
$1,447
$7,235
$723,480
From
Carrier No
Plan
w/Penality
0
2
1
1
3
0
2
0
From
Carrier No
From
Plan
From
Cerner
w/Penality Cerner OPEX
Extended OPEX Extended
$0
0
$0
$1,298
0
$0
$99
0
$0
$20
1
$20
$30
3
$30
$0
0
$0
-$400
0
$0
$0
1
$660
$1,047
$710
$5,235
$3,550
$523,480
$354,980
5 Year Cost Comparison
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Purchase 100 Devices From Carrier (AT&T, Verizon, Sprint,
etc)
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iPhone 5s 16gb without voice/data plan
Included the Cost of 1 Std Case and 3 belt clips per year per device
Included AppleCare and Cost of upgrading the device to latest model
100 Phones with Accessories for 5 Years = $723,480
Purchase 100 Devices From Cerner
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iPhone 5s 16gb without voice/data plan
Included the Cost of 1 Std Case and 3 belt clips per year per device
Includes Overnight Exchange, Pre-config to MDM/Apps, and 1
upgrade
100 Phones with Accessories & Service for 5 Years = $354,980
Basically $55 per month per device
Accessories for Consideration
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Basic Protective Case (with Hospital Logo) Third Party
Sled / Extended Battery & Scanner
• Consider if Using Phones for more than receiving alerts.
• We found if just using phone for Alerts Battery was
fine for 12 hour shift (no texting, internet, voice, etc.)
• Bluetooth Scanner
• + Could be used for Meds Administration, Supplies,
etc.
Next Steps
 Complete Production Implementation / BB Replacement
 Evaluate Options for Wider Alerting
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Labs
Medications
IV’s
Bed Management
Assignments
Housekeeping
 Evaluate use of iPhone as wi-fi voice device
 Evaluate Possible Replacement of Other internal Systems
with Connexall
 Nurse Call, Server Monitoring, etc.
Mobile Device Management
&
Wi-Fi Lessons Learned
Wireless Lessons Learned
• Have a “Wired Backup Strategy”
• Ensure Switches on Emergency Power
• POE Switch / AP’s
• Deny Wireless “b” (a/g/n)
• Support Voice First
• Dedicated VLAN’s / SSID’s
• Improves Power Consumption
Wireless Lessons Learned
• AP Placement
• Avoid Too Many or Not Enough
• Cover all Patient Areas
• Get Third Party Survey / Certification
• “Outside-In” Layout for best results
• Best For Location and Coverage
• Redundant, Embedded / Distributed
Controllers
• Consider Future
• (Wireless “ac”)
• Don’t Forget Security!
Security
• Devices must be registered
• User must agree to Terms of Use:
• Agree to report if lost or stolen
• Agree to allow remote erase
• Agree to use in accordance w/Policies
• Requires device access password
• Using Mobile Iron Device Management
solution.
• Balance End User Usability,
& Preference vs. Security, Risk & Budgetary
concerns
Summary / Closing
Summary
The Economic Case for Wireless
• Healthcare Reform Drives Organizations who can;
• Achieve High Quality & Satisfaction at Lowest Cost
• Wireless and Interoperability can be an Enabler for;
• Improved Quality, Safety, Efficiency = $$
• The Hard and Soft Economics of Wireless are Real
• You will be supporting Wi-Fi Regardless
• Design it right with medical grade redundancy
• OHH Saved saved nearly $2 million in Capital by implementing Wi-Fi Patient
Monitoring over WMTS (2 Campuses)
• The Flywheel Theory holds true for Wireless (Jim Collins)
• Build a Solid and Secure Wi-Fi Infrastructure to support your
future!
• Wireless Capabilities drive Innovation
Mobile Evolution
Applications versus Devices
Embedded
Apps
& Wearable
Wireless &
Interoperable
Wired &
Interfaces
Standalone
Devices
Final Thoughts
• Look For, Select, & Empower , Power Users at all levels (Physicians,
Nurses, Pharmacists, Network Engineers and Architects etc..)
• Partnership is Key (Physicians, Nursing, Lab, Pharmacy, Biomed, IT,
Vendors)
• Innovate for the best experience, improve processes & systems for
patients…clinician…all team members
• Usability Engineering & Service Focus can be major difference
makers (Consider the Human Factors!)
• Mobility & Wireless is here to stay – Plan & Design For it!
• Get Advice / Ask for Help!
Don’t be an IT/Clinical Engineering Department of NO,
be one of KNOW-HOW!!!
Thank you
Steve Miller
Chief Technology Officer
Coordinated Care of Oklahoma
[email protected]