The second day of GlobeStar's World Connex user group meeting included more informative end user experiences implementing ConnexALL.

Shawn Sicard, CEO of PiiComm in Toronto, Canada lead the customer presentations with a discussion about putting togeter complete solutions.  PiiComm is a systems integrator targeting the health care vertical market, with a long term relationship with GlobeStar. As an event sponsor, PiiComm has an exhibit demonstrating many of the products they support. Sean highlighted the Motorola CA 50 wireless VoIP phone with built-in barcode scanner. Built orignally for Home Depot, the phone has found some interest in health care. The phone has push to talk (PTT), a 1D barcode scanner in a small size (4.37"x 1.81" x 1" and about 4 ounces). The CA 50 is rather like a large Vocera pendant, there is no phone keypad. The phones are configured based on user profiles and voice input and text based menus on the phone to place calls. He also talked about the new Motorola EWP 1000/2000 wireless VoIP smart phones. The Moto phones were prominent in the Vocera/Motorola announcement at HIMSS, and is only one of two wireless phones that meet all the basic hospital requirements -- ruggedized, water resistant and impervious to hospital disinfectants. (The other phone is the also new Ascom DECT IP phone, the d62.)

Shawn described asset management, preventive maintenance, temperature monitoring, patient and staff safety and workflow and resource management as key applications supported by AeroScout. PiiCommis also an Ascom reseller. Shawn noted that going wireless, including wireless VoIP is hard; part of his company's mission is to help with that transition. He positioned Ascom as a DECT wireless phone solution that doesn't require Wi-Fi.

Patient Monitor Integration

After the break Stephen Rocha with St Vincent Heart Center of Indiana presented Patient Monitoring Integration.  Stephen described the corporate culture and noted that Siemens/Draeger are the predominate medical device vendors (Hospira too). They also have Dukane for nurse call, Hill-Rom beds and Siemens (the Chantry Networks acqusition?), Meru and InnerWireless provide wireless networking. ConnexALL is used as messaging middleware.

The Draeger monitors are installed using Pick and Go docking stations. When docked at the bedside, monitors are connected via Ethernet. When the patient is transported, the monitor is removed from the dock, moved with the patient and then docked again upon reaching their new location. When the monitor is docked again, data acquired during transport is uploaded to Draeger's server. Alarm notification is only available through ConnexALL to the Cisco handsets when the monitor is docked; during transport local alarms are the sole means for alarm notification.

St Vincent uses ConnexALL for messaging nurse call and patient monitor alarms to nurses via Cisco 7921G wireless VoIP handsets. The hospital defined a requirement that a waveform snippet accompany patient monitor alarms, so nurses can easily filter out false positive arrhythmia alarms.

They looked at Blackberry's, but the only channel available to them was Verizon who wanted $20,000 per month in "service fees" -- which was  a non-starter for the hospital. They also looked at Spectralink, Ascom and others, but they could not support waveforms.

They purchased the ConexALL Notification Server (the basic system), Device Assignment Client (nurse to patient and nurse to phone assignments), Wireless Telephony Client (to integrate with the Cisco handsets), and the Standard Input Client (integration to Draeger monitors and nurse call).

During configuration Stephen configured a test environment into the system, for verification testing at installation, and with subsequent hardware and software upgrades. This is an important process that takes real discipline to complete. Good practice for IEC80001!

The alarm classifications they defined are Advanced (battery, leads off, etc.), Serious (things like heart rate and non life threatening arrhythmias) and Life Threatening. Initially, during their pilots, they had some issues with alarm fatigue that they resolved by adjusting alarm categories and escalation to better match the unit's patient profile. They started their rollout in lower acuity units, and when they implemented higher acuity units, adjustments were needed to optimize alarm notification to match the different requirements of each unit.

One of the things on Stephens list of todo's is to define callpoints for when ventilators are connected to their Draeger monitors, and then configure specific workflows for respiratory therapy. GlobeStar's already done implementations like this in other sites. Stephen also would like to be able to access and display near real time surveillance waveforms on their Cisco handsets. This is a capability that ConnexALL has not yet implemented.

Detailed ROI Analysis

Jeremy Wyatt with Valley Medical Center presented Workflow Before and After the Wonders of ConnexALL.  Their ConnexALL implementation centers on improved messaging and automation for common communications workflows in surgery. The scope of the project is comprehensive, including admitting through discharge, including support for exceptions during surgical cases (like equipment that wasn't initially specified as need for a particular surgical case). Their implementation also addresses room turnover.

Jeremy started this project a few years ago doing direct observation of existing workflows. He documented the workflow processes and the times associated with each step of the process. After the ConnexALL implementation, he repeated his observations to document the savings resulting from the system. This is an important process that takes real discipline to complete. It's really no fun until you get to document all the money you're saving at the very end.

Benefits: real time data distributed immediately, noise reduction (little or no overhead pages), increased staff satisfaction, improved surgical throughput, improved staff deployments. Main productivity improvements came in maintaining whiteboards (2 hours nightly), admitting, starting and ending cases, and reducing unnecessary case delays. The annual hard dollar savings came to $2, 428,873, plus value added "soft" dollar savings. Not included in the analysis is the incremental revenue from the increase surgical cases.

In talking with other ConnexALL users, it was reported that at least in the OR, pay back for a complete ConnexALL system is less than a year -- sometimes a lot less. Like many similar point of care systems, ConnexALL requires certain infrastructure a hospital may or may not have. A hospital starting from scratch, and assuming infrastructure costs like wireless phones, and RTLS and the Wi-Fi network into the ConnexALL system, reaches payback  in closer to a year. Hospitals who already have all or most of the required infrastructure reach payback much quicker.

Valley's next goal is to incorporate an RTLS with ConnexALL (a key feature in the new version 4.0 announced yesterday) as well as their EMR (also enhanced in the new 4.0 release). They also plan to automate workflows around on-call emergency surgical cases. Another planned extension of the system will select the surgeon, generate automated text to speech calls, ensuring the proper equipment for the emergency case, and integrating with their Kronos staff scheduling system.

Pictured above is Nokia's E65, a $100 Symbian cell phone with Wi-Fi, GSM and SIP connectivity. That certainly gets my imagination going, doesn't it?

UPDATE: You can read the first day's post here, and the last day here.