Technology: Tracking Success
Features
Written by Deborah Geering   
Friday, 29 February 2008
Technology: Tracking Success - Health Executive - RedCoat Publishing
IT experts tell us about the enormous benefits of eliminating those pesky departmental silos.
Anyone who has ever served on an acquisition review board for a piece of high-tech hospital equipment has probably thought, at one time or another, of Betamax.

Introduced by Sony in 1975, Betamax was the original video recording format. It was followed a year later by JVC’s VHS format. The standards battled for market dominance for more than 10 years, until VHS finally won out. In the meantime, consumers fretted over their purchase decisions, wondering which format would prevail. Ultimately, millions of Betamax consumers would end up with a second set of videos, a VHS machine, and buyers’ remorse.

Because of similar standards battles and market competition, hospital employees can easily become overburdened with gadgets and logins as they struggle to keep up with the latest device to improve patient care. Add to this scenario the complex decisionmaking structure of the typical hospital (lots of independent silos trying to choose between any number of Betamaxes and VHSs) and you get some idea of the challenges facing both caregivers and decisionmakers.

Such is the environment that Yadin David and several colleagues at Texas Children’s Hospital decided to try to improve, and their efforts won them the 2007 Health Devices Achievement Award from ECRI Institute.

“A lot of institutions do their technology planning within silos,” said James Keller, Jr., vice president of health technology evaluation and safety at ECRI. “Those silos can create a problem: you could end up with systems not talking to one another if they were built on different standards.”

The skunk team
At Texas Children’s, David, director of the biomedical engineering department and Center for Telehealth, was concerned with the potential for wasted energy and resources caused by overlapping projects. “We wanted to gain better synchrony and control over the various projects converging at the point of care.

“Every project had implementation time, resources cost, and outcomes—but independent of other projects going on at the same time,” said David. He knew that, soon, project heads would be stumbling over one another and caregivers would be overburdened trying to implement uncoordinated changes.
 
David recruited several people in the hospital who shared his viewpoint: a nursing director, an IT senior project manager, and several risk managers. They called themselves the Skunk Team. “Because, like the animal, nobody wanted to get near it,” he joked.

The team got to work—outside the hospital’s official power structure and without funding. Their idea was to identify a situation where overlapping projects were causing complications and then work to unify them and align their objectives. With a small success under their belts, they reasoned, perhaps they could illustrate the need for an interdisciplinary approach to clinical project management.

“The nurses were looking at the IT department and saying, ‘What a barrier,’ and the IT department was looking at the nurses and saying, ‘They don’t understand,’” David explained. Everyone had good intentions, he said, but they didn’t see the big picture: small steps toward a common goal.

The Skunk Team turned its attention to the alarms that were deluging nurses’ pagers, cell phones, and PDAs. “They were overburdened with alarms, and everyone was aware of that, but nothing was done about it,” David said. “We said to the front-line nurses, ‘Tell us exactly what you are experiencing, and let’s see what we can do about it.’”

The group got hospital funding for the pilot study of the alarm issue and escalation process, and in partnership with the Health Care Technology Foundation developed knowledge needed for the next step. They invited nine vendors to work with them to develop a new system, now called the Integrated Platform for Life Safety and Tracking (IPLST). Eight of the vendors are still with the program.

Open architecture
In about a year, the team (renamed the Clinivators for clinical innovators) had rolled out a pilot program in which nurses gave up their pagers and PDAs and received a single communication device: the Spectralink phone. The phones are fed alarms based on a priority system developed with the nurses’ input.

“That was the beginning of looking at improving patient safety, managing the proliferation and cost of technology, and improving communication between different projects without taking control from their leaders,” David said.

With an open architecture, the hospital is able to more effectively add on new solutions to the IPLST, one at a time. For instance, after developing a database of staff contact information for the alarm solution, solving another problem that plagues many hospitals (closing the communication loop to make sure a nurse or resident has received critical information) was just a small step away.

“We have a system in place that identifies Brenda as the nurse taking care of John today,” David said. “If you are trying to deliver lab results for John, you can go to the white board directory to see what type of communication this individual prefers (desk phone, pager, or wireless phone) and it will send the message and expect a confirmation of delivery,” he explained.
As the recipient, Brenda can press one button on her wireless phone to indicate she’s received the message or another to indicate she’s busy and the message should be sent elsewhere. If there is no response from Brenda, the message will automatically be escalated. Currently, the team is looking to develop a black box type of communications record to be used as a learning tool. Said David: “We have an integrated platform that is collecting information about alarms and other communications going back and forth. If there is an adverse event, we can go back to see what led to that and address it immediately.”

After presenting the results of the initial study at the Harvard Quality Colloquium and publishing in Critical Care Nursing, and especially after winning the ECRI Institute award last July, David’s team has gotten quite a bit of attention. The team has made several presentations around the country and in China, and they get visits or calls on a weekly basis from people and institutions eager to learn about their methodology.

The awards review committee at ECRI was impressed by the project’s collaborative approach and foresightedness. “I think this is where a lot of hospitals will be going, getting related technologies to talk with one another across a common network,” Keller said. “This submission, to us, represented a classic example of what technology management is supposed to be. You need to look at how you’re managing technology across the whole system.”

Deborah Geering, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , is a freelance writer based in Atlanta.
 
< Previous Story   Next Story >