unifying hospital communications presented by: arnaz alavi, daryl wieland, andrew o'hara, and...
TRANSCRIPT
UNIFYING HOSPITAL COMMUNICATIONSPRESENTED BY: ARNAZ ALAVI, DARYL WIELAND, ANDREW O'HARA, AND JAMES TESSIER
Board of Directors Presentation
March 2013
Memorial Hospital
Introduction
Patient care involves many different individuals and support services–all of whom need to share and discuss patient information in a timely manner
Critical need to connect and communicate with the right clinician at the right time about the right patient
Better communication means better care–both in terms of patient safety and quality
Problems with Current Communications
Healthcare industry has been using outdated methods of communication for decades (pagers, stationary phones, etc.)
Both productivity and patient safety are impacted by poor communication between clinicians
Communication inefficiencies cost hospitals more then $10 billion annually (Sands, 2008)
“Ineffective communication is the most frequently cited root cause for sentinel events”
-The Joint Commission
Current State of Communications at Memorial Hospital
Technology: Avaya PBX phone system Rauland Responder 5 nurse call system Proprietary text and overhead paging system Separate paging system for critical patient alarms
Problems: Difficult for clinicians and support staff to connect with each
other in real-time (leading to delays in care) Clinicians texting on personal phones (HIPAA violations) Frequent noise from alarms and overhead paging (affecting
patient satisfaction) Alert fatigue from alarm pagers and beeping devices (patient
safety concerns)
Proposed Solution
Unify Memorial Hospital’s communication system Eliminate legacy system, including call
bells, numeric and overhead paging Implement integrated voice, two-way text,
and alert system on a single communication device
Integrate new system with existing phone and nurse call systems which will run on existing 802.11n Wi-Fi network
Advantages
Clinicians will be able to… Immediately connect with other clinicians
and support staff and improve timeliness of notifications
Send HIPAA-compliant text messages to other clinicians and support staff
Receive relevant patient alarms that auto-escalate to other clinicians if necessary
Advantages
Memorial Hospital will… Have a unified hospital-wide
communication infrastructure Experience a significant reduction in
overhead paging Have a reliable record of all hospital
communications and alarm receipts
Disadvantages
System is heavily network and Wi-Fi dependent
Clinicians and support staff will have to adapt to a new technology
Perceived disruptions of use of smartphones and weakened interpersonal relationships by decreased direct communication
Individual devices are fairly expensive – loss and theft could be an issue
Available Systems
Vocera Utilizes proprietary, wearable devices for voice
communication and uses iOS, Android, and Blackberry for voice and secure messaging
Voalte Utilizes iOS for voice, secure messaging, and
patient alarmsTiger Text
Utilizes iOS and Android for secure messaging and notification (no voice capability–excluded from further analysis)
Vocera
Lead offering is voice-activated hands-free badge allowing instant communication with clinicians and support staff (however, primarily used by nurses)
Offers smartphone app for voice, secure messaging, and alarms systems, but not widely used today (limited opportunity for site visits)
Estimated cost*: Initial investment: $1.0 million Present value of 10-year costs:
$2.1 million
*Financial model available in Appendix 1
Voalte
Lead offering is iPhone-based voice, secure messaging, and alarm system
Commonly used by both physicians and nurses
Also offers desktop-based messaging app that communicates with all mobile devices
Estimated cost*: Initial investment: $1.1
million Present value of 10-year
costs: $1.5 million*Financial model available in Appendix 2
Metrics for Communications Systems Upgrade
Objective Provide safe, patient centered, timely, and efficient care
through improved communications Goals
Decrease time spent finding the most efficient way to communicate to other healthcare team members
Facilitate more efficient and safe patient hand-offs Expedite room turnovers
Measures Track the amount of time spent connecting to the correct person Track the time spent from initiation of communication to end of
communication for patient hand-offs Track the time lapsed between calling for room turnover and room
being ready for the next patient
Implementation
Propose a staged deployment:1. Emergency Department (initial trial area)
Uses: contact between triage, main desk, and staff location
2. Operating room suite Uses: turnover teams, front desk contact, minimizing
overhead paging, anesthesia/surgeon notification
3. Intensive care units Uses: emergency response notification, staff location
4. Roll out to all nursing floors Uses: notification and paging between nursing staff and
clinicians, eventual integration with call lights and network connected devices
5. Eventual roll-out to outpatient clinics Uses: clinician paging, notification, and alerts
Request to Proceed
Allocate manpower, draft RFP, conduct site visits, choose vendor (with input from clinical leadership), and enter negotiations;
Conduct ED pilot; and, if successful, Continue with purchase and implementation
of full system in FY14
Other considerations: May need to expand Wi-Fi infrastructure to
handle increased load on the network
Questions
Appendix 1 – Vocera 10-year Plan
Back to Vocera slide
0 1 2 3 4 5 6 7 8 9 10 Total
Devices:New devices 1,000 10 10 10 10 10 10 11 11 11 11 1,104 Replacement devices - 100 100 101 102 103 104 105 106 107 108 1,037 Total devices 1,000 1,010 1,010 1,020 1,030 1,041 1,051 1,062 1,072 1,083 1,094 1,094
Replacement rate 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% Device growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
Cost per device $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 $ 425 Total device cost $ 425,000 $ 4,250 $ 4,250 $ 4,293 $ 4,335 $ 4,379 $ 4,423 $ 4,467 $ 4,511 $ 4,557 $ 4,602 $ 469,066
Licenses:New licenses 1,500 15 15 15 15 16 16 16 16 16 16 1,657 Total licenses 1,500 1,515 1,530 1,545 1,561 1,576 1,592 1,608 1,624 1,640 1,657 1,657
License growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
Cost per license $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 $ 250 Total license cost $ 375,000 $ 3,750 $ 3,750 $ 3,788 $ 3,863 $ 3,902 $ 3,941 $ 3,980 $ 4,020 $ 4,060 $ 4,101 $ 414,152
Cumulative license cost $ 375,000 $ 378,750 $ 378,750 $ 382,538 $ 386,400 $ 390,302 $ 394,242 $ 398,222 $ 402,242 $ 406,302 $ 410,402 $ 410,402
Maintenance:% of cumulative license cost 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%
Annual maintenance expense $ 113,625 $ 113,625 $ 114,761 $ 115,920 $ 117,091 $ 118,273 $ 119,467 $ 120,673 $ 121,891 $ 123,121 $ 1,178,445
Implementation / professional services $ 200,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 20,000 $ 400,000
Total cost $ 1,000,000 $ 141,625 $ 141,625 $ 142,841 $ 144,118 $ 145,371 $ 146,636 $ 147,913 $ 149,204 $ 150,507 $ 151,823 $ 2,461,664
Cost of capital 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%
Present value $ 1,000,000 $ 133,608 $ 126,046 $ 119,932 $ 114,155 $ 108,630 $ 103,372 $ 98,371 $ 93,612 $ 89,085 $ 84,777 $ 2,071,589
Appendix 2 – Voalte10-year Plan
Back to Voalte slide
0 1 2 3 4 5 6 7 8 9 10 Total
Devices:New devices 1,000 10 10 10 10 10 10 11 11 11 11 1,104 Replacement devices - 100 100 101 102 103 104 105 106 107 108 1,037 Total devices 1,000 1,010 1,010 1,020 1,030 1,041 1,051 1,062 1,072 1,083 1,094 1,094
Replacement rate 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% 10.0% Device growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
Cost per device $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 $ 800 Total device cost $ 800,000 $ 8,000 $ 8,000 $ 8,080 $ 8,161 $ 8,242 $ 8,325 $ 8,408 $ 8,492 $ 8,577 $ 8,663 $ 882,948
Licenses:New licenses 1,500 15 15 15 15 16 16 16 16 16 16 1,657 Total licenses 1,500 1,515 1,530 1,545 1,561 1,576 1,592 1,608 1,624 1,640 1,657 1,657
License growth 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0%
Cost per license $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 $ 150 Total license cost $ 225,000 $ 2,250 $ 2,250 $ 2,273 $ 2,318 $ 2,341 $ 2,364 $ 2,388 $ 2,412 $ 2,436 $ 2,460 $ 248,491
Cumulative license cost $ 225,000 $ 227,250 $ 227,250 $ 229,523 $ 231,840 $ 234,181 $ 236,545 $ 238,933 $ 241,345 $ 243,781 $ 246,241 $ 246,241
Maintenance:% of cumulative license cost 20% 20% 20% 20% 20% 20% 20% 20% 20% 20% 20%
Annual maintenance expense $ 45,450 $ 45,450 $ 45,905 $ 46,368 $ 46,836 $ 47,309 $ 47,787 $ 48,269 $ 48,756 $ 49,248 $ 471,378
Implementation / professional services $ 50,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 5,000 $ 100,000
Total cost $ 1,075,000 $ 60,700 $ 60,700 $ 61,257 $ 61,847 $ 62,420 $ 62,998 $ 63,583 $ 64,173 $ 64,769 $ 65,371 $ 1,702,818
Cost of capital 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0% 6.0%
Present value $ 1,075,000 $ 57,264 $ 54,023 $ 51,433 $ 48,988 $ 46,644 $ 44,411 $ 42,286 $ 40,263 $ 38,337 $ 36,503 $ 1,535,152
References
Horwitz, L. Detsky, A. Physician Communication in the 21st Century: To Talk or to Text? JAMA. 2011;305(11):1128-1129
Wu,R et al. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res. 2011; 13(3): e59.
Wu, RC, et al. The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. JAMIA. 2013 Jan 25. ePub.
Daniel Z. Sands. Challenges in Healthcare Communications. How Technology Can Increase Efficiency, Safety, and satisfaction. July 2008