CINs play a lead role in changing the future of healthcare

A few weeks ago, I had the opportunity to attend the Lurie Children’s Clinically Integrated Network annual meeting. Brent James, MD, known internationally for his work in clinical quality improvement provided the keynote. Also, presenting were Madeline McDowell, MD and Karyl Kopaskie, PHD of Sg2 and Toya Gorley, MBA from NRC Health.

It quickly became evident that this was not just a group gathered to sit back and idly listen to the speakers. These were providers and support staff from across Chicago, who had gathered to connect, share ideas, ask questions, and collaborate as part of a larger community. They were here to tackle problems from many different viewpoints – the analyst, the practice manager, the surgeon, the researcher, the pediatrician etc. For a few hours that day, I had a window into a group that is committed to keep at this, to iterate again and again as necessary – to ultimately seek a better way for patients and providers.

As a consumer of healthcare who is at the mercy of the institutions, individuals, technology, traditions and training that collectively create our “healthcare system”, I was encouraged to see that the human side of that system is alive and well. What I saw were people who stepped away from their packed day and obligations to actively participate in improving this system.

Brent James, while briefly lamenting the fact that the Senate Judiciary committee members in 2009 had enjoyed using his message to decry all the ills of our system, was energetic about the opportunities within reach … not dependent on correcting complex laws and payer relationships but actually within reach today for providers.

There was much talk and data supporting industry trends moving from pay for service to pay for value in a provider at risk financial environment. There were discussions around reducing the massive variation in clinical practices, increasing E&M virtual visits, direct employer contracting, consumer trends in social media usage for healthcare decisions and more – so much to digest and consider.

Ultimately, my biggest takeaway was an appreciation for the role the CIN plays in bringing together the people who actually embody “the system” and in providing pathways for these individuals to lead the way in improvements that can eventually impact us all.

I am excited about the work we do with Lurie Children’s Clinically Integrated Network, and look forward to being part of the change they are creating. You can read more about that in this case study or contact us to learn more.


Overcoming barriers inherent in the development of new and innovative solutions for the clinical environment

Getting from idea to impact:

Due to the complexities of care coordination, disconnected systems, speed of technology and innovation, hospitals and other healthcare organizations face unique challenges in bringing new technology innovations to life. Moving from original idea to building a fully fleshed application requires judiciously and quickly overcoming barriers inherent in today’s medical environment.

Our team was invited to present on this very topic at last month’s Epic App Orchard conference in Madison, WI. We extended that invitation to Allie Lindahl, Administration Specialist to the Senior VP and Chief Nursing Officer at WakeMed Health & Hospitals. Together, we shared what we have learned building RapidConnect with and for WakeMed. We specifically focused on four barriers that hospitals must overcome.

The presentation was very well received, with a lot of great feedback and questions from the audience. With that in mind, we decided to share some of the key points we included in our presentation and reflections on how we responded to those.

Deciding What to Build:

Key points:

  • Focus on how your solution solves a real problem. Build it and they will come is not a strategy for success.
  • The ‘Build it Right’, ‘Build the Right Thing’, and ‘Build it Fast’ voices all need to have a place a the table, and are sometimes opposed to each other. If it were easy, anybody could do it!
  • Pick your key design point(s) and stick with them.

Our reflections:

We use Agile Methodologies and started with an MVP (Minimal Viable Product), started with a Beta in a smaller group within the hospital and continued to build RapidConnect out based on that experience. This approach worked extremely well for both our company/product and customer (WakeMed). It helped us hone in on the importance of Physician adoption/usability, which continues to be the guiding light throughout the development of RapidConnect.

Barrier 1 – The Engineers who build your App lack the in-depth clinical knowledge:

Key points:

  • Assemble a passionate product team with representation from a variety of relevant disciplines: IT, nursing, physician leadership, whoever is “doing” this work now, project lead, engineer, UI designer, product manager, etc.
  • Create a disciplined framework for user stories and use it. For example:

As a _____ I need to ___________ so that I can __________.

And if I can’t then I will ___________.

While I am doing this I am also________________.

  • Capture key workflows – discover secondary players and take time to gain their trust.
  • Mock-up screenshots and sit down with user in their environment, not in a conference room. Be careful not to give leading information.

Our reflections:

Getting all of the key groups involved as stakeholders in the project was critical, along with the discipline to capture the workflows and write the use cases in a structured way so our Development team could have a full understanding of what needed to be built. The stakeholders definitely appreciated a seat at the table and were instrumental to our success in the WakeMed rollout.

Barrier 2- People who give you valuable and much needed input will steer you off course: 

Key points:

  • Evaluate requests against your mission statement, and remember that each feature (no matter how small) has a cost.
  • Define your critical user and understand the impact of any feature request on this user. Does this feature improve my critical user experience or impede it?
  • Have a simple method of prioritization for Product Team discussions:
    • T- shirt size- S, M, L, XL
    • Allow for and look for the 3 agile perspectives
  • Have a separate deeper process for investment/partnership opportunities.

Our reflections:

Developing the mission statement up-front and sticking to it was a critical factor in in getting the RapidConnect product to market. We have focused on Physician Usability from the start and it has had a dramatic effect on the RapidConnect adoption rate. While this may seem like an obvious statement, users really like Apps that are easy to use.

Barrier 3 – Legacy systems are there and are easy for people to fall back to:

Key points:

  • Establish open lines of communication with staff – clinicians are often too busy to respond directly to you but will give feedback to their administrative staff.
  • Create proactive alerts of poor experiences and a way to respond – simple is better to begin with.
  • Have a way to gain insight into use of legacy systems to see who has jumped ship.
  • Provide reporting on positive outcomes and experiences, and put this information in hands of champions.
  • Consider average age and technology aptitude of your users – ideas from your product design team may be lost on your users.

Our reflections:

When developing a new solution there is a tendency for you to not think about legacy technologies. We had some of that early on with RapidConnect, however we realized that pager users were a critical part of our user base, to support either gradual adoption of RapidConnect or the ability to use RapidConnect despite still carrying a pager. As much as it pained us to invest more in the technology we are ultimately trying to replace, it was absolutely the right thing to do for the Product. 

Barrier 4: New and improved infrastructure options come on the market every day, leaving yesterday’s choices outdated

Key points:

  • Be ready to evolve quickly – Smaller user stories with iterative development and daily communication (< 10 developer hours per card).
  • Early on have a peer review of your technology stack.
  • Speed is essential to end user experience.
  • Bug Fixes – Gauge number of users affected and impact on your critical users to ascertain urgency.

Our reflections:

Our philosophy in this area is to ensure that we meet patient safety, regulatory, performance, and security guidelines while still providing an easy-to-use solution focused on Physician usability and adoption. Along with that, we have found that providing an incremental path for key infrastructure changes is much better than a ‘big bang’ approach. This has cost more from a development/testing and elapsed time perspective but has been worth it in that it has kept the end-user experience simple and consistent.

Summary:

We hope that mapping out these key factors is useful for those of you who are developing or updating solutions now or in the future. We have learned a lot throughout this process and continue to learn on a daily basis. Please reach out to me at jeff.kramer@mdinterconnect.com if you would like to further discuss any of the points raised. Contact sales@mdinterconnect.com if you would like to see a demo of the RapidConnect product.


How Better Physician-Nursing Communication Leads to Better Patient Care

As the primary patient caregivers, nurses are responsible for most of a patient’s direct care. Ensuring nurses have the information they need from physicians to manage that patient’s care is critical. When that communication is delayed or inaccurate, the quality and timeliness of patient care is affected. This can lead to medical errors, extended wait times, delayed discharges, poor decision making, and increased stress. All of those factors can negatively impact patient outcomes and a hospital’s bottom line.

Delayed or inefficient communication can be attributed to dead cellular/page services within the hospital, paging the wrong level of provider, incorrect or unpublished call schedules, uncertainty in the delivery of one-way communication, and waiting for call backs and shift changes.

WakeMed Health and Hospitals turned to RapidConnect to help improve communication between nurses and physicians, with the goal of improving patient care. The hospital deployed RapidConnect to all nurse workstations and to the over 800 shared mobile devices used by nursing to manage bedside.

Using RapidConnect, nurses were given direct access to providers and a quick and easy way to view call schedules. They no longer have to wait for a call back to share clinical information, can see read receipts on RapidConnect, can easily access accurate call schedules, and can easily forward information at shift change ensuring a clear line of communication. Providers can now reply directly to the floor nurses via RapidConnect instead of calling the charge nurse and getting transferred.

Based on their success, nursing management requested that additional ancillary services be given access to RapidConnect. Physical Therapy, Occupational Therapy, Speech Therapy, Case Managers, Diabetes Nurse Educators and Wound Care Nurses have all started using RapidConnect too, increasing robust communication throughout the entire system.

To learn more about how better communication is helping WakeMed improve patient care, see the use case here. Or contact us directly to talk about your communication needs.