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.


Avoiding the best of breed vs best in suite technology trap

Have you ever heard your neighborhood barista ask, “would you like your coffee to be hot OR taste good”? Of course not! There is no sense spending the time in line or spending your money if the coffee is not both hot and good.

Unlike your neighborhood barista, many health systems are asking an “either-or “question when it comes to new technology – “do we go to a new vendor for full functionality or use a limited add-on offered by a current vendor?”

CIOs and CTOs have struggled with this same question for years. They often follow a well practiced analysis of best of breed vs best in suite (in this case probably your current system) by weighing the benefits and costs associated with implementation, integrations, security, networking complexity, user training, duplication of data and processes, timing of upgrades, customizations, flexibility of vendors, user- interfaces, and more.

While this approach may seem “tried and true” it can actually lead to a terrible waste of time and money. The best technology choice will only be found if you start with a entirely different question. Are you going to mandate the use of this technology or give users a choice?

If choice is permitted, then your evaluation process needs to start with user adoption in mind. In that case, here are some criteria to consider:

  • Ease of use- Can people easily understand purpose and use of system?
  • Ease of access- Can people easily find system and log on and off without trouble?
  • Clinical impact – Does using this system improve user ability to accomplish clinical goals?
  • System Support- Is system support uniquely attuned to the medical environment in terminology and speed?
  • System Flexibility- can the system be easily configured to meet unique needs of various service areas?

If you start by defining a platform or tool that your users will actually choose to use before thinking about vendor selection, you are more likely to see a better return on that technology investment in addition to higher user adoption and satisfaction.

If you would like to learn more about our philosophy on technology solution, or talk to one of our customers about their selection process, let us know.


Pagers Putting Hospitals (and Patients) at Risk

With the Kansas City Star article making waves across the nation, there is no excuse for thinking that pagers are still an acceptable option for sending patient health information (PHI). And no one can deny that healthcare workers routinely include PHI in their pages. According to 2017 study by the Journal of Hospital Medicine, nearly 79 percent of 620 hospital-based clinicians said they are provided pagers for communications, while 49 percent said they receive patient care–related communication through pagers.

As the IT worker in the Kansas City Star article demonstrated, anyone with $20 and TV antenna can now easily stumble over or intentionally access PHI. Awareness of the security risk posed by sending PHI via pager has increased nationwide.

What is being done about it?

Red flags should be flying. Not the kind with the white cross in the middle but the kind that indicate “Danger ahead. Stop, or proceed with extreme caution and at great risk!” Using pagers to send patient health information, as practiced today in most healthcare organizations, is unsecure, puts a system at risk for significant HIPAA violations and compliance fines and creates additional vulnerabilities for the patients themselves.

To further emphasize the importance and urgency of action, just last week an administrative law judge ruled that the MD Anderson Cancer Center in Houston must pay $4.3 million in fines over a stolen laptop and two lost USB drives; an amount that cannot be easily ignored.

So the question has shifted from “can we use pagers for sending patient health information?” to “how quickly can we move to an encrypted method of communication?”. Now, more than ever, speed of deployment is of great importance but training, reliability, accuracy, and patient safety cannot be short-changed. Traditionally, changing communication tools, workflows, processes and expectations in a hospital has been more like moving a barge than racing a speedboat. Speed was definitely not a top consideration option. Several high profile incidents have changed this. Speed is now required.

Finding a Balance

So how do you quickly provide a compliant system without jeopardizing patient care?

First, every system must immediately educate employees and providers on acceptable pager use and explicitly prohibit patient health information. Actions must be taken to monitor accountability to the policy. Informal polling often finds that there continues to be confusion over what information is considered PHI and if there are certain situations where it is still “OK” to use the pager for PHI.

Second, an encrypted method of communication must be made available to all providers. This method needs to be a simple solution for quick deployment, but also a robust system that can support increased usage and complex workflows in later implementation stages. The simplest solution will be a download and go mobile communication app, which encrypts in rest and in transit.

Finally, the chosen encrypted method of communication must be easily monitored and provide tools for accountability. Monitoring will need to include real time alerts, escalations and read times analysis in order to ensure the smooth and quick flow of patient care information.

There are many more questions to be asked and issues to be addressed in the months after initial implementation such as questions involving system integrations with call schedule and EHR systems, access points, and adoption by the referral community. These questions may need to work their way through hospitals at a more “normal” speed and will benefit from the deliberate and collaborative ways that change has been traditionally implemented in large systems. Finding that balance is key.

Let us know if you would like to learn more about secure communication alternatives that are designed for physician adoption, to support health system integration and to deliver immediate value.


Hospital compliance officers must think beyond “security” when it comes to text messaging

Today, hospitals know that they need to find HIPAA compliant communication solutions, but often to struggle to identify the right solution and/or to identify (or agree on) who is actually responsible for finding the right solution.

They are starting to realize that finding the right secure communication solution is more than just a technology decision. With ultimate responsibility for adherence to health care regulatory enforcement and compliance activities, more and more compliance officers are now finding themselves playing a key role in that decision-making process. In that new role, they typically work closely with hospital administrators, IT and physician leaders to choose a solution.

We recently spoke with compliance expert John Finley about this topic. His 15-year career has spanned a number of compliance and regulatory roles at WakeMed Health & Hospitals, CHRISTUS Health, Aetna and the FDA.

Finley says that while there may be some confusion around The Joint Commission’s recommendations, there is no official ruling that prohibits hospitals from using secure texting. He knows that texting is a reality of life, and that it has become a regular practice for physicians. He says that he and probably 90% of his peers support the use of texting, if it’s done in a secure manner and doesn’t result in a breach.

“The bottom line is that physicians are already doing it, and it can help deliver better care to patients. We just need to figure out the best way to support that, while minimizing a hospital’s risk and exposure,” Finley explains.

At a minimum, a secure texting solution should meet a checklist of basic security requirements including:

  • Encrypted at rest and in motion
  • Cloud based – nothing stored on phone
  • Secure messages pincode protected (not just phone code)
  • Ability to remotely wipe if lost/stolen

But, Finley emphasized that he and his compliance counterparts need to focus on more than just security and compliance, when thinking about text messaging technology.

We agree. While checking off a list of standard security requirements is a good starting point, choosing a solution can’t stop there. Hospitals still need to balance compliance and security with overriding business goals such as:

  • Improving care
  • Reducing costs
  • Increasing growth

To support these goals, hospitals should look for a solution that offers a number of other benefits including:

  • Inpatient/outpatient integration
  • EPIC integration – particularly for consult requests
  • Designed to stay compliant with all stark/anti-kickback regulations
  • Flat license fee with ability to broadly distribute
  • Implementation process that actively engages users to promote adoption
  • Offers a solution for physicians in the OR/procedure rooms
  • Message preference routing (includes residents, fellows, mid-level providers)
  • Integrates with nurse duty phones
  • Addresses call center and ED volume issues

Finley also emphasized that technology is only one part of a true secure messaging “solution”, and that hospitals need to implement policies and practices that support the use of these technologies. They are increasingly looking to vendors to help provide these “guardrails for proper texting” and to help them think through a number of “what if scenarios” to ensure ongoing compliance and usage.

It’s also important for hospitals to think about communication outside their own four walls. Implementing a secure communication solution becomes more complicated when it has to be managed across a wider care continuum. Today, hospitals must collaborate with multiple providers and rely heavily on physician referrals. As a result, they need to communicate and share patient information across numerous organizations.

A solution that supports in-hospital communication only or in-hospital workflows only, won’t truly address their communication or compliance needs, and won’t truly improve overall patient care. The right secure communication solution should support communication, collaboration and care coordination across the entire patient care continuum.

If you would like to learn more about how MD Interconnect does just that, or to learn how WakeMed addresses the need for HIPAA-compliant messaging, let us know. You can also read the WakeMed case study here.