The Call Light System has been commoditized for several years, but as the CIO
emerges from the budget controlling cycles of implementing an EMR they are emerging
with a new direction….
1) What technologies will we need to optimize the investment of the EMR?
2) How will the “Internet of Things” enable more seamless engagement with this
engine, data warehouse, that we call a Medical Record?
3) How will my Health Delivery Organization (HDO) enable the Real Time Health
System?
4) How do we align our HDO spend with our business plan and desired outcomes?
Based on these needs the CIO will require partners that understand beyond the button
and can enable optimization of their investments towards the HDOs business model
and desired outcomes.
The CIO needs providers who are concerned more with interoperability than their
competitive strategy.
The CIO needs providers who understand the Nexus of Forces. This term is used by
Gartner to describe the convergence of specific technology trends: Social Interaction,
Mobility, Cloud, and Availability of Information.
The CIO is being driven to create the Real Time Health System within their HDO. The
RTHS at a high level is Awareness, Mobility, Collaboration, and Point of Care or Action
Data Analysis.
The CIO is averse to risking his reputation on “small regional players” they have been
indoctrinated to look for a MegaSuite Vendor to care for their needs.
Information Referenced from the following Gartner Research papers:
*Analyst Barry Runyon “2014 Strategic Roadmap for Real Time Health System”
*Analyst Barry Runyon “10 Key Action Items for HDO CIOs to Harness the Nexus of
Forces”
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May 1, 2015 pg. 1
Drivers for HDO CIO/ CTO decisions surrounding the Call Light System
Bi-Directional Sharing with EMR
The Health Delivery Organization (HDO) has come to expect that a Call Light system
should be able to accept basic ADT information. The ADT interface allows for an
architectural based product (hardware installed in the wall) to align with the EMR patient
centric structure. In the data structures of the EMR the patient is the central component
of all records, thus the HDO workflow is tethered to this type of structure.
The expectation of the HDO is that the EMR will be able to send and receive information
to the Internet of Things (Technology to Technology communication) and allow decision
and process to be enabled from the data engine they have built (EMR is the data
engine.). The EMR has and will continue to transition from a software people
interact with to a data warehouse where information is stored and transferred
regarding patient care. Thus requiring technologies that “attach” to it.
The CIO will (and some have) began to recognize the deep value of documenting and
recording patient behaviors within the medical record. This will be mobilized thru the
thought process of the CMIO. The CMIO is responsible for understanding the
information about patient care and how it affects care models, analysis of condition, and
recommendation of prescriptive measures. While this position in the HDO has been left
out of most conversations he will begin to emerge as a critical decision making factor.
The Call Light System serves two rolls within the structure of patient behavioral analysis
and EMR data sharing:
1) Patient Behavioral Analysis when aligned with the EMR will be critical for the
CMIO to manifest understanding of how prescriptive measures are creating
patient response. The simple understanding of when and how often the patient
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May 1, 2015 pg. 2
is requesting or presenting a need should update the EMR to render further
knowledge surrounding care planning. For example, pain medications or
indicating pain (via a request) aligned with medication administration patterns.
2) Patient Behavioral Analysis will become a critical factor in the CNIOs efforts to
create clinical operational models for better care design. The CNIO is and will
continue to become responsible for air traffic control creation for the HDO. Their
roll is ever evolving into managing the expectations for care team delivery.
3) Patient Behavioral Analysis will in the future become part of the population health
analysis. The methods used to identify pattern of need and pattern of risk will be
applied to models for long term care, home care, and patient engagement
strategies.
Multi-Technology INTEROPERABILITY
The CIO, generally, does not care for the word “integration”, it will (and should) create
apprehension. Integration is a legacy term that implies one technology telling another to
react. It is tightly coupled with a world that is tethered to proprietary and or less
flexibility technologies. While the “word” and its meaning can be debated it has clearly
become replaced in the industry with the word du jour interoperability. Interoperability
indicates that neither system is a hub that at some point in the journey of our interaction
the information shared causes:
1)
2)
3)
4)
Reaction
Response
Acknowledgement
Data Aggregation of all actions
These are basic principles of software design and while it can be argued that
“integration” (when done properly) accomplishes these concepts. The importance of
this model is that no one holds the keys to the kingdom. Interoperability models human
interaction as it looks, listens, and engages with the world around it. While this may
sound esoteric it is the vision.
Practical application for this means that the Call Light System is not “middleware” it is
simply a point that takes information, creates an electronic hardware reaction,
acknowledges it with a handshake, and aggregates that information within their
historical databases. This is often a shortcoming of the modern call light system.
The thought process that information is sent thru legacy protocols to tell another system
to react hamstrings the HDOs desired model. Whether it appears effective or not it can
be argued that it is not a modern form of interoperability. It would serve all technologies
well to remove the strategic designs that hinder the free delivery and acceptance of
information. It would benefit the HDOs/ industry to create standards around such
interactions.
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May 1, 2015 pg. 3
Point of Care Collaboration Engines
As convergence within the Nexus of Forces* occurs so will the migration to a more user
friendly end point that enables true point of care applications. Point of Care
Collaborations Engines (PCCE) extract information from a plurality of locations to
present them in a format that:
1) Enables communication with and about the patient
2) Aggregates information to create smart messaging for alarms, alerts, and
notifications
3) Simplifies the end users abilities to interact with the data compiled in the EMR
data warehouse. This will eventually replace the current day person to computer
interface required by EMR.
The job of this engine is to aggregate and disseminate data in useable structures to
enable care models to be more mobile and effective. It provides social constructs for
caregivers to engage with one another in a form similar to text messaging.
The tools are hindered by the inability of legacy platforms to have true interoperability,
and limited by the available data structure of HL-7. HL-7 is designed to be a standard
but are variable by nature. (“If you have seen one HL-7 string….you have seen one.”)
Yet still they are able to provide a valuable user experience. Advents of newer models
such as SMART on FHIR.
Current technologies:
1)
2)
3)
4)
CareAware Connect by Cerner
Voalte
Patient Safe
Patient Keeper by HCA
Note: The PCCE is NOT a hardware technology. It is a software platform that by its
nature is vendor neutral to reside on any “smart” end point device. There are a number
of devices but as the industry continues to evolve these will become disposables
managed by contracts with extremely slim margins. The legacy tools that are littering
the current HDO structure hinder the advancement of the industry to truly provide
integrated care.
©Sphere3
May 1, 2015 pg. 4
Analytics as part of the Real Time Health System
A major consideration for Call Light vendors and providers is the movement of the HDO
to the Real Time Health System (RTHS). The Call Light is a data point feeding the
engine of information surrounding the behavioral modeling of patient and care givers.
Patient Generated Data (PGD) includes patient actions and reactions that are recorded
by technologies that enable physical interaction, location, and physiological changes.
1) The data set enables a balance point to many manually collected data points for
the EMR. This includes the ability to enhance acuity modeling platforms that do
assignment process in the EMR.
2) The data set plays an important role in flexible staffing modifications based on
the demand base the patients are creating simply by the physical requests and
physiological need.
3) The data set is an identifier of risky patient behaviors for pre-emptive measures
to avoid incidents such as patient falls.
4) The data set is complimentary in the constructs of Clinical Decision Support
algorithms.
The expectation of the CIO is that hardware technology will not limit the ability of the
real time health system. What does this mean? A data enabled HDO that utilizes real
time visualization of data will quickly identify when technology lacks basic forms of
interoperability. The CIO will call into question items that were never noticed. The real
time nature of the desired information increases the demand for real time
responsiveness of the people caring for the system. The need for data becomes a
drug and creates fear when it is not available or when there are gaps.
The data from the Call Light System must become more accurate. Data visualization
engines compile information into useable format to enable judgement of performance of
the care team. This aspect alone, while not at the criticality of Clinical Decision Support,
is by its essence in demand of perfection.
Data opens the eyes of a HDO to possibilities and workflow design as have never been
experienced in the Call Light Industry. The speed of desired change based on feeling is
amplified by the backing of data models. However, it is critical to control the
methodologies of managing change in a controlled process. The data will reflect
unintended consequences caused by rapid fire unplanned change.
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May 1, 2015 pg. 5
The Legacy of Hardware
While it is important to recognize the change in mindset surrounding the Call Light
Systems place within the healthcare ecosystem, it does manifest its operation thru
electronics.
The delivery of the information system must be by creating understanding around
“Electronic Life”. For a CIO, electronics are often disposables. The Tablet, the Surface,
the wireless phone, and to some extent a computer are no longer critical investments
that they need to examine. Once basic functionality is established and end user
influence the decision is relegated to a purchasing agent for acquisition. The Call Light
manufactures view is that the tightly coupled world of hardware is dependent on
software. It is important to recognize the industry’s thrust to decouple those
environments and remove the limitations around a tethered system.
The CIO sees the hardware as something that enables the 4 quadrants listed above,
but is still bound by things that regulate the functionality of that technology.
1) Life Safety aspects of this hardware – UL1069
2) Mission Critical Communications
3) Regulatory body requirements
These are basic expectations of the technology but must be balanced with the
deliverables of improving patient experience, providing an ease of use for caregivers,
and providing a safe environment that enables quality of care.
For example: Patients expect to see modern technology in use in the patient rooms.
The hardware must be aesthetically pleasing to the patient and provide the appearance
of advanced smart room functionality.
The care team members are expected to follow specific procedures to enable safe
environments. The technology must not hinder the software’s ability to perform.
The CIO expects the components of the Call Light System to enable a forward thinking
Smart Room Design. The hardware must support an evolution of visuals that are visible
to the patient. They are used to the evolution of end user tools such as the abilities of a
tablet. They have expectations that the hardware will mimic these flexibilities.
The ideal situation for the CIO is to untether the abilities of the software associated with
the hardware and allow for groups who are more versed in hardware management to
manage these technologies. This will allow the HDO to take advantage of the
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May 1, 2015 pg. 6
commoditization of technology while unleashing their ability to exploit the 4 topics
above.
Take for example the Location and Sensing industry (commonly referred to as RTLS).
This industry has had to live in an untethered world for much of its existence. In general
the hardware lacks a specific software platform, but aligns with whomever is the hub in
the organization.
The location and sensing industry in the HDO environment lacks standards in general
for what defines how they collect the information. Many of these vendors have taken
the risk of fighting a battle without a software platform and entering the market “vendor
neutral”. Their goal is by land share they will help shape the expectations of what
standards should be based on the large scale investment made by the aggregate HDO.
The commoditization of this industry will reduce barriers to entry and for a time the
providers with the most land mass will be able to contain their market share.
Conclusion
As the industry matures and understanding shifts surrounding the critical nature for the
Final Mile of Data it will result in better care for patients and a better environment for
care providers.
 The static nature of hardware will continue to be needed but the flexibility of
software will define the future of the industry.
 Vendors who are seen as “blocking” or “proprietary” will find themselves
excluded as hospitals become savvier in demanding a Best of Breed
environment for their technology.
 Vendors who create hubs presenting themselves as the center will be seen as
dangerous purchases.
 Vendors who can leverage the existing investment of EMR will be positioned
well.
©Sphere3
May 1, 2015 pg. 7