Bridging the Persistent Chasm Between Healthcare and IT

The following is a guest article by Troy Foster, Senior Manager of Communications Infrastructure.

As an IT professional in healthcare, I learned a valuable lesson early in my career.  While working for a medical device company, I was involved in the rollout of new IT functionality that introduced the concept of passively monitoring various sensors and equipment and allowing hospitals to send alerts directly to nurses, providers and staff.   Software engineers proudly explained the functionality and expressed a high degree of optimism that this would revolutionize the healthcare industry, saving hospitals millions of dollars by allowing staff to receive and respond to potential safety issues much faster.   I was sold!

Being very new to healthcare, I bought into the concept immediately and enthusiastically participated in several meetings with hospitals I was currently working with to introduce the opportunity and encourage adoption.  In short order, I was flying out with my installation team to implement this new and groundbreaking solution.  Little did I know how much the next 6 weeks would change my view of IT within the healthcare arena.

We arrived onsite and soon sat down with all of the clinical leaders and sponsors.  We gave them a brief overview of what we were offering and explained the benefits.  At this point in time, very few hospitals in the country were integrating alerts and alarms into a mobile device workflow.  With the limited information we provided, the nurses were all excited about the idea of creating a safer and more responsive working environment.  We had a list of 25 different safety “triggers” that we had the capability of monitoring and forwarding and they signed onboard to turn them all on.  Why not, right?  We proceeded to charge forward with our configuration tasks and training and happily left confident that we had just measurably improved the safety of patients and the satisfaction of staff.  How wrong we were….

A week or so after the implementation, we received a call from the CNO demanding we return and remove the high tech solution we had so eagerly installed.  I was shocked!  How could a product that provided so much immediate and proactive visibility into preserving patient safety be viewed negatively?  I immediately got back onto a plane the next day and flew back out to the site.  As I walked onto the unit, I immediately noticed that the warm and friendly atmosphere I previously experienced was gone.  Nurses greeted me with scowls and red rimmed eyes.  It was not a happy place.  We sat down with the clinical team and soon learned why… Our great plan of turning on all 25 patient safety notifications to all nurses, had generated an AVERAGE of over 500 alerts PER HOUR to the nurses on this poor unit.  The unit only had about 6-8 nurses and no more than 25 patient rooms.  Each nurse ON AVERAGE was receiving 1+ alert PER MINUTE!

After disabling the alerts, we returned back and got on the phone with our design and product engineers.   The ensuing conversation is what laid the foundation for a radical change in the way I try to approach implementing and supporting IT in a hospital.  As we shared the experience of the nurses receiving so many alerts with the internal engineers, they all expressed some confusion and bewilderment as to why the nurses and hospital staff were so upset.  The system was doing what it was designed to do and the volume of alerts should be an indication that maybe they need more staff in order to insure patient safety was prioritized.  As they continued to talk, I realized that not one of them had a clue what the environment was like that they were designing for.  None of them (including myself) had ever spent significant time on a nursing unit shadowing a nurse to understand what they do all day.  In fact, after this conversation I immediately reached out to a couple of hospitals I was currently engaged with and scheduled myself the opportunity to shadow a nurse on her shift.  3 different times I shadowed a nurse for their 12 hour shift and my perspective on healthcare was changed forever.

Fast forward 15 years and I unfortunately still see so many of the same problems today.  I was recently in a meeting where a vendor was demonstrating some of its capabilities to a hospital IT group.   As the features were presented I consistently heard the hospital IT group express doubt and apprehension about the value of the offerings.  Unfortunately, not a single clinical representative was present and I suspect it has far more value to our clinical partners than IT realizes.  Although I clearly realize that clinical involvement in every discussion about new technologies or new features may not be realistic, how can we improve the design, implementation and operational considerations of IT offerings to insure that the intended outcomes are realistic, feasible and functional within our hospital ecosystems?  I thought I would share 3 ideas that I’ve seen that seem to have contributed to a much healthier synergy between clinical reality and IT roadmaps,

  1. Start at the top – In every one of the facilities where I see much stronger clinical and IT collaborations, executive leaders (CTO/CNO/CIO) seem to be more closely aligned and create a culture below that encourages and fosters close collaboration.  I’ve also noticed that the executive team is often much more personally involved and informed on the initiatives being evaluated and implemented.
  2. Clinical representation in innovation and emerging technology groups – Within facilities that fund innovation or new technology, the groups that have clinical experience included in the team tend to source, evaluate and test with a much stronger focus on operational functionality and realism.
  3. Source to solve problems rather than trying to solve problems on what is sourced – Seems logical but how many times do we send off armies of folks to HIMSS to source out new technologies or host vendors presenting new offerings and in the course of those discussions/presentations we try and figure out if there is a known problem we may solve. Collaborating with our clinical teams to identify key problem and targeting solutions or new technologies that address those specific problems will insure we have clinical buy in from the beginning.

As technology continues to advance, nurse and physician shortages continue to increase and hospital costs continue to rise, the demand for streamlining and simplifying workflows within our hospital environments has never been higher.  As we strive to manage our various different IT groups, my hope is that we can continue to align more closely with clinical needs and limitations to maximize our time and investments.

About Troy Foster

Troy has been working in healthcare for almost 25 years. He has worked as a consultant, vendor and internally within hospital IT. Troy has spent the past 5 years as the senior manager of communications infrastructure at Stanford Hospital. Troy’s background includes extensive experience in nursecall, secure messaging and alert/alarm middleware as well as several other communication and clinical IT systems and he has presented at numerous conferences across the country. Currently, Troy is heavily involved in the activation of a new 850,000 sq foot hospital.