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Point of Care (PoC) Technology Planning Prepared for Cardinal Health External Hospital Pressures Patient safety – JCAHO, Leapfrog, etc. Publicly available outcomes data Adoption of mandated nurse to patient ratios Continued nursing shortage and skill gaps

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Point of care poc technology planning l.jpg

Point of Care (PoC) Technology Planning

Prepared for Cardinal Health


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External Hospital Pressures

  • Patient safety – JCAHO, Leapfrog, etc.

  • Publicly available outcomes data

  • Adoption of mandated nurse to patient ratios

  • Continued nursing shortage and skill gaps

  • Patient satisfaction – Press Gainey scores

  • Evolving technologies and new vendors

  • EMR/EHR adoption pressures


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Resulting Health Care Trends

  • Most patient flow bottlenecks occur in critical care areas – ICU and telemetry – ED overcrowding and ambulance diversions continue

  • Patient monitoring and ventilators are moving to general care units to off-load critical care areas

  • New care delivery strategies – variable acuity units, house-wide monitoring, medical emergency teams

  • Renovation and building trends – private rooms, decentralized nursing stations, “universal rooms”


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Technology Evolution

  • Medical devices and IT systems are blurring

    • Device data integration with EMRs

    • Central station proliferation (telemetry, pumps, ventilators)

    • Alarm notification systems

  • Increasing PoC software adoption (meds admin, EMR, CPOE, etc.)

  • Proliferation of PoC computing devices

  • RFID adoption (patient, staff, asset tracking)


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Changes at the Point of Care

  • Enterprise solutions are needed for what was once considered stand-alone

    • Various medical devices integrated with information systems (e.g., EMR, remote care)

    • House-wide access to surveillance and therapy delivery data – management and alarms

    • Wireless communications with phones, nurse call, and medical devices


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What’s Your Situation?

  • How many different nurse call systems do you have?

  • How many individual medical device networks are installed?

  • How many vendors provide your monitors, pumps and ventilators?

  • How many central stations will you have on nursing units in 5 years?

  • How many point of care computing devices do your nurses really need? How many will they accept?

  • What would it cost to “upgrade” all your nurse call, patient monitoring and IV pumps to support connectivity and IT integration?


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IT

Project mgt

Nursing

Mission-critical infrastructure

Staffing models

Care delivery methods

PoC computing

devices

Admissions criteria

Policies & procedures

Enterprise solutions

Nursing unit design

Biomeds

Medical Staff

Patient safety

Access to resources

Device evaluations

Administration

Patient satisfaction

Direct clinical

support

Outcomes

Productive

environment

Patient satisfaction

Bed utilization

Clinical

arms race

Organizational Silos

Point of Care


The point of care l.jpg

Communications

Phones

Pagers

PDAs

Computers

on wheels

Overhead pages

Nurse call

Medical

Devices

Tasks

Patient care

PoC diagnostics

Patient

assessments

Ventilators

Patient

monitors

Alarms

Meds

administration

IV pumps

Telemetry packs

Documentation

Spot vital signs

monitors

Coordinating care

Patient education

The Point of Care


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Communications

Phones

Pagers

PDAs

Variable workload by patient

Direct care vs. facilitating care

Open nursing positions

Nursing skill levels

Interrupt-driven environment

Direct care sometimes lags

Delays in care delivery

Tasks poorly aligned with devices, and information systems

Computers

on wheels

Overhead pages

Disparate alarms

Different alarm annunciation

Different alarm classifications

Alarms at device or central station

Alarm fatigue

Failure to rescue

No single vendor solution

Vendor standardization difficult to achieve

Nurse call

Medical

Devices

Two-way phone tag

Unheard calls or pages

Delayed or undelivered pages

Proliferation of devices

Noise and confusion

Unreliable communications

Delays in care delivery

Patient safety impact

Tasks

Patient care

PoC diagnostics

Patient

assessments

Ventilators

Patient

monitors

Alarms

Meds

administration

IV pumps

Telemetry packs

Documentation

Spot vital signs

monitors

Coordinating care

Patient education


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Point Solution Limitations

  • Vendor’s PoC solutions fail to cross vendor and device categories – they only solve part of the problem

  • Unnecessary and expensive upgrades

  • Proprietary tech that creates lock-in through high changing costs

  • Proliferation of computing devices at point of care


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Emergin Integration Suite

  • A foundational integration platform that drives process improvement – standardization, interoperability and automation

  • Open, vendor-neutral, device independent

  • Orchestrates over 200 best-of-breed systems using plug-and-play technology

  • Modular and scalable, begin with a single system and add service components incrementally

  • Zero-Defect Communications


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Enterprise Architecture

Infrastructure

Systems

Point-of-Care

Systems

Information

Systems

Building

Systems

EMR

Adapter

Adapter

Adapter

Staff

Directory

Dashboards

Enterprise Service Bus

Emergin

Orchestrator

Client

Patient

Directory

Adapter

Location

Services

Communication

Systems

Universal Assignments

White Board

Command Center

Patient Safety Indicators

Quality Metrics


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Available Adapters

A4 Health Systems

Adaptive

Aeroscout

Alcatel

Amtelco

Aarmark

Ascom

BMC

Canamex

Cardinal Health

Care Technology

Cerner

Cingular

Cisco

Comtech Wireless

Datascope

Draeger Medical

Dukane

Eclipsys

Ekahau

ELO

EXI

Frontrange

GE Healthcare

GE Security

Get Well Network

Hewlett Packard

Hill-Rom

Home Free

Johnson Controls

Life Line

McKesson

Meditech

Microsoft

Motorola

Multitone

NEC

Nextel

Notifier

Nortel

Note Page

PCSC

Philips Medical

Picis

Premise

Premise

Radianse

Rauland

RF Technologies

SBC

SDC

Siemens

Skytel

SimplexGrinnell

Spacelabs

SpectraLink

Sprint

Startel

Surguard

Swisslog

Symbol

TAC Americas

Tektone

Teletracking

TMA Systems

TOA

Tyco

USA Mobility

Varatronics

Vasona

VeriChip

Verizon

Versus

VisionLink

Visiplex

Vocera

Waveware

Wescom

West-Call

XTend

Zetron


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Performance Management

PatientSafetyOfficer

Nursing Leadership

IT/Communications

IT/Communication QoS Reports provide the following to monitor IT Quality of Service:

System Malfunctions

Total Successes/Failures Per Vendor

Total Messages Per System Type

Total Messages Per Carrier

Total Messages Per Recipient

A Patient Safety Officer can review a root cause analysis transcript of activity to trace errors and omissions to the second:

Alarm Set

Delivered to Communication System

Delivered to Communication Device

Delivered to Recipient

Read by Recipient

Acknowledged by Recipient

Alarm Reset

Nursing Reports provide the following to evaluate staff-patient ratios and nurse vigilance:

Total Alarms Per Vendor

Total Alerts Per Vendor

Alarms Per Location

Alarms Per Sensitivity


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Operational Efficiencies

  • A Service-Oriented Architecture unites departments and drives teamwork across the healthcare enterprise

  • Leverages and extends the life of legacy system investments

  • Drives standardization & interoperability across multiple silos

  • Enables healthcare organizations the flexibility to pick-and-choose any combination of disparate technologies; enables best-of-breed selections

  • Produces score cards that monitor progress of event activity and dashboards the measure operational performance


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Staff Productivity

  • Creates teamwork by enabling communications across multi-disciplinary departments

  • Automatically populates patient and staff directories; no more manual data entry

  • Standardize the way that clinicians enter staff assignments; perform this task globally, not locally

  • Location services -

  • Quickly and efficiently find objects and people


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Failure Mode & Effects Analysis

  • Proactively identifies system malfunctions and alerts supervisors to take immediate action

  • Reduces, if not eliminates, human mistakes by proactively monitoring common errors and omissions

  • Helps healthcare organizations move away from timely and anecdotal investigations; produces a root cause analysis transcript that can quickly and efficiently identify errors

  • Adds checks and balances to identify patient and staff location during a critical alarm situation

  • Can assist in reducing mortality rates by adding the necessary ‘safety net’ required for improved patient safety


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Cardinal Alaris Gateway

Dashboards

Emergin

Orchestrator

Client

Point-of-Care

System

Communication

Systems

Communication

Systems

Enterprise Service Bus

Alarms Management Server

Point-of-Care

System

Communication

Systems

EMR

Staff

Directory

Patient

Directory

Location

Services


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Gateway Features

  • Pump alarms transmitted from Alaris to Emergin

    • Pump, Syringe, PCA

    • Occlusion, PCA-pause, Air-in-line, etc.

  • Monitoring alarms supported

    • SpO2, EtCO2

    • EtCO2 – no breath, disposable disconnected, etc.


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Gateway Benefits

  • Improved Communications

  • Faster Response Times

  • Improved Workflow

  • “Root Cause” Analyses


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Return on Investment Summary

Quantitative ROI

  • Leverage existing technologies -- not ‘rip-and-replace’

  • Enterprise workflow automation -- assignments, management reports, communication systems

  • Nurse Productivity Gains – 51% improvement in completing patient tasks, $37,700 per care unit per year (see U of Maryland study)

  • Patient Safety – root cause analysis transcripts for adverse events, including sentinel events/ supervisory alerts

  • Patient Satisfaction – raise scores by improving response time

  • Staff Satisfaction/Retention – improve the clinical processes to reduce workload

Qualitative ROI


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Some Key Questions

  • How long does a root cause analysis take now?

  • How can you maximize communications for disaster readiness?

  • What facilities alerts need to be managed? How is that done today?


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Tim Gee

Principal

[email protected]

www.medicalconnectivity.com

www.cardinal.com

www.emergin.com


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