COVID Series: Communication with Dr. Ben Kanter CMIO of Vocera
Episode 25322nd May 2020 • This Week Health: Conference • This Week Health
00:00:00 00:22:53

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 Welcome to this Week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Have you missed our live show?

It is only available on our YouTube channel. What a fantastic conversation we had with . Direction for David Mutts s Shade around What's next in health? It, uh, you can view it on our website with our new menu item appropriately named live. Or just jump over to the YouTube channel. And while you're at it, you might as well subscribe to our YouTube channel and click on Get Notifications to get access to a bunch of content only available on our YouTube channel.

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Special thanks to Sirius for supporting the show's efforts during the crisis now onto today's show. All right. This morning we're joined by Dr. Ben Cantor, a pulmonologist by training and CMIO for communications. Ben, and welcome to. Good morning, bill. Thanks for having me. We have that, we have that delay going, we're getting used to this, uh, this world of zoom that we're all living in.

I'm looking forward to this conversation. Communication is extremely important normally within a hospital, within the health community, but, uh, during a pandemic that is really magnified. So let's go ahead and dive right in. How, how have systems been utilizing technology to support communication? Yeah, you're absolutely right, bill.

The, the need to keep your staff safe, the need to keep the patient safe has really accentuated the complications of communicating, particularly if you're wearing PPE. So that was, and has been an ongoing challenge. Um, and it's, it's not unique if you think about it to healthcare. First responders, let's say firemen, they need to be able to communicate with the rest of their team.

Um, folks that are on a battlefield, soldiers, they need to be able to communicate and you certainly wouldn't expect your soldiers to have to stop what they're doing and take off their protective equipment in order to do communication. And so the same thing holds for our, our first line, uh, folks in healthcare.

The physicians and nurses who are taking care of patients really shouldn't have to doff their PPE if they're gonna have communication. Yeah. So what, what have the solutions looked like? I, I, I saw in one of your blog articles, you guys had a, you know, caregivers shouldn't risk contamination for communication.

So how do we get around that? How do we, um, give them the opportunity, communicate with patients with each other without. Uh, with that without taking that, that protective equipment on and off. Yeah. So let me just highlight the, the difficulty of taking off your PPE correctly. Uh, it's hard to do. Uh, it takes time.

You have to be really vigilant. Um, and physicians and nurses, last big study that I looked at, you know, showed that roughly 40% make errors when removing their PPE, and that significantly increases the risk of, of self contamination. If you self contaminate, not only are you at obvious risk, but you become this unwitting vector for ongoing infection within your organization.

So the key then is to minimize, first of all, the need to put on your PPE in the first place. So how can you enable two-way communications with a patient, even if they're not in a traditional patient bed? Right? When in the, in this pandemic. We've got patients that are in pop-up beds, if you will, temporary beds that may not have a standard nurse call.

So how do you enable two-way communication so that the nurse or the physician can talk with the patient without having to, to put on PPE in the first place to get into that room? Secondly, if I'm in the room, what I really wanna be able to do is communicate. In some manner, uh, externally, um, without having to take off my PPE.

And so for that, uh, with vra we have our, our traditional badge that I'm wearing, and we have our smart badge, which is right next to it. Um, these can be worn underneath PPE and, and underneath PPE, they still give you the full access to all the communication channels. So whether you're calling one person.

Calling a group, uh, calling your command center, need to reach the covid intubation team. You can do all of that from one of these devices underneath the PPE. That's interesting. Has, has, I mean, obviously the, the, uh, the, the contamination being what it.

Communication changed fundamentally as a result of the pandemic, or has it just changed the way we're doing it because of, of the need for PPE throughout the entire system? I think it's more the latter. It's really changed the manner in which we can do it safely. So, uh, you know, before the pandemic, leaving a room and picking up a phone would not be thought of as a dangerous thing to do, but it's dangerous now.

It's dangerous. And so, uh, minimizing the need to use multi-use devices, you know, where people are sharing devices is important. So I think it's more the latter. Well, you know, but, you know, communication in this setting is as important as ever. 'cause because you've got the, you've got the deal not just with the patient and the the care team, but how do you move the patient efficiently through your hospital?

How do you handle the surges? And you can't do, you can't manage a surge. You can't manage throughput without communication. Yeah. Normally, when we're doing this kind of thing and we're rethinking this, we, we spend a lot of time on policies and procedures leading up to this. Now, obviously, we did an awful lot of work in a very short period of time, and I've heard some really creative, almost MacGyver like.

Uh, will we now go back and update our policies and procedures and are we gonna, are we gonna see that happen? And do you think coming out of this, that people will rethink their communication platforms? I do. Uh, and you're right, there's nobody more creative than the frontline nurse who is stifled from doing his or her job.

Uh, they will figure out a way to get something done, uh, whether it's through the use of things like baby monitors. Uh, or other off the shelf solutions. Uh, if you think about PPE, um, gloves, masks, face shields technologies have been around a long, long time, but gloves started out as sheep intestine. We don't use sheep intestine anymore.

Right? And the masks that we use are not just simple cloth, they're polyester, you know, N 90 fives. And so technology has evolved and I think that we're going to see communications, technologies, hands-free technologies become really an integral part of PPE moving forward. Yeah. So that's, that's one major shift.

Do you think there will be a lot of policy work that has to be done and, and how we think about it? And so what I hear you saying also. Um, hands free communication will, will probably become the norm. There's no reason for it not to become the norm throughout the entire health system, right? Uh, yes. Uh, uh, and I, I do believe that things are moving that way.

There's a time and a place to where you have access to your hands, uh, where you have access to a smartphone. Uh, there's a time and a place where you need to be hands free, whether that's, uh, in an isolation room under PPE or it's in the or, or you're doing a procedure. Uh, so hands free. And using the voice interfaces.

The way that we've become used to in our commercial devices over the past couple of years is, is really the future. So voice-driven actions are gonna be key as far as, uh, policies and procedures. It's an interesting question because over. As smartphones have come into use in the hospitals, there are now more and more ways to reach people, whether it's by text, voice, SMS, video, et cetera.

Um, each of these modes of communication brings with it advantages and disadvantages. So for example, if I'm trying to communicate with you and it's a large volume of very highly contextual information, it's probably best that we have that discussion like we're doing today. Some kind of synchronous uh, communication.

If it's a small short message that's not very intricate, perhaps a text message is appropriate. Some of these message, uh, modalities are more interruptive than others, so it's actually made the communication environment more complicated, not simpler. Uh, in the old days, I either walked up to you or I called you.

So you do need policies today. You need policies that guide what are the appropriate uses of certain technologies and inappropriate. I'll also give you one other important example. Uh, in health systems, there's a policy that defines the electronic health record as your gold standard place for all patient documentation.

There's probably 150 different options for secure texting. I mean, I could literally build a secure text solution if that's all I wanted to do. Build an isolated, secure texting solution. I could build that in my garage, uh, you know, in in days literally. Um, I've done that. Um, so, uh, you need to have a top-down solution that says, look for our enterprise communication and collaboration.

Here is the system that we will all be on, because if you have your doctors on one system, your nurses on another administration, on another respiratory care, on another. They're not truly communicating and they can't collaborate. So policies regarding communication in general are gonna be very important.

You know, it's interesting. So, um, so I'm asking the question and, and you've been great and not doing a sales pitch, but I'm gonna ask the question because it's been a while for me. I was ACIO, it's been about four years since I was CIO. We had in a couple locations, and you almost just described what we had, so.

16 hospitals, I think three of the hospitals were using vra. But each, each individual, uh, nursing community or uh, care community just decided what communication platform they were gonna use. And, uh, it did create it from an IT perspective created all sorts of challenges from our perspective, but it also created challenges and from their perspective.

And they were constantly coming back to me saying, Hey, can we, can we integrate with this? Can we do this? Can we do that? Gimme an update on voc. I, I assume you're talking more like a platform for communication across the entire hospital today, as opposed to a point solution, which is what I was dealing with maybe four or five years ago.

That is exactly right. Um, we have become a full fledge platform. We are the communication collaboration hub for the organization, so. If I were to describe our system, um, at our central, at the centerpiece of the VRA offering, uh, our secret sauce, if you will, is our ability to, first of all integrate with up to roughly 150 different hospital systems.

Uh. Aggregate that information in our system and we can bring disparate data from different systems together, write rules around it. So we can take information from example, uh, from your ADT system, from your alarm system, from your tele system, from your lab, from rad, from wherever. Bring all those pieces of information together, write rules around it, and then act so we can then escalate those messages and we don't care what the end point is.

Whether it's our device or whether it's a smartphone using Android or iOS or a tablet or a desktop, we then can message that out. If it's not accepted, we can escalate those messages to one or more people. We have essentially an unlimited ability to do that with tremendous flexibility. And then all the audit and reporting is on that same platform.

So we become a hub for all of the voice, all of the text, all of the alarms, the alerts. I. All of that flows through our system. And then since we're agnostic as to the end user device, we don't care whether that nurse or physician are using A-B-Y-O-D, whether they're using a badge or whether they're switching between the devices, it doesn't make any difference.

So then in our directory, we not only can show, you know, who's acting now, we have all of the presence information. And so you can tell a glance, for example, if I'm a a physician, I can look up a patient on my app and I can see in real time who are the nurses that are caring for this patient right now, who's available and immediately reach them.

It's very simple things like that that gives a lot of power to the end user. You know, one of the things that we've been talking about and.

Challenges that health systems are gonna be facing, uh, at least for the foreseeable, you know, next year or two years coming out of this. Um, and, and so we talk a lot about platforms in it, and I think one of the things about it is the ability to automate, right? So we take a bunch of touchpoint out of outta things.

That's one of the things platforms do. And they also put the security layer around the whole thing. So I don't have to think through security on this one, security on this one, security on passing the information. Um, talk a little bit about your, uh, the automation that is available on your platform. So I'm gonna go back to something you just said a second ago and that is, um, you know, there's, with a platform like ours, one of the goals of communications inside healthcare is to try and minimize delays or drop communications, right?

Communication inefficiency is, is a problem for the hospitals and it's a major cause of sentinel events. Virtually every system you place in a hospital today has an ability to send alerts or alarms directly to someone. So with the best of intentions, a lot of those alarms now route directly to the nurse carrying a smartphone.

And I just call it a, a perfect storm of good intentions. You now have all of these various systems that can pinging the poor nurse, and so the nurse ends up spending his or her shift handling issues that are coming to her directly on the phone. When in the past that didn't used to happen. Many of those calls went, for example, to the the clerk on the floor who would then do the triaging.

Route those, so nurses were getting interrupted a lot before we ever put a phone in their hands. So you have to be really, really careful about how you automate these processes. There's, there's, I think, you know, a really good intent to minimize the delays in communication and route things to the staff, but there's a limited amount of bandwidth that people have, and they've got to be able to have time to do patient care without getting interrupted.

So everybody's familiar with alarm fatigue. We really talk about interruption fatigue. How do we orchestrate, how do we, um, mediate the needs to reach that same person with different information? And it's getting more complicated over time. It's not getting easier. Um, so just putting a smartphone in the hands of your staff does not make things better for them.

It can paradoxically make things actually more difficult. It's how you orchestrate those calls on the backend. Um, that that's really key and that's what we do. We're, we're a workflow orchestration platform. So I'm, my last question coming out of this is, are there best practices around doing that to avoid fatigue or, um, or, I don't know, transition fatigue?

Priorities and those kind of things. So people aren't constantly changing their focus. Yeah, I, I think there are, so for example, if you're gonna automate an alarm that's going directly to your staff, um, I think it's incumbent, uh, on the IT department to. To set up those alarms ahead of time and then monitor them, sort of mirror them before bringing them live.

How many alarms? How many interruptions per nurse or, you know, and, and you can set up metrics, for example, alarms per patient per shift. I. How many are coming in and monitor that before you ever turn it on. Um, there's nothing worse than saying, okay, we're gonna, um, set, for example, let's say we decide that we're putting in a tele system and I wanna pass all of my atrial fibrillation alarms directly to the staff.

We know that the false positive, uh, for telemetry alarms is in the nineties. The vast majority of telemetry alarms are not actionable. Um, you'll absolutely, you know, destroy your nurses with interruptions if you do that. Or the same thing with oximetry alarms, basic unedited oximetry alarms. Just passing them all to the nursing staff, uh, is, is a road to disaster.

So you need to turn on these systems ahead of time, monitor them. So, so that's one important part. Second best practice is to have a clinician be the mediator between, for example, your nursing staff and the IT department. You want a trusted nurse leader, a nurse informaticist, ideally, who is that go-between who can work with the nursing staff to adjust the alarm threshold parameters, the annunciation delays and other things so that again, by the time the nurse gets a, an alarm or a message.

It's highly likely to be true. The positive predictive value is, is to be high. I think a third is to integrate your communications platform, particularly if you're gonna be passing alarms and interruptions with your alarm management committee. It's a, it's a great role to have your multidisciplinary alarm management committee take ownership of a lot of these, uh, policies and, and practices.

You know, I, I, I, I want to close with one last question, and this is mostly you're pulmonologist by, by training and, and just what, what do you think, just personally, what do you think the most lasting impact of the work that we've done in healthcare will be, uh, coming out of this crisis?

So my analogy is, if, if, if you. If you're, if you're alive long enough to remember when the guy was poisoning the Tylenol bottles before that, you could open up any jar of food and you had immediate access to the food, none of these safety layers were there, where now you have to peel off that paper after you unscrew the lid.

That has become the norm. What today is the exception becomes tomorrow's norm. Um, so the way we're using PPE, this requirement for communication, that's gonna change the, I think we're gonna accelerate, obviously we've already accelerated our move to telemedicine. We probably did five years of telemedicine evolution in five weeks.

It will never go back. Telemedicine is here to stay, uh, and here to stay in a much wider . Um, swath of medical practice than ever would've been envisioned. Um, so, so, so that's, that's not gonna change. Um, the, this, I, I think the recognition of the dangers that our staff go through. When caring for patients with infectious disease, it's something that sort of like normalization of deviance.

We, we all recognized that it was there. Uh, when I worked in a highly resistant, multi-resistant, uh, tb, uh, clinic, there was no treatment for the diseases we were treating. If we had, we had been contaminated, it would've been, you know, really life threatening. Um, we just accepted that. I think there's now a, a better recognition that we need to protect our, our healthcare workers, you know, to the utmost, I don't think that's going away.

You know, I, I remember that Tylenol scare and that was really scary and I'm, they, they responded very quickly. Yeah. I lost your audio. I. Oh, you did. Sorry about that. I, I could still hear you. Great. I, I, you know, I, I really appreciate the, the analogy around the, uh, the Tylenol, the exception from yesterday will be the norm moving forward.

I think that's what we're gonna see. Um, you know, that's, uh, that's all for this week. I, I, I really appreciate the time Dr. Cantor. Thanks for, uh, coming on and talking about communication during a pandemic. My pleasure, bill. I, I appreciate it, uh, and happy to do this again in the future. Thank you. That's all for this week.

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