It is all about the Nurse

I have talked in my past postings about how innovation does not happen in vacuum and how one of the best ways to sharpen the value proposition of a product/service is to observe the end-user/customers “in the moment”, i.e. what they do just before, during and after they use your product/service. Focusing on observing their use and the problems they encounter during this critical window reveals insights that one would not nominally garner sitting inside conference rooms and doing brain storming sessions on white boards.

Today, our predominant end-user customer is a nurse. Here’s a glimpse of what a day-in-the-life-of-a-nurse looks like:

Nursing is one of the most stretched resources, and nurses are some of the most stressed employees in the hospital. Remember that patients who are in their care are often experiencing the scariest times in their lives and their emotions have an effect on the caregivers. Add to that there’s a country wide nursing shortage estimated at 116,000 this year, likely to increase to 550,000 in 2025. Plus, the aging of the US population has resulted in more people looking for acute care later in their life and it is little wonder why there are increasing rates of depression and stress related disorders among nurses. To top all this, nurses are also being burdened with hospital customer-service policies, privacy (HIPAA) laws which put extraordinary onus on them to complete extensive documentation for the sake of patient security, and you start to see the picture.

Against this backdrop hospital administrators, and quite rightly so, are turning to technology to their rescue—one of the reasons why Vocera has been so well received in this segment. With technology, comes increasing complexities of the hospital IT systems. There is a frenzy created by the promise of Obama Care’s $19B commitment to EMR (Electronics Medical Records) which has contributed to its own layer of chaos around how to best implement interoperability standards amongst various EMR/EHR components. Check out this hilarious spoof on EMR information technology interoperability. While it might take the healthcare IT industry many years to reach the “interoperability nirvana”, nurses who represent a third of all hospital staff have to bear the brunt of having to deal with a plethora of devices, alerts, alarms and book-keeping.

Walk through a typical hospital and you’ll hear a cacophony of alarms, bells, other tones coming from medical equipment and computer terminals. American Medical News recently cited a study showing that 16,934 alarms sounded in a medical unit during an 18-day period—translating to approximately 40 alarms an hour! Alarm fatigue is the term medical professionals often use to describe this malaise. A study of VA hospitals published in WSJ in 2007 states:

Doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% of cases.

We heard also about the recent press release by the Joint Commissions Center for Transforming Healthcare that BZ sent around yesterday which reiterated the same malaise couched in a slightly different statistic

An estimated 80 percent of serious medical errors involve miscommunication between caregivers when responsibility for patients is transferred or handed-off.

With as many alerts/alarms and stress as a nurse is subjected to each day, no wonder this profession is so error prone, and lives of our loved ones are at risk as a result.

So how is all this relevant to us at Vocera apart from the fact that there are a lot of companies chasing the limited healthcare IT dollars within the hospital? As we design products, add-on features, or integrate hand-off solutions into our product lines, we must not lose sight of the problems facing our ultimate end-user customer, the nurse. If that means that we create tiered alarm/messaging structure in our products, or improve readability of text messages, or make tweaks to our voice user interface, improve noise immunity for our badges—it must all ultimately help lower the fatigue factor and help them do their jobs better rather than have to get “trained” on yet another new device/system. Our products have the rare privilege of being worn by the nurses and we therefore own a very coveted “real estate”. Let us keep the design principle of “keep it simple stupid” to guide our product decisions going forward because nurses won’t tolerate anything less.