In­no­va­tion through trial and er­ror

Modern Healthcare - - INNOVATIONS - By Lisa Ward Lisa Ward is a free­lance writer based in Mend­ham, N.J. A ver­sion of this ar­ti­cle also ap­peared on Mod­ern Health­care’s Trans­for­ma­tion Hub. Read more at ModernHealth­ Trans­for­ma­tion.

Health sys­tems will­ing to ex­per­i­ment with new pay­ment mod­els have cre­ated an un­prece­dented op­por­tu­nity for startup com­pa­nies. But first their tech­nolo­gies must get to and through the pi­lot phase.

That test pe­riod al­lows in­no­va­tors to de­velop a so­phis­ti­cated un­der­stand­ing of how their tech­nol­ogy works in a clin­i­cal set­ting. Oth­er­wise, in­no­va­tors might get trapped in what is known as the “pro­duc­tiv­ity para­dox,” where in­creases in in­for­ma­tion tech­nol­ogy are ac­com­pa­nied by a si­mul­ta­ne­ous slow­down in pro­duc­tiv­ity.

Sara­sota, Fla.-based Voalte, whose app al­lows clin­i­cians to com­mu­ni­cate via text or voice over in­ter­net, learned that les­son the hard way. Af­ter its two-month pi­lot at Cedars-Si­nai Health Sys­tem in Los An­ge­les failed, the com­pany had to com­pletely re­vamp its app.

Voalte’s big break came through a chance en­counter at the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety con­fer­ence in Chicago in 2009. Dar­ren Dworkin, chief in­for­ma­tion of­fi­cer of Cedars-Si­nai, showed up at the Voalte booth, where Trey Laud­erdale, the firm’s pres­i­dent, was demon­strat­ing the prod­uct. Dworkin agreed to a pi­lot on the spot.

Cedars-Si­nai had been strug­gling with dis­rup­tive over­head pag­ing, frus­trat­ing bouts of tele­phone tag and costly cel­lu­lar bills. The fact that Voalte’s app could be used through­out the sys­tem was a ma­jor plus.

But the first de­ploy­ment at Cedars-Si­nai was rough. Clin­i­cians strug­gled with dropped calls and bad re­cep­tion. The app was weak when it was used too far from a Wi-Fi ac­cess point.

Voalte also no­ticed work­flow prob­lems. What were the pro­to­cols for when a call should be made or text sent? What if some­one was busy? How could im­por­tant con­tacts be es­ca­lated and sep­a­rated from rou­tine chat­ter? “We didn’t fully ap­pre­ci­ate how much it im­pacted nurses’ daily life,” Laud­erdale said. “Com­mu­ni­ca­tion is em­bed­ded within each task.”

Af­ter two months, the pi­lot ended in fail­ure. Voalte went back to the draw­ing board in Sara­sota. For nine months, they worked 12 hours a day to re-en­gi­neer the app.

The com­pany op­ti­mized the soft­ware for Wi-Fi roam­ing. Voalte ad­dressed work­flow is­sues by hir­ing ex­pe­ri­enced clin­i­cians who un­der­stood both the med­i­cal and IT sys­tems and could fig­ure out the best way to use the app.

These pro­fes­sion­als iden­ti­fied backup con­tacts for when a crit­i­cal staff mem­ber wasn’t avail­able; and they set pro­to­cols for when to send alerts. To­day, these clin­i­cal staff at the soft­ware maker are key ad­vis­ers to hos­pi­tals when they be­gin de­ploy­ing Voalte’s app.

De­spite Voalte’s ini­tial fail­ure, Cedars-Si­nai’s Dworkin and Laud­erdale stayed in touch. Dworkin ad­vised Laud­erdale not to rush into the sec­ond de­ploy­ment un­til the app had been per­fected.

“It’s im­por­tant to show po­ten­tial cus­tomers that you have the chops to work through prob­lems,” said Eric Jensen, chief op­er­at­ing of­fi­cer at Chicago-based Avia. Star­tups should be forth­com­ing about how they plan to over­come ob­sta­cles, even if it means de­scrib­ing in painstak­ing de­tail what has not worked, he said.

One of the key chal­lenges in de­ploy­ing new tech­nol­ogy is fig­ur­ing out how to mea­sure pro­duc­tiv­ity gains. This re­quires mea­sur­ing the suc­cess of a pi­lot over var­i­ous in­ter­vals of time. In the short term, say the first 30 days, adop­tion or sat­is­fac­tion are key in­di­ca­tors. More tra­di­tional mea­sures, such as re­duc­tion in re­sponse times, can be used as the tech­nol­ogy be­comes more in­grained in the daily work­flow.

In the case of Voalte, it used the num­ber of texts to mea­sure over­all adop­tion rates. One of the big­gest sur­prises dis­cov­ered dur­ing the roll­out was that a ma­jor­ity of its users pre­ferred tex­ting rather than phone calls. On av­er­age, the com­pany sees nine texts for ev­ery phone call.

The im­prove­ments Voalte made to its soft­ware earned it a sec­ond chance at CedarsSi­nai. Other de­part­ments be­gan us­ing the tech­nol­ogy within a cou­ple of weeks. And over the past few years, the app has be­come widely used through­out the sys­tem.

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