The Importance of Doing BCMA Right

Neither Jamie nor I are aware of any hospitals who have implemented BCMA and then stopped using it. There have been many who have de-installed one system to install one from another vendor, but we don’t know of any that have stopped going forward with bar-code verification.

So, if “failed” implementations don’t result in de-installs, what are the negative consequences of failed implementations, and what are the motivators for doing it right?

The negative consequences could include a number of outcomes:

• Failing to design process well results in workarounds because the process wasn’t designed to proactively prevent the need for workarounds
• If the system isn’t used in practice, it certainly can’t help prevent errors
• Poor implementation of technology (computers, wireless networks and barcode scanners) can frustrate nurses and add yet more stress to their stressful days
• technology isn’t utilized, wasting investment (workstation on wheels parked and not used)
• If extensive process exceptions are discovered after going live, lengthy project stabilization periods are almost guaranteed, which cause problems with other projects down the road, cause re-work, and postpone the benefits of the technology
• At worst, poor implementation can lead to unintended consequences and potentially negatively impact patient safety

By “doing it right,” hospitals can achieve several benefits:

• Decrease the timeline and expense of implementation
• Build a culture of safety that continues after the installation, with multidisciplinary teams convened to continuously improve process
• Improve Nursing/Pharmacy collaboration and improve efficiencies (this is only if the broader medication-use process is considered)

Some organizational barriers to success I’ve encountered as a hospital begins its BCMA process:

• Lack of clinical system implementation experience, or lack of working through significant change management as a team
• Lack of “street” knowledge of what’s happening at the bedside, or redesigning workflow with a “conference room” knowledge of their process
• Unrealistic schedules that cause strain on the bandwidth of key people
• Often schedules don’t build in “process design or change management,” or “stabilization” time
• Jumping into implementation prematurely, such as purchasing devices before the desired process is understood

I understand that many hospital leaders are unwilling to absorb the need for process introspection and culture change, but some amount of targeted planning actually reduces overall project timelines and expense, by avoiding re-work and extensive stabilization.BCMA completely changes the way nurses deal with medications, even in scenarios where nursing documentation and an eMAR is in place. Assuming safe use, BCMA forces the computer/scanner to be used at the bedside immediately prior to administration. Before BCMA, nurses could document in a variety of locations. BCMA is not nearly as complicated than CPOE to implement, but it is a process that touches on a lot of different disciplines and processes.

Mike Wisz to speak at Bedside Medication Administration and Verification Roadshow: Anaheim, CA 3/25 2010

Mike will describe how barcode point of care applications help close the loop to ensure right patient and right therapy and diagnostics, and detail the 10 most critical factors in implementation success.

Thursday, March 25, 2010
10:00 AM to 3:00 PM
Crowne Plaza Anaheim Resort (12021 Harbor Blvd. Garden Grove, CA 92840)
Cost: FREE

In addition, attendees will have the opportunity to get hands-on time with the printers and scanners so critical to positive patient identification. The program includes time with industry-leading vendors Code Corporation, Zebra Technologies, and Rubbermaid Medical Solutions.

For more information and to register:
http://www.codecorp.com/anaheim_roadshow_registration.php

Mike Wisz to speak at HIMSS/AHRMM Supply Chain Symposium

As part of a daylong program, Mike will speak to the challenges of improving patient safety in the supply chain of the future.

Session Description:
The healthcare industry has made great strides toward recognition of the value of industry standards to track products through the healthcare supply chain. But what is really required to turn that vision of value into reality, especially as it relates to patient safety. This session will look at the essential changes that are necessary to turn vision into reality.

http://www.himssconference.org/education/sessiondetail.aspx?eventID=3970

In consulting, experience is everything

I cringe to think of marketing firms that claim to meet the needs of all clients. I know there are general rules of engagement that might apply to sports drinks, exotic lumber, and healthcare information system but it is the knowledge that underlies these industries, not the mechanics of marketing, which produces results.

As a consultant, I ensure that I bring value to my clients by staying tucked into a niche defined by healthcare information technology above, medical devices and life sciences flanking the sides and wireless technologies underfoot. Inside this nook, years of professional experience serve me well recently I found a fresh source of valuable insight tucked into in an even smaller place.

Though it would be an imprudent business plan for me to rely on being a patient myself to gain experience, a recent visit to UCSD Medical Center’s CT/PET Imaging Center turned out to be consulting gold. I gained new insight on four truths of healthcare:

First, the balance of power in this consumer experience is off kilter before you ever hit the registration desk. You are either ill or potentially ill, or you would not be having a $15,000 body scan. This fact ensures that you are probably a little off your game. To exacerbate this disadvantage, I noticed that every room in the building had a “Warning: Radioactive” sign on the door. It dawned on me that it is actually the patients in the rooms who are surging with radioactive isotopes. Headed for my own personal day-glo lounge, I’m stunned to discover that the lead door is so heavy that I have to pathetically pry my way out of the bathroom with one hand while securing my peek-a-boo gown with the other.

Second, not everything in healthcare is featured in episodes of House, ER or Grey’s Anatomy. As a result, patients are often caught completely off guard by the details of a procedure. I eyed my little lead room with its heated massage chair and frothy drink with suspicion. It was only a scented candle away from a spa day. The mood was broken when a mountain of a man named Claude arrived with a lead lunch box. A moment later I had an IV catheter in my arm as Claude drew a cartoon-esque shiny metal syringe out of the box. It was a 007 moment for sure, and I fought the urge to look for razor wire on Claude's teeth. I was instructed to sit motionless - no typing, no talking, no NOTHING - for 1 hour to let the radioactive isotopes soak into my nooks and crannies uniformly. I talked Claude into letting me read from my Kindle because I could do it with one finger. (Maybe there is a marketing angle for Amazon in this?)

Third, for all those medical procedures we have seen on House, ER and Grey’s Anatomy, the reality pales in comparison to TV. There is little to no drama involved, except within the patient’s own frantic mind. It is your job to follow directions which you do carefully because – well, your life may depend on it. After my inert solitary confinement, I took my place on the metal plank of the highly intimidating PET/CT machine that consumed the majority of a room just slightly warmer than a meat locker. I demonstrated that I could lie on a 2-foot wide table with my hands above my head - elbows at my ears. I promise to stay this way for the next 25 minutes or so but I resisted the urge to laugh when Claude asked, rhetorically, if I’m comfortable - lest he glare at me with towering concern as I cost the Center hundreds of dollars per minute with my senseless sarcasm.

As the conveyor belt pulled me into the machine, I saw the red laser cross hairs and realized this is the point in House when the patient starts to asphyxiate or bleed from a facial orifice. Neither happen commonly, it turns out. Instead, the machine’s robotic voice (not a stylish doctor in an intimately lit tech room) ordered "breathe in" "hold your breath" and "breathe out". Steadily my arms went from uncomfortable to agony but I held my pose like a high diver going for gold.

My fourth realization was that many medical procedures elicit little known physiological effects. A wonderful sampling of such effects which relate to child birth are described in “What to Expect when you are Expecting.” They remain little known because, these surprises don't qualify as a topic of polite conversation. I now know that when you are injected with contrast agent for a CT study, you will experience a false sensation that you have just wet yourself. Thankfully, Claude warned me that this might happen or I would have certainly called for a time out. Eventually Claude extracted me from the bore just long enough to wrap my torso and arms in a Velcro sealed ace bandage and send me back in, snug as a bug, for a 40+ minute motionless PET marathon.

By four-thirty that afternoon three different radiologists had read my CT chest study, my PET scan and my contrast images. The radiology reports and images were electronically available to my primary care doctor, surgeon, and medical oncologist. Before dinner, I received the call telling me that my morning adventure was well worth the time – I was certifiably cancer free from head to toe.

A week later, a client called me to rework a slide deck on their medical imaging module. As I pondered the right clinical scenario to illustrate the value of connected health data, I didn’t have to search far. My experience along with my new insight is at least as valuable to my clients as a grasp of search engine optimization or consultative selling techniques. With me, they get the whole package – albeit radioactive.

Healthcare Informatics webinar: User authentication

Balancing security and convenience for logging into clinical applications puts IT leaders between a rock and another rock. Join me and our panel as we discuss user authentication and whether newer multi-factor techniques such as biometrics are ready for prime time.

The webinar is Thursday, October 29 at 1 PM Eastern and more information can be found here:
http://vendomewebinars.com/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=3B8BF8109DD04B0081BE42EDEE7B0A89

4th Floor Thinking

I live most of my life four stories above sea level. I live in a 4th-floor loft in downtown San Diego, and Jamie and I work in Suite 422. This consistency of elevation is completely coincidental. It's less accidental how Jamie and I approach our work.

We're comfortable developing strategy with the executives on the top floor. Unlike many consultants who constrain themselves to strategy-only, we like to mix it up with street-level tactics. We can see both extremes from the 4th floor. In all our work, executive-level perspective is embedded in what we deliver.