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Black Box Enabled Surgical Suites?

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Medical errors are estimated to be the third leading cause of death in America. This is worth repeating – the THIRD leading cause of death in this sophisticated, educated, economic power house of a country is mistakes, errors, mishaps…

Why aren’t we outraged? Why aren’t we paying more attention?

I understand that healthcare, as a “system”, is a complicated, ever changing industry that relies on fallible human beings to work well in complex, difficult to repeat situations each and every day. But, here’s the reality – healthcare is NOT alone! There are industries equally as risk-filled with far better safety records! Why is it that the same level of safety we demand for our automobiles or airline travel is not demanded to protect a life, our’s or a loved one’s, when we enter a hospital?

There are many industries, other than healthcare, that work in complex environments where the actions of one human can impact the life of another. Healthcare leaders need to acknowledge the reality that we have much to learn from other industries. While we cannot mimic others entirely, the same general operating principles (including mindfulness that serves as the overarching organizational spirit) that are the foundation for other high reliability organizations (i.e.: aviation, nuclear power) can work just as well to prevent harm from occurring in health systems.

One example of a safe practice or technology that could shared across industries is the in-flight data recorder found on all commercial airliners. It was because of the in-flight data recorder on board the two Boeing 747s that crashed into one another on the island of Tenerife in 1977 that we learned so much about the decisions and behaviors resulting in that game-changing airline disaster.  The time stamped voice commands of those at the controls were captured in real-time, and provided a blueprint of what “not to do” along with a snapshot of what needed to be changed.

Now envision this: following a surgical procedure, regardless of the outcome, we have the opportunity to review every piece of data related to the procedure.

We currently have the technology by which we can go back and look at thousands of time stamped data points to review and/or recreate events as they transpired in the operating room. We can capture voice, video, blood pressure, oxygen levels, numbers of plasma/blood transfusions. The data would stream from the medical equipment in the room, from the microphones, the cameras, and any other sources that we choose to capture, into a device that allows playback, review and re-enactment.

We could assess team work, learn from the practice of those at the top of their game, and use this data to improve. We could revisit poor outcomes and learn what should be done differently in similar circumstances. This is not a pipe-dream, nor is it my idea; it has been developed and is currently being used and piloted by Dr. Teodor Grantcharov, a general surgeon at St. Michael’s Hospital in Toronto, Canada.

An innovator if ever there was one.

The choice to innovate is not, in fact, a choice – it’s an imperative.

I firmly believe we have the expertise, the intelligence, the resources, and the creativity to make healthcare less costly, more effective, more patient centered, and far better. We need to give ourselves the permission to try, to innovate, to disrupt our environments in ways that lead to safer, more effective and more humane healing environments.

Reduce Non-Clinical Classroom Time for MDs

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MD per 100,000 population by state
Physicians per 100,000 population by state (2011)

Physicians are some of the most time squeezed professionals on Earth. Whether practicing at a hospital, or as part of a care delivery organization, physicians must keep up to date clinically while they serve their panel of patients. Additionally, many physicians are doing research or have management responsibilities within their organization. Lastly, in order to be a practicing clinician within their organization, these same physicians are required to learn the technology systems used in order to document their clinical encounters (mostly EHRs).

How do most organizations train their physicians? In classrooms watching trainers move through PowerPoint slides while lecturing. Do we want our physicians spending up to 20 hours of their time in classrooms learning to use an administrative system?

Physician staffing shortages are a reality. Utilizing their time for non clinical activities only exacerbates a bad situation. Most believe there are not enough Primary Care Physicians in the U.S. today, and the situation is only getting worse. (See Chart) According to the Association of American Medical Colleges, there were 744,224 licensed and active physicians in the U.S. in 2011. Of those, 208,802 were aged 60 or older. At the same time there were 80,279 enrolled in the 137 accredited U.S. medical schools. Assuming no attrition, medical school graduates transitioning into their clinical residency (3 to 7 years) will average 20,070 per year, fewer than those retiring.

There must be a better way to train physicians then spending the equivalent of 1,875,000 eight hour shifts (750,000 physicians times 20 hours training divided by 8 hours per shift) learning how to properly document a clinical encounter.

Virtual Immersive Learning is one solution. Can you recommend others?

2 Modalities, 1 Goal: EHR Learning

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Maximize your training $ ROIRecently, I was talking with a top tier EHR trainer at a very large regional health system. She told me that while their EHR vendor had a strict requirement for all trainees to take the standard EHR training courses, including eLearnings and classroom training, when a team of Emergency Department clinical staff began to use the new EHR they were unable to efficiently and effectively apply what they had learned. Why? Because they were so lost they didn’t know where to begin.

According to Wikipedia, “E-learning (or eLearning) is the use of electronic educational technology in learning and teaching.”  (http://en.wikipedia.org/wiki/E-learning ) But “e-Learning” is frequently as simple as a few PowerPoint slides with a simple test to take at the conclusion of the slides.

Static PowerPoint based eLearning gives you assurance that your staff has seen the material. They have probably even understood some of the information. But this modality gives you no insight into whether or not the staff can apply what they’ve learned in a realistic, job-oriented scenario.

In contrast, adaptive or virtual immersive training provides adequate integration, realism and immersion (the learner must engage with their full focus to make it through the training) that you will know for certain that your staff is ready to go.

According to Wikipedia, “immersion into virtual reality is a perception of being physically present in a non-physical world. The perception is created by surrounding the user of the VR system in images, sound or other stimuli that provide an engrossing total environment.” In layman’s terms: when your staff has experienced Virtual Immersive Learning they have already worked with your new EHR in their actual work role.

3 Benefits to Virtual Immersive EPIC Training

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9-info-tech-e1389127561311Many hospitals are implementing or updating EPIC EMR software. When we inquire as to what clients need they tell us that they need training that is engaging, effective and efficiently delivered. Historically, go-live has meant resources working at sub-optimal levels as users ramp up their knowledge and comfort with the EPIC system. The cost, in efficiency, of this learning curve is substantial and incremental to the already extraordinary out-of-pocket costs associated with the classroom training that is the current industry standard training approach.

There is an alternative. WP Virtual Learning has built and delivered a virtual, interactive training capability that replaces classroom training. Where individual instruction is required, avatars, videos and scenes with voice overs replicate the true-to-life where the learner actually works. This is far more realistic than a classroom setting. The learner responds to “live” patients, the actual screen they will be using and the correct workflow exactly as they will be doing when the software is implemented and “live”.

A few reasons why this approach is more effective and cost efficient:
• In one example, we reduced a 4 hour classroom training session (exclusive of travel time) to 2.5 hours
• The training will be available for refresher courses, new hires, job changes, etc.
• The learner is fully engaged at all time, not waiting for instructors or classmates to catch up, not checking email or texting a friend. The learner must stay engaged throughout the training to move forward with the session

This new-to-healthcare paradigm of training will change the way training is delivered throughout the industry. Why? Because the current classroom-based training is just not up to the task of delivering what healthcare organizations need.

5 Reasons to Use Virtual Immersive Learning for EHR Implementation

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blog ehr 1If your organization, like most, is now dependent upon an “Electronic Health Record” (EPIC, Allscripts, Cerner or Meditech) then you really need to be looking at changing the way you deliver training to the clinicians and schedulers who are now reliant upon the system for doing their work.

Classroom training, the current standard for most training delivery, is extraordinarily expensive. Because it’s expensive, many organizations cannot devote enough staff time to training, leaving those who use the system frustrated and inefficient during patient interactions.

Introducing Virtual Immersive Training for Healthcare System Training

Using a virtual instructor and avatars, virtual training:
1. Measurably improves the effectiveness of training, whether complex or simple
2. Significantly reduces the time spent by your staff engaged in training (travel and training time) and allows self-paced 24/7 access
3. Significantly reduces the cost of training delivery (trainers, rooms, computers )
4. Increases staff satisfaction by training them on their actual job versus generic transactions
5. Frees up resources to help clinicians personalize the use of their systems to increase their personal productivity

While virtual training for “go live” will deliver significant benefits, having virtual, high quality training available as needed can deliver consistent and long term benefits to the bottom line of your institution as new hire and refresher training needs are met with no incremental costs.

If you’d like to see a short video of the virtual capability, please click here.