HIStalk Interviews Kevin de la Roza, MD, Anesthesiologist, Arnold Palmer Hospital for Children

Kevin de la Roza, MD is a pediatric cardiac anesthesiologist at The Heart Center at Orlando Health Arnold Palmer Hospital for Children, assistant professor of anesthesiology at the University of Central Florida College of Medicine, and SVP/GM of Vocera’s Ease business unit.

Tell me about yourself and your work.

I’m a pediatric cardiac anesthesiologist at Arnold Palmer Hospital for Children in Orlando, Florida. I take care of babies and children that have congenital heart defects when they have heart surgery and any other type of surgery.

How is the Ease app that you developed being used?

It has been quite a remarkable journey for us. We created this from the need that, as anesthesiologists, we are the last person to take family members to surgery and away from their loved ones. We thought it was pretty barbaric the way that families are being ignored, whether they were just getting a phone call once in a while or maybe never when their kids or their adult loved ones were off to surgery, or had a board that they were looking at that didn’t tell any information.

The app is used universally in any location. We made it nimble and user-friendly for not only the families, but also the nurses. It fits in well with their clinical workflow and with the physician’s workflow. It has become an efficient way for us to communicate. You could be communicating with a loved one while I’m talking to you right now — via text or even a photo or a video or something like that — and it wouldn’t disrupt your workflow. We wanted to bring in the modern way of communicating from our world into a HIPAA compliant and secure way to do it in healthcare.

You see that moment on TV or in movies where the surgeon dramatically enters the waiting room full of anxious family members. How is the mindset different for the surgical team when they have the ability, and maybe then the responsibility, to provide regular updates to family members who may not be in the same city or even the same country?

We are all so connected now, whether it’s online or otherwise, that we are ready for instant information and instant gratification with knowing what is happening with our loved ones. We can track our package from Amazon, so why can’t we track our loved one’s progress and know what’s going on? 

When you talk about the care team, there are two aspects. There’s the surgeon and anesthesiologists, then the nurses. Vocera Ease is the modern way of communicating. It is a non-disruptive and it doesn’t bother their workflow. A nurse is used to taking essentially a snapshot or a barcode on the patient’s wristband and scanning it and getting a medication. We created the app to be the same way, so that whenever the patient or the nurse wants to send a communication, they scan a wristband and send off the message. That could be from the surgery or medical floor, because the program is now in the ICUs, medical floors, radiology, the cath lab, and obviously surgery, where it was born.

It’s a non-disruptive way for the nurses to communicate. Previously, if they were able, they would have to stop what they were doing, get on a phone, and call the families. Sometimes they answer, sometimes they don’t. Then have a two-way conversation, which can be disruptive. The surgeon might go out to the waiting room and the families aren’t even there.

You alluded to the fact that we have so many loved ones in other states and other locations who can’t be there. The great thing about Vocera Ease is that it sends one-way messages from the clinicians out to the family members that give them a step-by-step story of what happened, whether it’s on the floor, in the ICU, overnight, or in surgery. It is a remarkable way to communicate and increases efficiency. When those surgeons go out to the waiting room, the families already know what happened, so it’s a short, efficient conversation. The surgeon can move on to whatever is next in their busy schedule.

Do the messages go beyond simply “we’re starting anesthesia” or “we have made the first incision?” I can see where it might be dangerous to convey conclusions early in a procedure.

We reflect milestones. Let’s say your wife or your loved one needs surgery. First, there’s the emotional impact of, “Oh my gosh, they’re going to have this.” Then the surgeon will tell you in their office or wherever preoperatively, “These are the steps of what’s going to happen as it happens.” The day of surgery, you meet your anesthesiologist, who tells you, “This is what I’m going to do. I’m going to take you there. I’m going to give you some IV medicine and get you off to sleep,” et cetera. The patient and family members have a vague idea of what there is, and that vague idea can become fearful when you don’t understand, you don’t see what’s happening, and you don’t have that checklist of what’s happening.

Ease allows them to receive these one-way communications, such as “The patient is in the operating room” with maybe a little picture with a thumbs-up before they fall asleep. Then we will send them, “The patient is safely under anesthesia. Bill is now prepped and ready for surgery and Dr. So-and-So is about to walk in.” When Dr. So-and-So is scrubbed and over the drapes, we might take a little picture of him about ready to start. Then if it’s an orthopedic procedure, we might take a picture of an x-ray and say, “This is the fractured hip. This is what’s going to be repaired.” Then we can show after the fact that the implant is in place and the repair is in place. They have a vivid understanding of what’s happening as it’s happening.

Does Ease offer advantages over consumer video tools such as FaceTime to help families communicate with their loved one who they can’t visit because of COVID precautions?

Ease is literally created for something like what the pandemic has brought about, which is communication with people who are unable to be in the hospital. The operating room or the ICU are isolated areas don’t offer much access and don’t have a lot of information coming out of them. Now the entire hospital has become like those areas with COVID and visitor access restrictions. We have put Ease in these locations and added — beyond one-way communication via text, pictures, and videos — a FaceTime or video chat feature, where there can be two-way interaction.

Ease is HIPAA compliant and HITRUST certified. We set the standard for what security should be in this kind of communication, and we were the first to be able to do it. We are proud of what we were and how we could position our solution to help families out during this time of crisis. Out of necessity, hospitals started using Zoom, WhatsApp, and all these non-secure ways of messaging that they never would have done in an era outside of the pandemic. With Ease, they can do that safely and securely.

What IT technologies do you find most impactful or useful to your practice?

It depends on the problem that you are trying to solve. When it comes to communication, which is what we were focused on, anesthesiologists are in the perfect position to solve this communication issue from the operating room. I have to balance the patient’s safety, making sure that the environment for the surgeon is correct for them. I even talk to the nurses a lot to communicate how we send the family about this, that, or the other to let them know what’s going on. It’s quarterbacking everything to give the surgeon the right environment so that they can operate and do what they need to do. In that milieu, I think it was perfect for us to — my partner and I, Dr. Hamish Munro — to come up with the Ease solution for solving the communication problem and using healthcare IT in that way.

We have many health IT initiatives that we are using now in the operating room, whether they be just simple things like timeouts and keeping track of things. The EMR has become such a useful tool to help us with that. But this one problem with communication wasn’t solved until we brought our solution on board.

You created a health IT product and company and then successfully sold them. Will you get involved in other health IT projects?

I would love to be involved in something like that. We created a team. My partner Dr. Munro and I came up with the idea together. Then my brother Patrick became the CEO of our company. He has an MBA, a background in IT, and was an administrator at a hospital before that. These talents came together. We created a team that can foster new ideas. 

With my background in medicine, that would be an amazing thing to see. I don’t have any idea just yet, but I love thinking about different solutions we can find, thinking about problems with the environmental impact of hospitals and how we can help that. That’s where my brain is going, but we’ll see where it goes. It’s an exciting time to help find solutions to problems that have been around for a long time, or that are just starting to come to the surface.

Are you still involved with the product under Vocera?

Yes. I’m a clinical consultant for them and I help them out with anything that they need with regards to the platform.

Do you have any final thoughts?

In the journey we’ve had with what is now Vocera Ease, from eight years ago to today, it was about finding a strong problem and then putting the components together to find a solution for it. One-way communication via text, video, and pictures is the perfect way to communicate outside of healthcare because it’s non-disruptive and gets things out there, so how do we go about this? Let’s go read about HIPAA. Let’s go read about HITRUST. How do we create apps? Everybody downloads apps, everybody knows how to text.

From there, you start creating the solution to the problem, as opposed to creating the solution and then trying to find a problem to fix. It was created from a place of empathy, from a place of need. We saw these poor family members struggling when they weren’t with their kids who were in the NICU for a long time or they were in surgery. It’s important to find that strong problem and then hopefully an elegant solution to fix that problem.