Kelly Feist, MBA is managing director of Ascom Americas of Morrisville, NC.
Tell me about yourself and the company.
I started my career as a bedside clinician. I worked for 10 years at a couple of acute care hospitals in Florida in the respiratory care department, covering intensive care units, emergency departments, and neonatal ICUs. I have a strong appreciation for what a clinician experiences each day and their need for not just information, but information that is actionable and easily interpretable.
I joined Ascom on April 6, so my first day was after the pandemic started, which is an interesting way to start with a new company. I was drawn to the company because it is going through a transition and a transformation, moving from capital equipment to focusing more on workflow, clinicians, and patients. Our healthcare information and communication technology helps clinicians deliver bedside care in an effective way, managing communications between clinicians and from patients to clinicians. We start at the bedside with the patient in the center with nurse call, and then move out to mobility devices. It’s an end-to-end, integrated workflow that becomes increasingly important as we find new ways to manage clinical care while trying to limit contact.
What are the challenges and benefits of collecting and presenting information from hospital monitors to clinicians on mobile devices?
It’s not just hospital monitors, but also ventilators and laboratory test results. A vast amount and a vast variation of information can be presented on mobile devices in the clinician’s hand. It’s not just the information, but the actionable information. We can deliver so much information when we digitize a workflow that was previously analog. We can put a mobile device in the hand of a nurse at the bedside that can receive alerts from all of these different devices — ventilators, patient monitors, lab systems, and so on. A lot of information can hit that handheld and overwhelm the nurse.
The challenge is to identify what information is truly actionable and how that information is escalated so that the nurse can respond in an efficient and informed way to solve the patient’s problem. You can’t overwhelm people with a lot of information and then expect them to decide what’s important and what can wait. The value that we deliver is helping them understand how they should be prioritizing that information so that care providers aren’t overwhelmed by a new workflow that now happens to be digitized. Just because we can digitize it doesn’t mean we should.
Is technology such as AI, which is a term I hesitate to use, improving the ability to automatically prioritize information instead of having each facility or each user set up rules?
I share your reluctance to use the term AI. It is overused, and applying it in a way that makes sense is easier said than done.
I think about whether a hospital already has rules and policies in place. For example, does the facility have a policy for early warning scoring, where they have determined the parameters that can help identify a patient who is at risk for deterioration over time and then raise a flag before they become symptomatic? If that protocol exists, we can program it into the software aspect of our solution. We will raise the flag and create and escalate the communication in an automated way for the care provider to ensure that the patient who is at risk is identified quickly.
Most people don’t realize that the first indicator is typically an increase in respiratory rate. If we see it increase, or see the lactic acid test results increasing, the software can raise the flag, create the communication to the care provider, and escalate it in an automated way. That pays dividends. Healthcare facilities want to spend their capital equipment dollars on something that delivers measurable ROI. That becomes important in making their clinicians more efficient, keeping their patients safe, and increasing their own capacity if they can release patients or discharge them sooner. It’s a lot to say that, but we have done studies that have shown that at the very least, a well-designed, well-executed protocol decreases unplanned ICU admissions, for example.
How much of the nurse’s work can now be performed untethered, working from a mobile device that they carry at all times instead of being tied to a nursing station, a wall-mounted computer, or a computer on wheels?
As we are working with customers who are deploying these solutions, we find that the idea of the nursing station is going away. The push is to move the nurses and the frontline care providers closer to the patient and away from a centralized nursing station. This is the first real change that mandates finding new and better ways to manage that workflow.
It’s easy to think that we can apply technology to a workflow and change behavior because the technology exists, but the hardest thing to do in a clinical environment is to change the behavior of the care providers. Behavior change is always the hardest thing to affect. But if we can take our technology and support existing behaviors and make them more efficient, then we all win. The patient wins, the care provider wins, and the company wins.
That’s what we are focused on. As care and nurses move away from centralized nursing stations to something that is more distributed, it becomes important to have a communication device that pushes alerts to your hand. It allows instant communication to the care provider who knows that there’s a problem. Typically there’s also a secondary escalation path, so if that person is busy and can’t leave what they are doing, they can press a button and move it on to the next person, who can then respond. This allows us to build in safety nets.
I don’t think it’s reasonable at this point to think that all clinical documentation that goes into an EHR, for example, will go through a mobile device. Anyone who tries to type emails on their IPhone or their Android device understands why that is a challenge. But we can support the use of the EHR. Our goal at Ascom is not to compete with EHRs that are in place, but rather to support workflows and behaviors that enable and facilitate better use of the EHR. If we can close some workflow gaps at the clinician level and get the data into the EHR for a continuous health record, that is important. If we support the implementation of the EHR and make it successful, we can affect real change in the clinical process, and ultimately the outcome of the patient.
How can technology replace the continuous communication that occurs at the nursing station?
The mobile device becomes important. How well does it integrate into the overall workflow? How easy is it for the staff to communicate to one another, either voice-to-voice or via secure text message, or to receive alerts? When we think through an alerting process, there’s alerting the primary caregiver. But if that primary caregiver can’t respond, there has to be a secondary alert target, and then even beyond secondary, what we would call a catch net solution. Making sure that there’s a Plan A, a Plan B, and a safety net becomes important, because that central station doesn’t always exist any more. And even if it does exist, it isn’t always staffed 24/7.
We have to make it possible for communication to happen in an expedited way that fits into the workflow and meets the needs of the clinician where the clinician is. We are accomplishing that with mobility solutions, the software that drives the mobility solutions, and even starting at the bedside with the nurse call system so that the patient can communicate their needs as well.
What are the best practices in using technology to enable patients to communicate directly with staff to improve satisfaction, but avoiding overwhelming the employees who have to respond?
A care environment typically has registered nurses who are responsible for a level of care, and then often healthcare technicians or licensed nurse practitioners. If we can segregate the requests that come from the patient — based on need, priority, and criticality — to the right provider of those services, then we can get a faster response to the patient.
Patient satisfaction is incredibly important to our care providers, to the facilities that they work for, and to us. If we can make it a little bit more streamlined so that when the patient has a request — it could be, “I need a glass of water” — there’s a way for that patient to communicate and it can go to the LPN. It can go to a targeted recipient that can provide that service without them taking up time of the nurse who might be working with another patient on something that is more critical. But if it’s a critical need, the communication goes to the nurse. We can filter where the request goes based on priority to make sure that the patient gets the response they need in a timely manner.
What are the company’s goals in healthcare over the next few years?
Healthcare is our biggest growth opportunity. For my region in the US and Canada, it’s where the majority of our revenue comes from. The pandemic has shown how impactful we can be to the healthcare community.
As an example, when I started, field hospitals were springing up all over the place, such as at the Javits Center in New York City and McCormick Place in Chicago. They needed to give all patients in beds access to nurse call functionality. We were tapped to provide a lot of the technology for those field hospitals, and it felt good to be able to serve the community in a way that had impact. A lot of the field hospitals didn’t get a lot of census, but the fact that we were able to meet the needs of the community when those needs occurred was important.
Workflows have changed because of the pandemic and we are trying to decrease contact where we can to keep both patients and staff members safe. Ascom can play a big role in that. Those workflow adaptations aren’t all going to go away when the pandemic is over. We have to keep innovating on how we make communications more streamlined, more effective, how we get them to the right person, and how we ensure that priority items are escalated appropriately. Those will remain important. With virtual visits and other changes, we will need to monitor patients at home effectively. Ascom can play a part in that realm as well.
Do you have any final thoughts?
The workflow changes that we are experiencing as a result of the pandemic aren’t going to go away. Keeping the patient and clinician provider at the center of what we do will make healthcare delivery more efficient, and that will make us successful as a company. Focus on the patient and the provider.