Predict, Prevent, Protect: The New Age of Fall Prevention in Healthcare

Quick summary:

• By utilizing wearable devices, telemonitoring, and advanced AI algorithms, healthcare providers aim to reduce fall risks for patients, particularly those in high-risk groups like the elderly. These technologies allow for continuous monitoring and predictive analytics, providing real-time insights to inform fall prevention strategies.

• Successful implementation of these technologies requires more than just equipment—it hinges on proper staff training and patient education. Fall prevention efforts are significantly enhanced when staff members understand how to use technology effectively and patients are informed about its benefits. Proper adoption across both ends is key to maximizing the effectiveness of tech-driven interventions for safety improvements.

• Challenges like infrastructure limitations and alarm fatigue can hinder the efficacy of these technologies. Many healthcare facilities may not have the resources to support the integration of advanced systems, and constant alerts can overwhelm staff, reducing the response to critical events. Finding a balance between technological integration and operational feasibility is essential to success.

• Collaborations between tech developers, healthcare providers, and data scientists are essential for refining these systems. By leveraging real-world data and continuous learning from AI algorithms, healthcare teams can create a more targeted, responsive approach to fall prevention.

  
  

In the latest episode of CarePoints, host Kenny Schiff, Director of Marketing at Lone Star Communications, dives deep into the pressing issue of fall prevention in healthcare settings. He is joined by industry experts Guy Meger, Vice President and head of the Vayyar Care business unit, Elaine Bridge, former Chief Vice President of Enterprise Asset Management at Mass General, and Tim O’Malley, Vice President and Division Manager of TPC Systems’ healthcare unit. Together, they discuss innovative solutions and the real-world impact of fall prevention strategies on patient safety and healthcare operations, offering critical insights for providers dedicated to improving patient outcomes.

Aging in Place: The Role of Technology

For many, the desire to age comfortably at home rather than in institutions is growing. This is where home-based technology plays a crucial role. “People of my generation, we want to be at home. We want to heal at home and we want to age at home,” said Tim O’Malley, the Vice President and Division Manager of TPC Systems’ healthcare unit. “But we are also at risk of a great number of falls.”

The challenge isn’t just in installing a Wi-Fi or 5G network but in determining who will respond in case of emergencies. Emerging care models like paramedicine—where fire departments or paramedics monitor individuals at risk of falls and respond when necessary—are becoming more prevalent. This type of localized, technology-driven care model is already in use in some communities, offering a glimpse into how tech can support aging populations.

Data and Patient Safety: Bridging the Gap

Connected devices and sensors provide a wealth of data that can be leveraged to improve patient safety, especially when it comes to fall prevention. “With the right usage of the technology and the right balance between alerts and response time, you can reduce falls by half,” said Guy Meger, the Vice President and head of the Vayyar Care business unit.

Today’s devices can monitor trends in patient behavior, flagging changes that might indicate a higher risk of falling. For example, a sudden change in movement patterns or a shift in daily routines might suggest a need for reassessment or adjustments in treatment. But data alone isn’t enough; it has to be actionable. Caregivers need dashboards and decision support systems that can quickly highlight meaningful changes without overwhelming them with unnecessary information.

The goal is to predict and prevent falls before they happen, allowing caregivers to intervene early and make necessary adjustments to a patient’s care plan. “I believe that in the near future, we’ll see more preventive approaches than responsive approaches to treating patients,” said Meger. Healthcare technology companies must focus on the environments they aim to serve. Trying to implement solutions across too many sectors can dilute the effectiveness of the technology and slow down its adoption.

Addressing Alarm Fatigue: A Critical Concern

One of the significant challenges healthcare providers face when implementing technology is alarm fatigue. When caregivers are bombarded with constant alerts, they become desensitized, which can lead to slower response times or even missed alarms. To combat this, technology solutions must be designed to reduce unnecessary alarms while ensuring that critical alerts are acted upon promptly.

The key is to find the balance between gathering rich, contextual data and presenting it in a way that is both simple and actionable. Dashboards, for instance, allow caregivers to see at a glance where potential risks lie, without sifting through pages of data.

When healthcare organizations are evaluating fall prevention technology, there are a few key factors they should consider:

1. Passive Monitoring: The technology should be able to monitor patients without requiring compliance or disrupting their daily activities. Contactless monitoring is especially valuable in high-risk environments like hospitals or nursing homes.

2. Integration with EMRs: Any solution should be able to integrate seamlessly with existing systems like EMRs. This allows data from multiple sources to be centralized, giving caregivers a comprehensive view of the patient’s health.

3. Benchmarking and Measurement: Healthcare providers should use benchmarking data to understand how their current fall rates compare to national or industry standards. This allows them to set realistic goals and measure the impact of the technology.

The Future of Fall Prevention

The future of fall prevention is bright, with advancements in technology offering new ways to keep patients safe. This shift not only enhances patient safety but also reduces the financial burden of falls on healthcare systems. Fewer falls mean fewer hospitalizations, lower treatment costs, and better overall patient outcomes.

“Given the aging population and the potentially catastrophic impacts of a fall, it is essential that we continue to work to leverage technology to educate not just staff, not just patients, but especially patient families,” said Elaine.

As technology continues to evolve, the key will be finding solutions that integrate seamlessly into existing workflows, provide actionable data, and support the needs of both patients and caregivers. By doing so, we can create safer environments for patients and help healthcare providers deliver the best care possible.

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Guy Meger is Vayyar’s Vice President and head of the Vayyar Care business unit and the former Chief Technology Officer of Early Sense. With a focus on leveraging data analytics and wearable technologies, Meger has led initiatives that transform healthcare practices through continuous monitoring and predictive insights. His work aims to bridge the gap between cutting-edge technology and practical healthcare applications, enhancing both patient outcomes and operational efficiency in clinical settings.

Elaine Bridge is the former Chief Vice President Enterprise Asset Management at Mass General and also the former Chief Nursing and Operating Officer for Partners Healthcare, Newton Wellesley Hospital. She has dedicated much of her career to improving patient care, focusing on safety, quality, and operational efficiency in healthcare settings. Her passion for patient advocacy and nursing excellence has shaped her approach to leadership, driving her efforts to create better outcomes for both patients and healthcare staff.

Tim O’Malley is the Vice President and Division Manager of TPC Systems healthcare unit and the former President and Chief Growth Officer for Early Sense. With extensive experience in leading health tech organizations, O'Malley has been instrumental in developing and implementing cutting-edge solutions that improve clinical workflows, patient care, and overall hospital efficiency. He is dedicated to using technology to enhance healthcare delivery and drive more effective, patient-centered outcomes in clinical settings.

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To watch the interview, click the link: CarePoints: Failing on Falls: The Race to Make Hospitals Safer

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The Vocera Difference: Beyond a Panic Button

Quick Summary

The partnership between Stryker and Lone Star Communications aims to enhance communication and safety in educational institutions through the integration of Stryker's Vocera wearable mobility platform with Rauland's Telecenter U educational platform.

The Vocera solution offers voice-enabled communication and mobility, allowing teachers and staff to initiate lockdowns and emergency protocols from anywhere within the school.

Vocera’s integration with Telecenter U provides a comprehensive solution for communication, emergency response, and security in educational settings, addressing the limitations of traditional communication and life safety platforms.

The Lone Star/Stryker partnership offers a cost-effective and flexible solution that covers multiple communication needs in educational institutions, providing a one-size-fits-all approach to communication and emergency response.

The future of Vocera solutions in education involves streamlining workflows, integrating various communication modalities, and enhancing security measures to create a comprehensive fabric of protection for teachers and students.

Since its founding in 1991, Lone Star Communications has been providing life safety communications and instructional technology solutions to K-12 and higher education institutions. The company’s formula remains simple: provide innovative technologies, expert guidance, and ongoing services to meet the specific needs of the market.  

This legacy of excellence led to a collaboration with Stryker to provide a unique integration between Stryker's Vocera wearable mobility platform and Lone Star's flagship educational platform, Rauland’s Telecenter U (TCU). This integration builds off of standard communications technology, and gives educators and administrators the ability to go beyond walkie-talkies and panic buttons—creating an ecosystem that handles everyday communications and allows staff to connect and notify from classrooms and elsewhere. 

Partnering to protect students and teachers 

Long before Alexa, Siri, or smartphones, Stryker's Vocera technology was a pioneer in the wearable speech-enabled communications space, crafting faster and more efficient ways to provide one-to-one and one-to-many communication, predominantly in the healthcare space.  

With its own history of success in healthcare, Stryker acquired Vocera in 2021 and immediately saw a parallel between the Vocera solution’s ability to save patients and protect nurses and the growing safety concerns facing schools. Moving into the education space was an opportunity to protect students and teachers in critical emergency environments. 

Rauland’s Telecenter U had already gone a long way toward that goal. Its IP-based, critical communications solution leveraged schools’ existing networks, infrastructure, and legacy equipment to integrate with public address, visual messaging, security and access control systems. The resulting seamless, cohesive communications solution included IP addressable classroom speakers, district-wide paging, a web-based user interface and a mobile app. 

Moving beyond hardwired call buttons 

Stryker’s Vocera smart badges, with their ability to leverage a school’s existing Wi-Fi infrastructure and allow seamless conversations with other badge users, was a natural fit with TCU, with which it could form a direct link. The combined Lone Star/Stryker/Vocera solution—voice, messaging, marquees, in-room fixed devices—can offer far more than the simple overhead paging found in most schools. 

According to Jonathon Murphy, a technology innovation specialist at Lone Star, one of the limitations of traditional school intercom systems is that they’re hardwired—tied to a particular location such as a phone on a desk or a panic button on the wall. As a result, he explains, the teacher or staff member needs to be near one of those locations to send out an alert. But what if they’re outside on the playground, or walking down a hallway, when an emergency arises? 

That’s where the mobility of Vocera’s badges comes into play. “They're not tied to any one location,” he says. “Not only that, but the ability to know the location of the end user when something happens is also part of the solution.” 

Peter Kraslawsky, Stryker’s manager of Strategic Partnerships, agrees. 

“There is no other solution in the market today that allows for an individual...to initiate a lockdown from wherever they are,” he says. “It's extending the power of that TCU product to the individual wearer or the individual user.” 

Lone Star adds voice to the mix 

But Vocera’s technology allows it to be more than simply a mobile panic button.  

“The primary differentiator on a Vocera solution,” Kraslawsky acknowledges, “is, number one, that you're wearing the device. Number two, and this is really the key, it's voice. You, the teachers, the administrators, the school resource officers are able to use their voice and to let somebody know what's happening in a dangerous situation.” 

To this he credits Lone Star’s lockdown integration and engineering work, which allows alarm protocols to be initiated via verbal command. And because the badges can be targeted to individuals or specific groups, they are more effective than—and avoid the intrusive chatter of— walkie-talkies.  

Also unlike walkie-talkies, the badges can call back directly to in-classroom speakers if there’s no immediate response to a call button at the front desk. 

“It moves beyond the capacity of the panic button or the walkie-talkie,” Kraslawsky states, “by really being this everyday solution that can be used for calling somebody by their name, calling somebody by their role, or broadcasting.” 

One size fits all 

To many, the most potent aspect of the Vocera platform is its ability to create an overall fabric of protection for teachers and students, anticipating any holes that might exist in the traditional communications workflow. But the Stryker/TCU combo is also a one-size fits all solution, contends Murphy, one that allows schools to save money by solving multiple problems. 

“School districts are always looking for ways to save money,” he says. “When they can find a solution that covers two, three, four different problems, I think that's a win for them.” By having one vendor provide a single solution, he adds, “it gives them the flexibility they need to [both] handle emergencies and communicate on a daily basis.” 

Kraslawsky cites what he calls the “four pillars” of school security—physical security, resource officers, training, and communication—and believes that communication, while often the lowest priority, is regularly the number one failure point in active shooter situations.  

That’s why he sees Vocera continuing to streamline school workflows into the future. “What do those workflows need to look like?” he asks. “Who needs to get the alert and alarm notifications? Who needs to get those messages?”  

“I really do think the most exciting thing about what's coming down the road for Vocera are the integrations and the types of integrations that we're doing with Lone Star,” he affirms. That means being able to integrate the many disparate pieces of communication within a school—access control, video camera, PA—and bringing them into a central hub.  

“That,” he says, “has been the core business for Vocera in the healthcare space for the last twenty years. And bringing it into the education space is really exciting.”

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Peter Kraslawsky is Manager of Strategic Partnerships at Stryker, where he leverages his extensive expertise in healthcare and educational technology and solutions to drive innovation and improve patient outcomes and school safety. With a strong background in product development and strategic management, Peter has successfully led numerous projects that enhance operational efficiency and support healthcare and euucation professionals. His dedication to excellence and passion for advancing medical and educational technology make him a valuable asset to Stryker and the healthcare and education industries. 

Jonathon Murphy is a technology innovation specialist at Lone Star Communications, where he has worked since 2000, filling roles in almost every department—starting in installation, then as a service technician, and eventually in IT. As a service technician and system programmer, he gained valuable experience in building direct customer relationships, which led to a position as an education sales representative and ultimately his current role. 

Do Hospitals still need Middleware and CC&C?

Quick Summary

Middleware and CC&C, which play a crucial role in the hospital enterprise, have evolved from bridging systems like nurse call and telemetry to enabling clinical workflow on smartphones and other devices.

“Accidental architecture”—which comes from the lack of a comprehensive design and planning process—has resulted in complex and unmanageable integrated systems in healthcare organizations.

Patient engagement technologies are becoming increasingly important, both inside and outside the hospital, and may impact the future of CC&C and nurse call systems.

There continues to be a need for a comprehensive platform that combines messaging, patient engagement, and all forms of communication in healthcare.

The progress in managing medical device alarms and alerts has been limited due to manufacturers' reluctance to cede control of workflow and integration.

The future of nurse call systems in an EHR-centric universe depends on regulatory changes and the ability to integrate with IP-based patient engagement systems.

Once upon a time—as far back as, say, 2010—the purpose of alarm middleware in the healthcare enterprise was simple: to create a bridge between nurse call systems and telemetry, and provide a method for sending alarms and alerts to pagers and proprietary wireless phones. 

But as succeeding generations of medical communications devices grew more sophisticated—accompanied by a shift towards clinical workflow using smartphones and purpose-built, Android-based devices by Zebra, Spectralink, and others—clinical communication and collaboration (CC&C) systems arose to provide secure text-messaging between physicians and hospitals. Additional features like voice calling were soon added, eventually giving rise to a full communications platform that included scheduling, additional connected devices, improved routing and escalation, and even patient engagement. 

The resulting free-for-all between standalone middleware vendors, many on proprietary platforms, and EMR-centric systems like Epic and Oracle/Cerner, gave rise to a competitive marketplace where the final winners and losers are still being determined—and where the survivors must navigate between customer demand, a strict regulatory environment, and the possibility of a single comprehensive communications platform that would benefit some more than others. 

Such a platform, which to many seems inevitable, would result in a healthcare communications marketplace that looks very different from today’s. In the meantime, what can current CC&C and middleware platforms offer customers to remain competitive in an increasingly Epic-centric universe? 

Untangling Accidental Architecture 

According to Brian McAlpine, a digital health consultant for Cirkel Consulting Group with thirty years of industry experience, one of the major benefits of middleware and CC&C within the healthcare enterprise is its ability to address a problem that arises when institutions must upgrade their legacy clinical systems. As they add new layers of technological solutions and integrations over existing workflows, they can end up with what McAlpine refers to as “an unmanageable mess of integrated systems.” 

“Many organizations,” he says, “wake up one day and realize they've accidentally created a complex infrastructure that they never originally intended.” 

This “accidental architecture,” as it’s come be known, may begin life as a simple nurse call system that sends alerts to pagers. But with the gradual accumulation of new technology, the need to connect and integrate more things to support more workflows increases, with no overarching vision of how everything fits into the existing environment. 

“Most organizations didn't have a vision for what the end state would be,” McAlpine says, “so they simply charged ahead, adding more integrations to support more of the workflows.” 

The end result can leave clinicians stuck carrying multiple devices—pagers, phones, and any other devices used for communicating and receiving alarms. And because many of these come from different vendors, they don’t always work well together. This can lead to no prioritization or control over which, or how often, messages and alarms are received, compounding alarm fatigue and endangering patients. 

CC&C vendors, says McAlpine, can help clean up accidental architecture by providing a platform to help control and manage the alarms. Some organizations have figured this out, mostly by implementing a full CC&C solution that’s closely integrated with the EHR, which can reduce complexity and costs while eliminating excess vendors.  

But these organizations represent a small percentage of the market, and most hospitals today continue to use multiple vendors to manage their diverse set of messaging and alarms. And yet, as McAlpine points out, the more organizations who see the benefits of viewing EHR as a centralized platform, the larger the threat to standalone CC&C vendors. 

Middleware in an Epic-centric World

Epic Systems, with over 36% of EHR market share in the U.S., remains perhaps the largest of those threats. The company continues to push forward in these markets, and its outsize influence—along with the industry’s inevitable convergence—poses a major risk to standalone CC&C and middleware vendors. 

McAlpine recognizes that increasing numbers of customers are looking to leverage Epic’s mobile applications, such as Rover, wherever they can. But in today’s multi-vendor environment, he also sees this as an opportunity.

As long as Epic—due less to technological than regulatory reasons—is unable to integrate directly with devices like patient monitors to manage alarms, many CC&C vendors are positioned to fill this gap by providing validated alarm management integration into Epic’s mobile apps. In addressing a prevailing customer desire to manage all alerts and alarms within a single platform, standalone alarm management platforms can remain relevant. 

Likewise, since every customer has a different starting point, and not every hospital requires a comprehensive platform—sometimes basic nurse call integration is sufficient—there remains a place for CC&C, alarm middleware and Epic to all work together. As long as the customer makes clear what its needs are, vendors will be forced to find a way to make that happen. 

Does “good enough” supplant best-of-breed?

According to John Elms, a strategic adviser who is a former Chief Product Officer of TigerConnect and co-founded Connexall USA, Epic’s reluctance to avoid entering the FDA-regulated medical device space is both practical and strategic. But when, or if, that changes, the whole landscape will change with it—making a huge impact on the marketplace.  

History shows that it’s difficult to expect CC&C and middleware to thrive as standalone applications when competing against EHRs. Citing such once-dominant applications as Pyxis and the original Netscape web browser, Elms doesn’t believe the long-term prognosis is good for standalone providers, especially of physiological monitors and nurse call.

“‘Good enough’ features,” he maintains, “always supplant best-of-breed applications when they're tightly integrated with an enterprise platform.” 

If that makes the long-term seem grim, there are gaps in the midterm that could be filled between what’s available now and what’s likely to be available with CC&C in the near future. For example, ancillary augmentative technologies like building automation systems could be integrated with access control, lighting, temperature, sanitation, security, safety, and other things—which may be particular to healthcare, but not to the EHR and its related applications.  

Engaging with Patients 

Patient engagement, which intersects with CC&C and nurse call, is another area that might offer a lifeline. Whether inside the hospital or out in the broader healthcare enterprise, communications are something McAlpine believes have plenty of room for fundamental improvement. 

Accordingly, he points to the overlaps between nurse call and interactive patient care, and CC&C and patient engagement. And he agrees with many industry analysts who believe “a combination of CC&C and interactive patient care can essentially replace the functionality provided by a traditional nurse call system.” 

He also takes encouragement from the fact that, over the last five years, CC&C vendors have expanded in the area of clinician-to-patient communication.  

“Up to that point,” he explains, “the CC&C vendors' messaging was strictly designed to be between members of the care team and hospital employees. But healthcare organizations know they need to change and adapt in order to survive. And it's recognized that patient engagement will play a role in that.” 

A single, Comprehensive Platform?

Back in 2010, when Elms was still at Connexall, his company envisioned a sophisticated, automated air traffic control system “that would manage the delivery and prioritization of medical device alerts and alarms, making sure they got to the right person on the right device at the right time.”  

But that dream of middleware, smart alarms and universal connectivity has been far from realized. 

“When you look at the numbers of connections in a healthcare system connected to a mobile communication platform,” Elms says, “it's still predominantly about nurse call.” 

As further evidence he cites the continual presence of alarm fatigue on ECRI’s Top 10 list of preventable medical errors in healthcare. This is in spite of the 2014 Joint Commission mandate calling for accredited hospitals to better manage their medical device alarms to reduce alarm fatigue and the potential for patient injury.  

The lack of progress, in Elms’ estimation, is due to manufacturers not wanting to give up control—of workflow, routing, escalation, and notification—to a proposed centralized ecosystem, even as medical devices grow ever more sophisticated. 

Nurse call companies are known to be highly territorial about tying their infrastructures to third parties, he affirms, and are not only afraid of losing control over their workflow, but of the resulting decrease in their perceived value. This leaves the customer caught in the middle, between uncooperative manufacturers and their own specific integration needs.  

Which is why, at the end of the day, customers need to speak up. 

“When the customer demands a certain capability or feature, by and large, those manufacturers will respond to the customer,” Elms say. “And the customer needs to be loud. They need to be demanding.” They also need to be educated to be smarter about what they ask for. 

Ideally the industry will continue to converge toward a single platform that handles all communications. So many hospitals would like to be able to deploy a new nurse call system as easily as they deploy telephony systems. But with companies continuing to add features that are more proprietary, not less, it’s anyone’s guess how soon that might happen. 

The cost of Convergence

Is there a long-term future for standalone CC&C companies? 

McAlpine believes that healthcare organizations will continue looking to save costs, consolidate, and simplify their environment by cleaning up accidental architecture. One way or another, this will lead to a single comprehensive platform that combines messaging, patient engagement, and all other forms of communication, including contact centers.  

Whether that convergence happens in two years, five years or longer, it will start across the broader healthcare enterprise—which today extends as far as the home—before it happens within the hospital itself. 

Elms agrees that a single platform handling all communications “is really where we'd like to see the industry get to.” But he thinks the future of nurse call ultimately comes down to one thing: the fate of UL 1069, the regulation that requires an uninterrupted, fully reliable system for activating tones and lights when patients need attention. It’s a regulation he considers rooted in the past—one that prevents engineers from launching innovative, IP-based nurse call systems that use “tablets instead of pillow speakers and all those other things that we might imagine for a nurse call system.” 

“We’re either going to get more intelligent and less wedded to the standard that guides nurse call today,” he explains, “or we'll hold onto UL 1069, and nurse call systems will get dumber, not smarter.” 

Or, as Epic and Oracle already begin to incorporate new generative AI capabilities into their platforms, there’s a third possibility—nurse call systems that are both dumber and smarter.  

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Co-founder of Connexall USA and the former Chief Product Officer at TigerConnect, John Elms is an accomplished executive with over 25 years of leadership experience in the high tech industry. His career spans various roles, including CEO positions at public and privately held companies, venture backed startups, and his own entrepreneurial ventures. 

Brian McAlpine has spent most of his 30-year career assisting innovative startups with developing and taking to market solutions focused on the provider side, primarily in acute care. His career has been focused on developing new markets in healthcare IT including device data integration, connectivity workflows, alarm management, clinical surveillance, clinical communications, patient engagement, and medical devices segments. 

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