IT Innovation Contest

A team-based contest for creative IT solutions

ZipRounds Mobile Client

Proposal Status: 

Description: ZipRounds (ZR), a Salesforce Chatter-based collaboration tool, revolutionizes in-hospital communication. ZR enables providers to send, receive & store patient-related messages in an easily searchable, indexable & retrievable way. It hybridizes the asynchronous alerting capability of pagers (and the familiar web portals used for this purpose) with Facebook-like object-centered content management & on-the-fly hashtag indexing. Because ZR messages can subsequently be searched across patients and by keyword/hashtag, they open a vast window into clinical operations that were previously hidden by an inadequate and deliberately amnestic communication infrastructure. ZR was piloted in alpha form in April 2012 at Mount Zion to rave reviews. For the IT challenge, we will build for ZR a HIPAA-compliant mobile client (ZRMC) (ZR itself is already HIPAA compliant). This will reduce the redundancy of carrying a pager and a smart phone and ultimately allow UCSF Medical Center to transition away from pagers entirely—a long term dream for every functional department at MC from security to telecom to the privacy office.

Deliverables: ZRMC, once built, will be used by employees for all electronic communication in the hospital, supplanting in most instances both email and Pagerbox (the current text-paging solution). We will build ZRMC on the architecture of ZR (secure VM MCIT server, API-based connections to Chatter and paging infrastructure, a functional interface for sending and tagging messages), refactored for use from an iPhone or Android device. Using ZRMC, providers of all disciplines (nurses, physicians, pharmacists, etc.) will be able to securely text one another without the hassle of sitting down at a computer, while receiving messages on any device of their choice—pager, smartphone, or email.

Impact on UCSF’s mission and/or community: Once ZRMC is developed and rolled out, it will dramatically improve the work flow of all UCSF providers. Nurses and physicians will be able to text back and forth for simple questions, saving call backs for points that actually require discussion. Primary teams will be able to send pictures of rashes, wounds, and even x-rays to consultants, who will be able to track and prioritize questions and analyze them in real time (X % of our consults this month are for this problem; Y % for this other problem) directly from their smartphones. The increase in efficiency will ultimately benefit the 17,000+ patients admitted each year by the Medical Center, as well as the countless outpatients managed in primary and specialty clinics. 

List of team members and roles; estimated time devoted.

Michael Blum—visionary: provide clinical leadership and oversight; member of and bridge to C-suite at UCSF MC. Time devoted: 5 hours (done independently).

Raman Khannateam leader, visionary, user/subject matter expert: clinical input into all tasks involved in build. Time devoted: 200 hours (done both independently and on department time, see attached letter from Robert Wachter).

Lekshmi Santhosh—user/subject matter expert:input into build especially features affecting residents. Interface with residents to facilitate roll out. Time devoted: 40 hours (done independently).

Michael Turken—user/subject matter expert/design: input into build especially features affecting students. Design mockups for tech team. Time devoted: 40 hours (done independently).

Larry Suarez—technologist: ITS worker who builds mobile applications; his role will be to build the ZRMC, which will acts as a front end for access to ZR from mobile phones. Time devoted: 60 hours (done both independently and on department time; have email confirmation from supervisor Jeff Jorgenson that Larry has permission to work on this project).

Luis Campos—technologist: ITS worker who will work with Larry (potentially with help from external vendors at SalesForce.com and MuleSoft) to integrate ZRMC and ZR from the ZR production end. Time devoted: 60 hours (done both independently and on department time; have email confirmation from supervisor Ed Martin that Luis has permission to work on this project).

 

****NOTE****

our proposal has been merged with "Using Smart Phone app as Pagers" http://open-proposals.ucsf.edu/itcontest/proposal/167. We will be working with this team, and the team members are as follows:

John Houston – Project Manager for Department of Orthopaedic Surgery, HoustonJ@orthosurg.ucsf.edu

Erin Simon – Project Lead for Department of Orthopaedic Surgery, SimonE@orthosurg.ucsf.edu

Timothy Greer – Technical Consultant for Dean's Office, SFGH, TGreer@sfghdean.ucsf.edu

 

Comments

ZR Sounds like a very interesting project. I guess this is related to: https://uccsc.berkeley.edu/sessions/ziprounds-social-paging-solution-med... Is the technical design and architecture documentation for the ZR application available to be shared with the UCSF community? It will be insightful to learn how/what was done to circumvent or address potential for security and HIPPA breaches this application poses. Few questions (based only upon description): - I page some one #MRNFORVIVEK needs immediate treatment in #SURGERYROOM for #MALIGNANTDISEASE due to #SEVERECOMPLICATIONS. If you do #hastag indexing, how do you prevent anyone within the system from searching these terms and seeing these results? Does the data messaging data get stored on the Salesforce HIPPA compliant ORB? If yes, how long do the patient related conversations are all stored there? Are there roles or group based privileges within the system as well? If yes, how do they differ from what Saleforce offers out of the box? Assuming ZPMC gets developed, what happens if someone's smart phone is lost? Any consumer grade smart phone can be broken into within a few minutes with someone knowledgeable. Is there an encryption requirement on these devices now as well like there is on our laptops/desktops?

Hello Vivek, These are excellent questions! I will happily elaborate on some of the more technical questions at length if you prefer, but might be easiest to explain on the phone. In the mean time, a brief description: 1. Addressing HIPAA: a few ways. First, ZR is based on Chatter and Chatter is HIPAA compliant in the usual ways (secured servers, encrypted communications, audit trails to protect all data centers, etc.) Second, SFDC and UCSF have a BAA negotiated over 6-9 months that ensures that WE (UCSF) own the data even if it's on their cloud. There are a few other points we can discuss at length if you prefer. 2. As to the messaging, patients are inserted a different way than this (i.e. patients are not a hashtag, they are an "object" in SFDC parlance). To see a patient's whole conversational record you have to look by record, and there is an audit trail from you opening their chart or sending/receiving messages about them. 3. Conversations are stored forever. They are or rather will be a part of the record, though not a part of APEX (yet). This is actually true even now in that text pages are "discoverable" for lawsuits--so useful for those suing you but not very useful if you are trying to use them to monitor and improve care. 4. Data is stored on SFDC, yes. 5. There ARE roles/group-based privileges within the system. 6. The primary difference from SFDC's out of the box solution is that (1) patients are "objects" i.e. you don't have to mess with hashtags for them; (2) sending a chat queues what's called an "external message" that our server on the UCSF side can pull in through the Chatter streaming API and pass along to whichever platform the user prefers (pager, email, smart client, etc.) 7. If you lose your smartphone, you call IT security. They wipe your smartphone remotely. 8. There IS an encryption requirement on iphones used for sensitive communications and we will need to determine how best to meet it as we get to that point. Please let me know if you have further questions about the proposal or the system more generally! (rkhanna@medicine.ucsf.edu)

Hello Raman, thank you for ellaborating. I am very interested in knowing more about the technical details of the project and will touch base via email to see when we can meet. Some of the solutions you have developed can be very helpful for what we do in our custom developed Radiology applications.

Vivek - It is indeed one and the same application that is being presented at UC CSC. David Thomson, a former UCSF employee who volunteered for ZipRounds and is now working at the middleware company used for this project, is co-presenting with me. Hope you can attend!

Amazing concept that will bring us closer to the ideal of unified communications! If it can support seamless, secure access from the multiple devices (pager, phone, etc.) and allow the user to user their preferred device, and eliminate several web based services to boot, I imagine that folks will be beating down the doors to use this (and will throw away their pagers!). Additional bonuses are ability to track messaging by patient and a searchable database. Can't wait to try it out!

Thank you Dr. Terrazas! Will keep you posted. Hopefully this will have implications for lab results sent to the nurse/physician/etc. as well... but will have to think about that very carefully to calibrate alerts without inducing alert fatigue.