I was recently asked how outpatient prescriptions and over the counter medications are bar coded and how inpatient medications should be bar coded if they are repackaged.
Here's the overview.
Some outpatient prescriptions and most over the counter (OTC) medication package bar coding today use the 12 digit UPC-A bar code symbology. The OTC bar code may contain the NDC number or the Universal Product Code (UPC) number for the product.
Many outpatient medications that have the UPC number in the bar code also have a 10 digit National Drug Code number printed on the package (usually placed near the drug name) , in a 3 part format separated by dashes i.e xxx-yyy-zzz (where xxx=manufacturer, yyy=product, zzz=package size). A company called RxScan has created a database which crosswalks UPC-A bar codes and NDC numbers, enabling applications to be built which use bar codes to check drug safety.
Inpatient medications must contain the 10 digit NDC number embedded in the bar code itself per the FDA regulations specifying the bar code format .
The reason I was asked this question is that in FY09 we will implement electronic Medication Administration Records which depend on scanning a bar code on the unit of use package. In FY08, we set as a goal that at least 70% of drugs that we procure from vendors or which we repackage ourselves will have a bar-code on the unit-of-use drug package. During our mid-year physical inventory we took a snapshot and determined that over 90% of the unit-of-use packages we dispense have barcodes on them. 24% of these were RSS-stacked format, 8% were data matrix and 68% were single-line linear bar codes. However, we have not yet verified the readability or the content of those bar-codes, and we are not yet scanning all medications prior to administration to patients or upon filling automated dispensing cabinets (ADCs). We are barcoding certain high-risk medications upon filling ADCs in the NICU (e.g. heparin, digoxin, vitamin K) and hospital-wide for ADC-refrigerated, compounded narcotic-containing bags and syringes (for verification by RN upon removal from the ADC refrigerator because they can look alike).
Our efforts in FY09 will include documenting all the workflow redesign and new devices we need to deploy to support electronic Medication Administration Records. I'll document all these efforts on my blog!
Senin, 30 Juni 2008
Jumat, 27 Juni 2008
Cool Technology Commentary - RFID Safety
On Wednesday, JAMA published an article about the risks of active and passive RFID to other hospital equipment.
The Associated Press and ABC News issued major stories about it.
Although the study focused on RFID tags, the issue is more generic. Electronic Magnetic Interference (EMI) is generated by many devices including cell phones, laptops, and microwave ovens. Such devices emit RF energy which may interfere with the operation of sensitive electronic components used in medical equipment. The interference may be frequency related (signal jamming) or cause the device to fail because a chip or wire is exposed to too much energy from an emitting device. The very best defense is to have adequate shielding for medical equipment. It's inconceivable that hospitals can keep patient care areas free of RF emitters. Thus, it is important for hospital Clinical Engineering departments to be constantly vigilant in identifying potentially unsafe devices.
CareGroup addressed this issue 7 years ago with a global EMI guideline and summary, which we developed by inviting 100 industry experts and the FDA to a consensus conference in Boston.
Of course, we continue to test new EMI emitting technologies as they are introduced into the hospital. Our RFID use is well documented. The Active RFID tags deployed at BIDMC have been tested by Clinical Engineering for interference with other hospital devices and do not cause a problem.
In addition to thinking about the risks of new technologies, we should also consider the benefits. Remember that every activity in life has a risk (which I measure in Morts). If the risk of patient harm is 1 in a million, but the benefit of using the technology prevents harm to every patient, the hospital needs to carefully assess the balance. In the case of RFID, we have deployed the technology with significant testing and adherence to our guidelines, mitigating the risks and maximizing the benefits.
The Associated Press and ABC News issued major stories about it.
Although the study focused on RFID tags, the issue is more generic. Electronic Magnetic Interference (EMI) is generated by many devices including cell phones, laptops, and microwave ovens. Such devices emit RF energy which may interfere with the operation of sensitive electronic components used in medical equipment. The interference may be frequency related (signal jamming) or cause the device to fail because a chip or wire is exposed to too much energy from an emitting device. The very best defense is to have adequate shielding for medical equipment. It's inconceivable that hospitals can keep patient care areas free of RF emitters. Thus, it is important for hospital Clinical Engineering departments to be constantly vigilant in identifying potentially unsafe devices.
CareGroup addressed this issue 7 years ago with a global EMI guideline and summary, which we developed by inviting 100 industry experts and the FDA to a consensus conference in Boston.
Of course, we continue to test new EMI emitting technologies as they are introduced into the hospital. Our RFID use is well documented. The Active RFID tags deployed at BIDMC have been tested by Clinical Engineering for interference with other hospital devices and do not cause a problem.
In addition to thinking about the risks of new technologies, we should also consider the benefits. Remember that every activity in life has a risk (which I measure in Morts). If the risk of patient harm is 1 in a million, but the benefit of using the technology prevents harm to every patient, the hospital needs to carefully assess the balance. In the case of RFID, we have deployed the technology with significant testing and adherence to our guidelines, mitigating the risks and maximizing the benefits.
Kamis, 26 Juni 2008
Reduce, Reuse, and Recycle
I live in Wellesley, Massachusetts where we recycle nearly 90% of our solid waste. How is this possible? Here's my personal story.As part of my effort to be more eco-friendly, I spend each Saturday morning sorting our solid waste into the following categories:
Plastic
Natural colored high density polyethylene (HDPE) resin bottles
Other bottles
Non-bottles
Glass
Clear
Brown
Green
Paper
Brown paper bags
Newspaper
Junk mail
Cardboard
Metal
Aluminum, refundable
Steel
Aluminum, non-refundable
Copper
Wood
Organics - tea bags, food scraps
Yard waste
Grass
Leaves
Branches
Specialty items
Batteries
Printer cartridges
Paint/chemicals
In Wellesley, there is no garbage service. Every household sorts their waste into these categories and drives to the recycling and disposal facility (the RDF). It's a social occasion. I'm likely to meet Fidelity Vice Presidents, McKinsey Partners, and Venture capitalists while dropping my recyclables into the appropriate bins. People meet, have romances, and get married at the RDF (true story!).
Each week, after dropping off all my recycling, I have just a few pounds of waste left over. That, we compost. We have two types of compost bins - a compost tumbler in the yard and a compost pail for the house to collect and transport kitchen scraps to the compost tumbler. Since our household is all vegan, we have no grease or meat waste at all, so we never have issues with attracting wildlife or rancid compost.
One really handy area of the RDF is the "Take or Leave it" area. Whenever we have items in the attic, garage or basement that still have a useful life but are no longer needed, we take them to the RDF where others can take them at no charge. It's a kind of town-wide Yankee swap system.
Just a few hours each week by the 5000 households in the town reduces our solid waste by 90% and generates $2 million in revenue for the town through the sale of recyclable materials.
Reduce, Reuse, and Recycle - it's a great way to be green in your neighborhood.
Rabu, 25 Juni 2008
The Gift of Time
Time is the one commodity you cannot buy and you cannot make more of. To me, this means that time is our most valuable resource.The role of the CIO to allocate their time to those people and projects most needing of attention.
Every day, I would really enjoy meeting with friendly, aligned and supportive stakeholders. I would really enjoy focusing on those projects that are proceeding flawlessly. However, my most limited commodity, time, is best allocated toward those stakeholders who are not satisfied and those projects which are troubled by politics, scope, or technical challenges.
Every day, my staff ask for help with budget issues, strategy clarification, and political questions. The CIO should never be the rate limiting step. I answer these questions within an hour of their being asked with either an answer or a definite set of next steps. This is a great use of my time.
Every day, my customers ask for new projects, new priorities, or new features. I answer with either a blog entry so that I widely communicate the answer, a personal email, or a set of next steps involving our governance committees to consider the request. This is a great use of my time.
Every day, I receive numerous requests to travel to give presentations to organizations both large and small. I'm always happy to educate, communicate, and collaborate. The challenge is the time involved in travel. Doing a conference call, webex, or video teleconference is a great use of time. Sitting in an airport for half a day because of a canceled flight is not a great use of time. I'm hoping our culture changes to the point that everyone thinks about the value of time and does more virtual collaboration.
Every day, I receive a 100 requests from salespeople for my time. Money is one thing you can always make more of. Time is limited. As I've said before on my blog, I will not grant my time to cold calling salespeople who email me about the wonders of their product. Stop trying. As needs arise I'll search the web for technologies and user experiences with them. I'll then contact you.
The reason that I mention this entire subject is that recently I reflected on the best gift for Father's day. Anyone can buy a tie, a CD on Amazon, or the latest gadget. However, the gift of time is more valuable. Here's what I did.
I had a Google Advisory Council meeting in Mountain View from 8a to 1pm. My parents live in Southern California. I asked my father to meet me at the San Jose Airport at 2pm and I picked him up in my rent a car. We drove together through the most beautiful places in the Santa Cruz mountains - Crystal Springs Reservoir/Filoli/Alpine Road, Highway 84 to Skyline Boulevard in the Santa Cruz mountains, La Honda, San Gregorio, Highway 1 to Pigeon Point Lighthouse, and Pescadero. We had dinner at Duarte's, a 19th century restaurant which serves fresh artichoke dishes and homemade pie. We talked about life, goals, the future, family, and challenges. For 6 hours, we drove, talked, and turned off the cell phones. At sunset we returned to Skyline Boulevard (photo above) and played flutes together - my Shakuhachi and his Native American Flute. I then dropped him off at the airport for his return flight and I spent the night in San Francisco to attend an early morning Board meeting.
My daughter and I recently began playing the Native American Flute, so that we can have a family gift of time. My parents will join us on family vacation to Yosemite in August and we'll play music together across 3 generations.
To me, there is no more profound gift than time. If future Father's Days include the gift of time from my daughter such as a walk in the woods, kayaking a river, or playing a flute, I'll be completely happy.
Next time you ask how to organize your day, think about the value of your time. Think about the needs of your customers, staff, and family. If you think about your time as a gift and your most valuable commodity, I suspect your schedule may change. I know mine has.
Selasa, 24 Juni 2008
Electronic Health Records for Non-owned clinicians - Sharing data among providers
At times, the business case for interoperability is not entirely clear. If data sharing reduces the volume of redundant lab tests, then the healthcare system as a whole wins, but someone loses revenue.
Over the past year, I've seen a remarkable change in attitude among clinicians in Massachusetts communities. They are demanding data sharing. Here's the history, the specifics of the clinician requests, and the plan for making it happen.
When we first conceived our hosted software as a service model to provide electronic health records for non-owned clinicians, we designed one way interoperability. BIDMC has an ambulatory record called webOMR which contains the problem lists, medication lists, allergy lists, notes/reports, labs, and imaging studies for 3 million patients. We worked with our community EHR vendor, eClinicalWorks, to create a seamless web service that links eClinicalWorksto webOMR such that community physicians can securely view BIDMC data from inside eClinicalWorkswithout having to login again or use a separate application. However, we did not design a link between eClinicalWorksand webOMR to enable a BIDMC hospitalist or ED physician to view individual patient identified private practice data.
We did design aggregate data sharing such that the medical director of the Physician's organization could query private practices to retrieve performance, quality and outcomes data in support of pay for performance contracts.
As we began to communicate the vision of a community EHR, our private practice clinicians starting asking three questions:
1. How does a Primary Care Provider send a clinical summary to a Specialist?
2. How does the Specialist close the loop with the Primary Care Provider by sending an electronic consult note?
3. How does a hospital-based physician such as an Emergency Department clinician, hospitalist, or anesthesiologist retrieve patient summary records from private practices?
My initial response was that private practice data sharing is such a novel idea, that it would have to wait until after our EHR rollout was complete to formulate a strategy.
Clinicians were not satisfied with that approach. Thus, we've decided to accelerate our work on private practice data sharing sharing by creating a clinical summary repository for all our eClinicalWorksusers using the eClinicalWorks EHX product.
Here's how it will work.
1. Whenever a patient visits one of our BIDPO community clinicians, the documentation of their visit will be done in our hosted software as a service eClinicalWorksapplication.
2. Patients will be consented by the clinician for community data sharing via opt in consent at the practice level. Consenting at one practice implies that data from that practice can be shared with other practices, but not visa versa.
3. When the encounter is complete, a summary record including problems, medications, allergies, notes, and labs will be forward to the eClinicalWorks EHX repository using the Continuity of Care Document format.
4. Other clinicians, who are credentialed members of BIDPO will be able to view summary records from this repository, assuming the patient has consented to sharing that data.
5. An audit trail of all such lookups will be available to enforce security
Such an approach solves the PCP to specialist clinical summary issue, the specialist to PCP communication issue, and the hospital-based viewing of private practice records issue. From a technology perspective, it's an elegant solution that reduces the number of interfaces. All practices send their summaries to a repository in a standard format, then all exchange is done from that repository.
A similar approach has been used in the Massachusetts eHealth Collaborative pilots in North Adams, Newburyport, and Brockton to enable secure, patient consented data sharing in those communities.
This approach needs one additional architectural element - how do you share data among EHX repositories, with non-eClinicalWorks EHRs or hospital information systems like Meditech.
MA-Share provides the grid infrastructure in Massachusetts to enable community to community data sharing. Today, MA-Share's Gateway can push Continuity of Care Document Summaries from one organization to another. Over the next two years, we'll work with eClinicalWorks to expand this capability to push clinical document summaries between instances of EHX. This means that BIDMC will be able to push a discharge summary or other clinically important information to a community repository, where with patient consent, the clinicians of a community caring for the patient will be able to view the data, ensuring continuity of care.
I expect all of this bidirectional data sharing to be a journey. We're purchasing the EHX product as part of our licensing of eClinicalWorks software and will use it initially for performance reporting. But we'll configure it so that sharing of data between clinicians and among communities will be possible. I expect all these features to be implemented by 2011.
I'm hopeful that our BIDPO clinicians will be satisfied by our strategy to embrace bidirectional data sharing in this incremental way - sharing data from BIDMC, sharing aggregate private practice data, sharing data among private practices using eClinicalWorks, then sharing data among communities and hospitals.
Over the past year, I've seen a remarkable change in attitude among clinicians in Massachusetts communities. They are demanding data sharing. Here's the history, the specifics of the clinician requests, and the plan for making it happen.
When we first conceived our hosted software as a service model to provide electronic health records for non-owned clinicians, we designed one way interoperability. BIDMC has an ambulatory record called webOMR which contains the problem lists, medication lists, allergy lists, notes/reports, labs, and imaging studies for 3 million patients. We worked with our community EHR vendor, eClinicalWorks, to create a seamless web service that links eClinicalWorksto webOMR such that community physicians can securely view BIDMC data from inside eClinicalWorkswithout having to login again or use a separate application. However, we did not design a link between eClinicalWorksand webOMR to enable a BIDMC hospitalist or ED physician to view individual patient identified private practice data.
We did design aggregate data sharing such that the medical director of the Physician's organization could query private practices to retrieve performance, quality and outcomes data in support of pay for performance contracts.
As we began to communicate the vision of a community EHR, our private practice clinicians starting asking three questions:
1. How does a Primary Care Provider send a clinical summary to a Specialist?
2. How does the Specialist close the loop with the Primary Care Provider by sending an electronic consult note?
3. How does a hospital-based physician such as an Emergency Department clinician, hospitalist, or anesthesiologist retrieve patient summary records from private practices?
My initial response was that private practice data sharing is such a novel idea, that it would have to wait until after our EHR rollout was complete to formulate a strategy.
Clinicians were not satisfied with that approach. Thus, we've decided to accelerate our work on private practice data sharing sharing by creating a clinical summary repository for all our eClinicalWorksusers using the eClinicalWorks EHX product.
Here's how it will work.
1. Whenever a patient visits one of our BIDPO community clinicians, the documentation of their visit will be done in our hosted software as a service eClinicalWorksapplication.
2. Patients will be consented by the clinician for community data sharing via opt in consent at the practice level. Consenting at one practice implies that data from that practice can be shared with other practices, but not visa versa.
3. When the encounter is complete, a summary record including problems, medications, allergies, notes, and labs will be forward to the eClinicalWorks EHX repository using the Continuity of Care Document format.
4. Other clinicians, who are credentialed members of BIDPO will be able to view summary records from this repository, assuming the patient has consented to sharing that data.
5. An audit trail of all such lookups will be available to enforce security
Such an approach solves the PCP to specialist clinical summary issue, the specialist to PCP communication issue, and the hospital-based viewing of private practice records issue. From a technology perspective, it's an elegant solution that reduces the number of interfaces. All practices send their summaries to a repository in a standard format, then all exchange is done from that repository.
A similar approach has been used in the Massachusetts eHealth Collaborative pilots in North Adams, Newburyport, and Brockton to enable secure, patient consented data sharing in those communities.
This approach needs one additional architectural element - how do you share data among EHX repositories, with non-eClinicalWorks EHRs or hospital information systems like Meditech.
MA-Share provides the grid infrastructure in Massachusetts to enable community to community data sharing. Today, MA-Share's Gateway can push Continuity of Care Document Summaries from one organization to another. Over the next two years, we'll work with eClinicalWorks to expand this capability to push clinical document summaries between instances of EHX. This means that BIDMC will be able to push a discharge summary or other clinically important information to a community repository, where with patient consent, the clinicians of a community caring for the patient will be able to view the data, ensuring continuity of care.
I expect all of this bidirectional data sharing to be a journey. We're purchasing the EHX product as part of our licensing of eClinicalWorks software and will use it initially for performance reporting. But we'll configure it so that sharing of data between clinicians and among communities will be possible. I expect all these features to be implemented by 2011.
I'm hopeful that our BIDPO clinicians will be satisfied by our strategy to embrace bidirectional data sharing in this incremental way - sharing data from BIDMC, sharing aggregate private practice data, sharing data among private practices using eClinicalWorks, then sharing data among communities and hospitals.
Senin, 23 Juni 2008
Automating Inpatient Documentation
This year's IS Retreat focused on Acute Care Documentation and transforming inpatient wards into paperless workflows in support of our goal to have 85% of the BIDMC medical record automated by 2011.
Here are the minutes of our retreat, documenting our strategy for automating inpatient records.
1. A single point of entry for our built applications (or as few entry points as possible) would be ideal. The challenge is making this single point of entry default by person or location such that the entry view would be the inpatient dashboard, provider schedule, Emergency Department dashboard, or patient name lookup.
2. Having our departmental systems such as Anesthesia Information Management, Cardiology/EP, Metavision ICU Management, and Gcare Endoscopy documentation generate a PDF or summary accessible in one place would be ideal. Doctors will know that all the reports they need will be in one place, including highlights or abstracts of key information to speed the decision-making where possible.
3. Workflow analysis is important and should be completed before applications are coded. In FY09, Healthcare Quality will do the workflow analysis for "Who's the Caregiver", so that the first clinicial to call 24x7x365 is known for every patient. IS will do the workflow analysis on discharge worksheets with an eye toward smaller, short term enhancements in FY09 and more extensive redesign at a later point. Operations impact analysis should also accompany planned implementation. For example, electronic medication administration records may have capital needs such as bedside scanning. Operational and capital budgets should be approved and synchronized.
4. The discharge summary needs a comprehensive multi-stakeholder inventory. This needs assessment and policy should be done by the HIM committee. Once it is complete we can determine which data elements should flow from existing data sources and which should be entered by the clinician to achieve a "cognitive" overview of the patient's care.
5. Scanning should be used for charts/graphs/forms which are challenging to automate. Some forms, such as the medication administration record, have high clinical value and comprise a significant part of the record. Development of Medication Administration Record automation will begin in FY09 as part of our self built applications.
6. A problem oriented medical record requires histories/physicals and progress notes that include a robust community-wide vocabulary controlled problem list as part of their documentation design. These applications will be built rather than bought and will incorporate text entry/templates/macros. Introduction of controlled vocabularies for problem lists will be done via a phased, incremental approach. Team Census will be enhanced to become the daily documentation tool for progress notes.
7. Certain guiding principles should be included in our build and buy implementations - multidisciplinary, integrated, non-repudiatable, secure and web-based where possible.
8. Decisions between homegrown or vended products should consider the specific demands of an individual application and also the downstream impact of vended systems for other providers. Whenever possible we should use our existing applications.
9. Policies are needed to compliment our software rollouts. The HIM committee will suggest the policies and we will work together with the MEC to formalize policies and performance metrics as rollouts occur
10. We will review our plans with all our governance committees and stakeholders to ensure buy in for our approach.
Here are the minutes of our retreat, documenting our strategy for automating inpatient records.
1. A single point of entry for our built applications (or as few entry points as possible) would be ideal. The challenge is making this single point of entry default by person or location such that the entry view would be the inpatient dashboard, provider schedule, Emergency Department dashboard, or patient name lookup.
2. Having our departmental systems such as Anesthesia Information Management, Cardiology/EP, Metavision ICU Management, and Gcare Endoscopy documentation generate a PDF or summary accessible in one place would be ideal. Doctors will know that all the reports they need will be in one place, including highlights or abstracts of key information to speed the decision-making where possible.
3. Workflow analysis is important and should be completed before applications are coded. In FY09, Healthcare Quality will do the workflow analysis for "Who's the Caregiver", so that the first clinicial to call 24x7x365 is known for every patient. IS will do the workflow analysis on discharge worksheets with an eye toward smaller, short term enhancements in FY09 and more extensive redesign at a later point. Operations impact analysis should also accompany planned implementation. For example, electronic medication administration records may have capital needs such as bedside scanning. Operational and capital budgets should be approved and synchronized.
4. The discharge summary needs a comprehensive multi-stakeholder inventory. This needs assessment and policy should be done by the HIM committee. Once it is complete we can determine which data elements should flow from existing data sources and which should be entered by the clinician to achieve a "cognitive" overview of the patient's care.
5. Scanning should be used for charts/graphs/forms which are challenging to automate. Some forms, such as the medication administration record, have high clinical value and comprise a significant part of the record. Development of Medication Administration Record automation will begin in FY09 as part of our self built applications.
6. A problem oriented medical record requires histories/physicals and progress notes that include a robust community-wide vocabulary controlled problem list as part of their documentation design. These applications will be built rather than bought and will incorporate text entry/templates/macros. Introduction of controlled vocabularies for problem lists will be done via a phased, incremental approach. Team Census will be enhanced to become the daily documentation tool for progress notes.
7. Certain guiding principles should be included in our build and buy implementations - multidisciplinary, integrated, non-repudiatable, secure and web-based where possible.
8. Decisions between homegrown or vended products should consider the specific demands of an individual application and also the downstream impact of vended systems for other providers. Whenever possible we should use our existing applications.
9. Policies are needed to compliment our software rollouts. The HIM committee will suggest the policies and we will work together with the MEC to formalize policies and performance metrics as rollouts occur
10. We will review our plans with all our governance committees and stakeholders to ensure buy in for our approach.
Jumat, 20 Juni 2008
Cool Technology of the Week
In the days of TDMA cell phones, BIDMC was an early innovator with in-building cellular communications. We worked with AT&T and Ericsson to install their Digital Wireless Office Services (DWOS), which enabled employee cell phones to roam on our internal cellular network. Here's how it worked.
Imagine that a employee drove from home and made a call from their personal cell phone. That call travelled over the AT&T network, was paid for by the employee and used the 7 digit phone number on their cell phone. As the employee walked into a Beth Israel Deaconess building, control of the phone was transferred to the internal cellular system. Calls were routed through the PBX, the hospital paid for the calls via its negotiated rates, and standard hospital 5 digit dialing worked to and from the phone. Anyone calling the employee's desk phone was routed to the cell phone.
Ericsson discontinued its DWOS product as cell phone technology evolved to GSM/GPRS/EDGE.
Now, a new generation of products which converges fixed desk phones and mobile phones (called Fixed-Mobile Convergence) is emerging. The idea is similar to DWOS. Employees carry one device that serves as their mobile and desk phone. This one device is seamlessly integrated into the PBX. The infrastructure provides low cost voice connectivity while on campus by avoiding cellular charges. It's the Cool Technology of the Week.
There are two leading products in this space are (in alphabetical order, no preference indicated) Agito Networks' RoamAnywhere Mobility Router and DiVitas Environment Aware Roaming Technology
Here's how they work:
Agito
Nokia/Symbian phones (the only phones currently supported) run an Agito client which determines how best to connect to the Agito server that is connected to your enterprise PBX and your enterprise data network. Agito also interfaces to Cisco's Call Manager, providing device monitoring and management via the Session Initiation Protocol (SIP)
DiVitas
Windows Mobile or Nokia/Symbian phones run a DiVitas client which uses Environment Aware Roaming Technology to switch between a WiFi or Cellular carrier and connect back to a DiVitas server appliance connected to the enterprise PBX.
The technology is cool and promises one device connectivity, eliminating the desktop phone. The downside is that few handsets are currently supported (i.e. my Blackberry 8320 has WiFi and GSM/GPRS/EDGE but cannot run with Agito or DiVitas). Also dual mode phones really drain the battery when in WiFi mode.
This is a technology to watch, since I believe in a parsimony of gadgets. Getting rid of my desk phone would be great.
Imagine that a employee drove from home and made a call from their personal cell phone. That call travelled over the AT&T network, was paid for by the employee and used the 7 digit phone number on their cell phone. As the employee walked into a Beth Israel Deaconess building, control of the phone was transferred to the internal cellular system. Calls were routed through the PBX, the hospital paid for the calls via its negotiated rates, and standard hospital 5 digit dialing worked to and from the phone. Anyone calling the employee's desk phone was routed to the cell phone.
Ericsson discontinued its DWOS product as cell phone technology evolved to GSM/GPRS/EDGE.
Now, a new generation of products which converges fixed desk phones and mobile phones (called Fixed-Mobile Convergence) is emerging. The idea is similar to DWOS. Employees carry one device that serves as their mobile and desk phone. This one device is seamlessly integrated into the PBX. The infrastructure provides low cost voice connectivity while on campus by avoiding cellular charges. It's the Cool Technology of the Week.
There are two leading products in this space are (in alphabetical order, no preference indicated) Agito Networks' RoamAnywhere Mobility Router and DiVitas Environment Aware Roaming Technology
Here's how they work:
Agito
Nokia/Symbian phones (the only phones currently supported) run an Agito client which determines how best to connect to the Agito server that is connected to your enterprise PBX and your enterprise data network. Agito also interfaces to Cisco's Call Manager, providing device monitoring and management via the Session Initiation Protocol (SIP)
DiVitas
Windows Mobile or Nokia/Symbian phones run a DiVitas client which uses Environment Aware Roaming Technology to switch between a WiFi or Cellular carrier and connect back to a DiVitas server appliance connected to the enterprise PBX.
The technology is cool and promises one device connectivity, eliminating the desktop phone. The downside is that few handsets are currently supported (i.e. my Blackberry 8320 has WiFi and GSM/GPRS/EDGE but cannot run with Agito or DiVitas). Also dual mode phones really drain the battery when in WiFi mode.
This is a technology to watch, since I believe in a parsimony of gadgets. Getting rid of my desk phone would be great.
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