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How "Unified Communications" Died With the Landline Phone

Every hospital CTO has to be willing to confront realities of how clinicians need and want to practice and how their technology decisions impact physician workflow.

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Physicians increasingly spend their day on the go

As CTO at Stanford, my passion was and still is in my work now at Medigram, to save lives and improve hospital worker and patient satisfaction. I aspired to be my best in my role then as CTO as I do now and that meant that I was always learning, studying, understanding clinicians and their real world use cases. It’s both worthwhile and rare when IT and physicians are completely on the same page. That was my goal then as it is now. I spent much of my time rounding and observing their clinical use cases with technology. I wanted to see when the physicians were impeded by technology and how I could better enable them to do what they went into medicine for, treating patients. I was an early adopter to the notion that we needed to develop an innovative ecosystem to

achieve that goal, and not wait for something from a legacy vendor that might not ever come. I worked hard both then and now to continue to evolve this ecosystem.

We spent several years at Stanford working to assess and develop our infrastructure and ecosystem to support clinician communications. I eventually came to accept that if we chose a “one size fits all” solution that then needed to be configured to the lowest common denominator, that we would create no value and fail to solve for the specific challenges that clinicians have in each of their specific use cases. For example, for images doctors care about rendering colors like greys accurately whereas nurses do not need this level of discernment.

One of the biggest challenges is the adaptation of well understood frameworks to new, ubiquitous technology that did not exist before when that made up term was “invented.” A good example of this is the marketing term “Unified Communications.” Unified communications was from the era of voicemail popularity, IVR, and email; this included voice mail systems with IVR-like features and email reader features on voicemail systems. During a time of desktop phones, these combined features were considered “unified messaging” because they tied together voicemail and email. This never was meant to include messaging or apps which didn’t exist at the time the term was invented.

One of our favorite lines at Medigram about this topic comes courtesy of Computerworld. “Unified communications is a marketing Camelot.”

The reality now is that communications for different segments of users is multi-layered and very specific. Just like we have to segment our networks in infrastructure, it’s time to segment groups of people who need to communicate. This should be based on their specific workflow and the jobs that those roles do. One example is that those who partner with nurses and physicians in large health systems today will acknowledge that nurses and physicians do different jobs. These two groups have different training requirements, motivations, workflow, and are often best served with different plans.

“Like King Arthur's legendary city, the notion of unified enterprise communications is imaginary. Emerging companies instead meet the realities of today's worker. The term unified communications might have been a prediction of where the market would trend, but we never quite got there and are farther away than ever today.’ No one seems to be able to tell me what the term is intended to describe.

Gartner defines unified communications as products that “facilitate the interactive use of multiple enterprise communications methods by integrating communications channels (media), networks and systems, as well as IT business applications and, in some cases, consumer applications and devices.” Huh, does this tell us what that actually does in each use case? No one we talk to can name a single solution that did all of those things. Maybe the term unified communications was aspirational, but we never really achieved that and are farther away than ever today.

Enterprise communications are currently un-unified, and that’s a good thing I believe for employees who are using something they will actually adopt and will help them. This lack of unification and the expectation gap has resulted from decades of PR and marketing spin. This creates opportunities for innovators such as Medigram with a team who has a track record in healthcare, technology, and unparalleled history of partnering with physicians.

Enterprise communications applications and platforms traditionally were dominated by a few companies without much differentiating value between them. The industry never really met the needs of the modern worker, let alone clinicians in medicine. What resulted is a mix of shadow IT, legacy and IT dictated applications that get used but not adopted only when someone is assigned to force users to “comply” with the solution.

As increasingly digital natives reach critical mass in organizations, things are moving with incredible speed to new models for enterprise communications. 80 percent of the global workforce don't sit at a desk, don't work in an office, and don’t use a computer according to a recent report [1]. Physicians are mobile and communications today are mainly asynchronous, which is their preference. Ask them. In a physician’s workflow conference calls, web conferences or videoconferences aren’t typically feasible.

Traditional unified communications vendors, including Avaya, Cisco, Mitel and Unify, are game to protect the user base for their legacy UC platforms. Recent offers show in all fairness, some promise. These include Cisco’s Spark Board, a wall-mounted iPhone analog; Avaya’s Equinox; and the application platforms Cisco Spark and Avaya Breeze that these applications are built upon. I’m just not as excited about these options to serve clinical users in a hospital environment for all the connectivity and other challenges we’ve documented so many times in a leading infrastructure journal. [2] The problem I see is that these legacy approaches are just too tethered to the past. They are built on an architectural premise that has become increasingly irrelevant in this mobile dominant world. Don’t wait for an imaginary “unified communications” solutions, attack your challenges now with purpose built solutions. I wish it was easier but it can be done, we can save lives, we can digitize post it notes that get lost, insecure and unreliable consumer chats, and whiteboard messages. When a delay in information is still a leading cause of preventable death, it deserves our focus. Let’s do this.

Dean Shold VP Technology, Medigram

Dean Shold is the VP of Technology for Medigram. Before his current role, Dean was the VP of Infrastructure and Chief Technology Officer for Stanford Health Care, and was previously the VP of Global Data Operations for Zephyr Health. With a degree in computing science and a passion for social good, real time data analysis and mobile computing, he brings a unique background and perspective to the healthcare industry. At Medigram, Dean drives enterprise customer complete solution development, implementation, support, and customer success. At Stanford Health Care, he led a global team of 180+ personnel at 24x7 support to 50+ locations including multiple hospitals. He managed the technology and support budgets and built and reorganized teams to drive performance and reliability. He built a command center based on FEMA’s (Federal Emergency Management Agency Guidelines) and oversaw data center performance and builds.

Dean also has deep passion for practically addressing the opioid crisis. His interests are in the scientific and the social sides of the opioid crisis bridging the people who use drugs and are opioid dependent with the researcher and the lawmaker. He is fascinated by how the worlds of legal and illegal opioids intertwine and how our societal biases impact treatment and recovery. In his work, he brings a vision of how Health IT can be leveraged to better understand and address the crisis. This includes examining the following key dimensions in addition to Health IT such as fentanyl, naloxone, harm reduction, detox, treatment and recovery.

Outside of the office, Dean also co-founded a non-profit organization to create novel ways to donate to charities. Dean is an instrument rated pilot and avid music lover. He and his wife, Pauline recharge by exploring harm-reduction organizations, the arts, craft beer and music scenes.



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