Pursuing BYOD: The Ottawa Hospital

One of the biggest questions for hospitals is whether or not to allow staff to use their own devices for communications. But it's a question with many answers. We've talked with a lot of customers who are pursuing a BYOD environment—some are still planning, some are in process, and some have fully matured programs.

Each story is unique and demonstrates that there is no singular way to implement BYOD. From the initial planning through post-rollout training, every facility has different approaches, hurdles, and solutions. My staff recently had the privilege of talking with two people from The Ottawa Hospital in Ontario, Canada. Cathy Cockburn, Manager of the Call Center, and Dom Stenta, Support Analyst with the Telecom Integrity Team, were both instrumental in the design and rollout of their BYOD environment, and this is the story they shared with us.

What were the drivers behind your decision to pursue BYOD, and what were some of the important considerations?
Cathy: We started our BYOD journey back in October of 2012. We wanted to give providers a secure way to message one another for patient care coordination. With a secure texting option our staff can share details about cases that otherwise wouldn't be permitted through open SMS. In addition, many of our physicians were looking for a way to simplify their communications and workflows. They wanted to be able to text each other, access e-mail, and receive pages, messages, and alerts on their phones and tablets.

From the beginning we knew that the hospital would not be providing devices to all staff because of the cost, so we started the process with a BYOD environment in mind.

When we started down the path we had to do a lot of legwork within the institution to put things in motion. We worked with hospital management to get initial approval for this type of technology, including writing a business case to outline what we wanted to accomplish. We also worked closely with our IT team to make sure that the messaging solution we chose would work in our environment and provide the security we needed.

Dom: One of the decisions we had to make pretty early on was what devices we were going to support. Our IT team determined that the best option for our environment was to allow a single manufacturer, which most of our staff already used. The choice had to do with how we're set up within the hospital, and did not have to do with the devices we decided to exclude or solution we chose.

Cathy: We selected an encrypted messaging app that fulfilled our requirements for encryption and messaging capabilities. It also offered the integrations we needed with many of the solutions we were already using (employee directory, operator console, and on-call schedules) to make communications for physicians much easier and faster.

How did you move forward with implementing the new messaging capabilities and what were some of your challenges?
Dom: Once we set out to make things happen we pulled together a project team and our director set some pretty aggressive goals for getting a certain number of staff using the application by a specific date. A big part of our plan was methodical trials for several different groups of people. We started with managers and directors. We set them up, provided training to get them started, and remained available for support. We monitored how things were going with our first pilot groups and received feedback about what worked and what didn't. Once we were confident everyone was on track we started rolling it out to other groups, including social workers and physicians. By our third level of trials we were monitoring about 80 people. From the first registered user to the end of our trials took about a year—we wanted to make sure we had it right before going wide with the solution.

During our trials, the biggest challenge we encountered was our infrastructure. We're a multi-site campus, and the Wi-Fi and cellular coverage is different at each campus, even within each building. We have miles and miles of tunnels and our pilot users discovered that there is no cell service or Wi-Fi reception down there. We walked around to identify the areas on all campuses that needed to be boosted, and from there we were able to install antennas to boost accessibility. The best piece of advice I can offer to other hospitals that are rolling out a solution like this is to make sure the data coverage is there. Whether you're planning to use cellular or Wi-Fi, I can tell you it's really hard to sell your staff on using a new mobile technology if the signal is poor.

When we were ready to launch the solution to a wider audience we made a big push and published announcements in our weekly newsletter and in the hospital journal. We also sent group e-mails to everyone with details. We helped register users, gave them documentation and FAQs, and offered group training or one-on-one training, based on each individual's comfort.

The reaction to the availability of this new way to communicate was mixed. Some people simply didn't want to use their personal devices for work, and those folks still carry pagers for their alerting. Other people were very excited by the option to add secure texting to their smartphone or tablet.

What is the feedback from users and what benefits are you seeing?
Cathy: We haven't forced anyone to adopt the secure messaging solution, we've let people choose what works best for them in their workflows and how they prefer to communicate. We've had a few physicians try the solution and decide they preferred their pagers, so they switched back. Since the initial rollout we haven't advertised again, so other than when we offered it to the incoming residents last July, the solution has largely continued spreading by word of mouth. We do have some super users, real champions who share the benefits for us and push their colleagues to switch.

Dom: And every day when physicians call me I mention the option to them. For example, I just talked to two doctors this morning and I'll be setting them up tomorrow. We've been letting it grow organically since the big rollout, but we might pursue another internal campaign. We want to make sure everyone knows about all the features and advantages of the application and the integrations with our directory and on-call schedules.

Cathy: That's really big for us, actually. The entire hospital has access to the online employee directory and can see who is on call. After physicians have the app installed on their device, whether phones or tablets, they can access the directory from their device and directly page a colleague on call. They like the ability to do their own paging and especially that they can see when a colleague has received and read their message. They can even get detailed replies right away. With these clinicians, it's all about time. They're so busy that anything that saves time is huge for them. The fact that they can trigger messages and reply to pages directly from their device of choice saves them time. They can be mobile in the halls and call back a colleague, or respond to a text without having to find a phone or a computer. As an added bonus, their assistants can also log into the Web portion of the mobile solution to see that they've responded.

Dom: The part that really impresses our users are the templates and photos. We have five or six pre-programmed messages of the most common requests and responses so providers don't even have to type a new message every time—they select a template, who they want it to go to, and touch their screen to send it. And a lot of clinicians really like that they can take and send photos to colleagues, such as a patient's pill bottles, because the entire app is encrypted, not just text messages.

Cathy: For the call center, having this secure messaging solution gives us another huge benefit. We do all the paging for the facility and we used to just have to trust that pages were received. With the tracking feature in the app we can see when someone responds, and that closes the communication loop for us. When we page someone through the app on their phone or tablet, it's great to be able to see a page was delivered and acknowledged, even if the response is "I'm driving, call you back in a few minutes." We can also set reminders for operators to go back in a minute, or two, and if a page was not viewed we can escalate the message. Our process is very proactive now, which is a huge plus.

How would you say BYOD is working for your hospital?
Cathy: Overall, BYOD is working very well at TOH, and our CMIO is one of the loudest supporters. Dr. Geiger tells anyone who asks that texting and using their smartphones will make a huge improvement in their workflows. Secure texting lets providers include patient details for message context, and the app's integration with our directory is helping them save time by finding the right person quickly. Dr. Geiger points out that if the care team can get hold of the person they need, it's easier to create a good care plan—better communication equals better care. And that is of course what we're all here for, to serve our patients.

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