According to Wikipedia, there are many origins to this adage ranging from Chinese proverbs to Napoleon to a pitch for advertising on streetcars from the 1920’s. In any case the adage seems to ring true especially since the majority of individuals, according to the National Institutes of Health, are either visual or kinesthetic (tactile) learners. So given that most of us like to see and touch things in order to learn, why is it the 10’s if not 100’s of millions that are spent on health information technology (HIT) are usually based on evaluation from the verbiage in an RFP? Is it tradition, ease, lack of technology to support alternatives, aversion to change, or something else? I would postulate it is a combination of the first four with a focus on aversion to change – vendors have 1,000's of canned responses in databases, consultants have an equivalent in questions to put in to RFPs – a nice cycle and relatively easy, why change? Realistically, if we are all honest, when we get those multi-hundred page responses do we read each and every page to get a holistic view or is the RFP “chunked up” and reviewed by a committee? I would say the latter rather than a former and that brings to light another adage – “a camel was a horse designed by a committee”.
So what’s my point – how do we get the picture instead of the 1,000 words? It is accomplished by leveraging the fantastic technologies that are available to each and every one of us. The needed picture can be provided in the virtual worlds of Second Life and Project Wonderland. These virtual worlds can be used to visualize and “touch” the impact of the systems being deployed. Imagine being able to understand that upon deployment of the multimillion-dollar CPOE system the clinicians ordering time will climb above 10 minutes, but that over a period of 3-4 months that time will drop to 5 minutes and more importantly if the encounter is looked at as a whole, the encounter time drops from 17 minutes to 14 minutes (inclusive of ordering). Imagine being able to understand the impact of real time Master Patient Index (MPI) interaction for the admissions/registration personnel and so many more. No vendor RFP will enable you to visualize these things, but this can be accomplished in the virtual worlds of Second Life and Project Wonderland. That is the purpose of this blog.
Virtual Worlds
First and foremost, what is a virtual world? Well, a virtual world is an interactive simulated environment accessed by multiple users through an online interface. Virtual worlds are also known as "digital worlds," "simulated worlds" and "MMOG's." (Massively Multiplayer Online Role Playing Game)
All Virtual Worlds have six features in common:
- Shared Space - the world allows many users to participate at once.
- Graphical User Interface - the world depicts space visually, ranging in style from 2D cartoon" imagery to more immersive 3D environments.
- Immediacy - interaction takes place in real time.
- Interactivity - the world allows users to alter, develop, build, or submit customized content.
- Persistence - the world's existence continues regardless of whether individual users are logged in.
- Socialization/Community - the world allows and encourages the formation of in-world social groups like teams, guilds, clubs, cliques, housemates, neighborhoods, etc.
Virtual worlds are best known as a gamers world simply because that is the most ubiquitous use, but that is not where it stops. The virtual words can be used for educational purposes, training (the military uses virtual worlds for exactly this purpose), sales, what if scenarios and many more. Specific to healthcare, these virtual worlds offer the perfect environment for:
- Education/Training (both vendor and site specific)
- Collaboration
- Vendor demonstrations
- Proofs of Concept for innovative approaches to improve patient satisfaction (enable time motion studies)
- Workflow visualization
- Risk Mitigation with new system deployments/upgrades
- RFP responses and distribution
The Virtual World Leaders
The following is a little background on the virtual world leaders - Second Life and Project Wonderland.
Second Life ( http://secondlife.com/ )
Second Life (SL) is the leader in the virtual worlds with 2M+ users. SL enables its user, called Residents, to interact via avatars. An avatar is a character that can be constructed with SL’s self-contained toolkit, then personalized to reflect the user(s) personality and deployed in the SL Virtual World. With the avatars SL residents can:
- Explore
- Meet other residents via avatars
- Socialize/Interact
- Participate in individual and group activities
- Create and trade virtual property and services
- Travel throughout the virtual world or grid
Project Wonderland ( https://lg3d-wonderland.dev.java.net/ )
Project Wonderland is an open source 3D toolkit for creating collaborative virtual worlds and sponsored by Sun Microsystems. From a technical perspective Wonderland is built on top of Project Darkstar (A Massively Multiplayer Online Role Playing Game engine (MMOG)) and Java3D. With the Project Wonderland virtual worlds, users can:
- Communicate with high-fidelity, immersive audio
- Share live applications such as web browsers, OpenOffice documents, and games.
Project Wonderland is the relative newcomer to virtual world. Wonderland’s goal is to provide a secure world in which organizations could conduct business and/or allow employees to collaborate online.
Workflow Optimization
One of the key areas of focus for a virtual world is workflow visualization and optimization. Most sites, inpatient or ambulatory, when trying to define, document, modify or deploy a workflow will follow these steps:
- Establish a committee or working group with appropriate personnel
- Have several meetings to discuss the current and future states
- Develop a flowchart defining the workflow
- Publish the flowchart
- Have IT or the vendor build the flowchart in the appropriate products
- Deploy the workflow to visually understand the impact
- Evaluate the impact
- If the impact is more pronounced than expected (more often than not the outcome) go back to step 1 and repeat the process until fixed or shelved.
What would it be like if at step #3 the flowchart was built in a virtual world and visually evaluated for impact and/or comparison with the current state. Then if the impact was too pronounced, changes could be made and retested in the virtual world until the flow meets the needs. Then and only then will the workflow be published and steps 4 – 8 executed. The value of the process could be profound and include:
- Risk mitigation – the site would have a much deeper understanding of what they were getting into to as well as the virtual world provides a relatively inexpensive test bed
- Clinical Community Satisfaction – the virtual world build out would greatly diminish the number of workflow misfires and thus the clinical community’s skepticism/cynicism would decrease
- Financial – The cost of the cycle of build, deploy, evaluate is expensive when using the system (not to mention it is much akin to being on a high wire without a net when using the production system)
To help you imagine the opportunities, check out this demo made by the University of Arkansas.
So is a picture worth a 1,000 words – a resounding yes!! The use of virtual worlds is gaining popularity, in fact some vendors have shown their products on Second Life. The time is right to expand and use the environments to change the way workflows are built and deployed as well as alter RFP processes and so many others. The technology is there, the time is right and to quote Benjamin Franklin – “you may delay, but time will not.”
For these and other highly innovative approaches, contact us a Santa Rosa Consulting and let us help you understand how innovation can help save money, time and effort.
Dale Will
Associate Partner
Santa Rosa Consulting, LLC