October 4th, 2019

Talking with Emergency Nurses About Modern Software

Justin Schrager
Written byJustin SchragerChief Medical Officer

The Vital team just returned home from a productive Emergency Nurses Association conference in Austin, TX. It was fantastic to engage with ED nurses from around the country, to listen to the innovative ways they have addressed ED problems, and to get their perspectives on Vital. Lots of positive feedback from the nurses.

There is a bit of a tongue-in-cheek axiom I heard a few times at the conference, one that ED leaders frequently bring up when discussing operational issues: “If you’ve seen one ED, you’ve seen one ED”--meaning that all EDs have their own structural challenges and solutions have to be tailored. The solutions are well-described in the ED management literature: they are implemented incrementally, usually sequentially, and at varying levels of cost.


What I have come to realize through the process of designing new software for the ED is that ED leaders who are tasked with organizing, implementing, and measuring these interventions are fighting for ever smaller rewards for their efforts. They are hamstrung by external forces over which they have no control. When you look at the potential operational improvement that, say, you might yield from a simple intervention like handing out urinalysis cups to every person in the waiting room, we’re really talking about reductions in minutes for a small segment of the ED population. Together, interventions like this are inexpensive and can move the needle, but every change takes time and interpersonal capital to reach the cumulative rewards to flow we desperately need in Emergency care.

The proverbial elephant in the room, the thing that ED staff feel powerless to change, is of course the thing we use the most: the EHR. Nurses and doctors spend twice as much time performing administrative tasks (primarily tasks related to documentation in the EHR) than we do at the bedside. This has been well described in the literature, and was as true 20 years ago as it is now. Frankly, EHRs haven’t fundamentally changed over that time period so this is unsurprising. We, in the business of providing healthcare to our patients, can no longer expect the big EHR companies to change. They have had enough time, and they are at this point structurally incapable of doing so. We must look to the entrepreneurs and innovators, startups like Vital and others to push the limits of how we make healthcare software work for us.

This was the topic of the talk that Aaron and I gave at ENA: the fundamentals of consumer-based software design--on how we at Vital have chosen to approach this challenge in the healthcare arena. Consumer-based design for software demands a product that is fast (think about how long it takes you load a screen in your EHR), intuitive (meaning it just works, no more two-day training marathons for your staff), safe (researched and rigorous), and most of all smart (removing the burden of clerical tasks and letting you work at the top of your license). At Vital we live and breathe this ethos. We run every single feature of our software through this exacting standard. This is how we show respect to our end-users, and their feedback is starting to reflect this.

It is a magical thing to give people in the ED (staff and patients) access to our modern software tools. When a patient turns to the triage nurse at the end of their encounter and asks how long they will have to wait in the waiting room, I love that Vital enables them to answer that question with the mathematical precision that only machine learning enables. The patients completely love the updater feature: they love the control it gives them and I love how it sets their expectations. Their feedback has been effusive and overwhelmingly positive. I love how nurses can just sign in and use the software. No training needed. It just works! I love that we are giving the bed coordinators insight into which ED patients are likely to be admitted up to four hours before the admit order is placed.

When we showed these things off at ENA: the general impression was a mixture of disbelief and happiness. “How are you doing this?” and “how is this possible?” were common refrains. The fact of the matter is that we are simply applying industry-leading but ultimately standard practices of consumer-based software design. The result is something akin to what you would see in a modern website--but when juxtaposed with the stark reality of even the best modern EHR, Vital seems almost surreal. This gives me unending pride and hope for the future direction of health IT.