Good product development is slow and difficult.  And, the outcome doesn't always end up pointed at the original target.

I think of developing product like the creation of a volcanic island.  The original idea is a fiery blast of energy so volatile it breaks through the ground and begins slowly creating the landmass around. As the product idea takes hold it begins to push the boundaries from where it initially emerged. Features added, taken away, melded with one another. The landmass itself won't be inhabitable for quite a while but inch-by-inch the creation of new territory gains shape until you can see it from the air.

That first idea is the spark and, though you may have an incredible team all working toward the goal, making a great product isn't going to be fast. It's likely to consume months or years as it resolves closer to reality (1).

Not to skip ahead too far but the current incarnation of Olli wasn't even thought of as a point of sale device when we began. Olli, the barcode scanner and magnetic stripe reading case for iPhone, iPod Touch and iPad mini started as a product for hospitals.

We began Olli with this lofty premise: Make EHR data collection easier for nurses

A grand goal, for sure. After many hours collecting data by phone calls, roundtable discussions with nurses and practitioners over coffee we discovered an interesting paradigm: many nurses still (to this day) rely on carrying a piece of paper that itemizes out the list of tasks like medicine administration, patient rounds,  etc. This "brain" as many called it, filled out at the beginning of the shift, became their task list for the day.

This handwritten "brain" was more than just a notepad, it was a catalyst to a chain of succeeding events nurses performed -- check paper, gather medication for rounds, pull COW (computer on wheels) to patient room, scan patient wristband, scan medication, mark medication consumed, notate any other information, repeat.

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For as little as our team knew about hospital EHR/EMR systems we understood there to be a place for us to improve the on-boarding of information. Instead of a piece of paper we'd supply an app. Instead of a massive cart and computer with a spiral-bound barcode scanner we'd replace that with a smartphone or tablet. And, for secondary authentication, as in the case for some med administration, we would apply a magnetic stripe reader for ID badges.

We knew, at the start, device ergonomics would be a priority. The case needed to slip easily into typical scrubs pocket. Scanning shouldn't create undue stress on the wrist so we angled the barcode scanner down from the front face about 12˚. It needed to resemble something more than a cell phone else patients may think the practitioner was doing something other than work. Devices are likely to be dropped onto hard surfaces, so, that had to be considered. And, finally, weight should be kept to a minimum as the average nurse is a woman in her mid-40s.

Next came infection control. Hospitals, for their many rules, are full of inconsistencies. Each ward, division, and wing has their own brand of thinking about how devices should be cleaned (2). Outside the sterile circle in an OR each group can manage their infection control priorities slightly different. All will require devices to be cleanable but in that there are varying degrees from autoclaves to bleach wipes. Olli needed to fit somewhere in the middle.

The walled city

EMR/EHR vendors, at that time in the early throws of Meaningful Use (3), weren't known for adoption of new technologies that fit outside the bounds of  their expertise. Adding a smartphone or tablet to the workflow was somewhat regarded as fringe if you can believe that. We reached out to every major EMR vendor, of which there are really only about five, with little to no response. We began to notice a layer of block at our feet but hadn't looked up just yet.

 In a change of direction we took the conversation to several hospital CTOs. From the outset they knew exactly the problem we were trying to solve. Their eyes lit up and they discussed other uses for the hardware. Unfortunately, as one CTO outrightly told us, "I'd buy one for every person on every floor of my hospital if it had the stamp of Cerner or Epic on it. But until they approve it, I can't do a thing."

The city of healthcare, as you might expect, has few entrances and a very high wall. We're still knocking but we aren't sure there's anyone on the other side who can hear us yet.

POS doesn't have to be a P.O.S.

Luckily, as we were developing Olli the team had also embarked on another sideways venture: Kiosk Retail. We had been making a standard iPad Kiosk for a while but wanted to put a stake in the ground of using it for restaurant/retail use as well. The Kiosk Retail incorporated a magnetic stripe reader (MSR) for credit cards or identification.

With the knowledge, and early SDK in place, our Kiosk Retail started us down the path of entering the point of sale (POS) market and we quickly realized our Olli product was only a small step away from usefulness in that market, too.

 

 


1. Even the shortest projects, in hindsight, take 7-8 months from start to finish. Don't let anyone fool you into thinking otherwise.

2. No matter how many practitioners and infection control people we talked with none could not agree on an exact method of cleaning that would encompass the entire hospital requirements. All agreed, however, that devices like the COWS, didn't get cleaned very often, if at all.

3. Meaningful Use, simply, is a series of government regulations for the adoption of technology by healthcare systems in exchange for monetary incentives. More often than not, this technology enabled updates and transferability of patient documentation from one system to another. No updates = no medicare/medicaid money.