What is VIZR?
VIZR is a suite of software that gives clinicians the peace of mind that comes from knowing that every one of their patients is getting the most effective care every time. It facilitates the seamless integration of visual checklists, reminders and time management into emergency surgery, trauma evaluations and complex, time-sensitive clinical scenarios. It also allows for first-person instruction of manual tasks.
VIZR, which stands for Visual Information Zonal Reminder system is used by physicians, nurses and hospital staff to improve situational awareness while providing access to time-based reminders that are linked to evidence-based processes. Furthermore, some programs allow an individual to be "walked through" a complex manual task, by providing a voice-activated way to scroll through annotated photos of the task being performed.
VIZR can help:
• Reference time-based reminders relevant to specific clinical scenarios
• Manage multiple patients easily and keep track of clinical milestones
• Maintain situational awareness during high pressure situations
• Streamline communication with the entire clinical team
• Reduce team anxiety over complex procedures
• Improve patient outcomes
How is VIZR used?
While often associated with Google Glass, it can be used across a variety of electronic platforms. To see an example of how surgeons use VIZR, watch our YouTube Video:
What is VIZR Wall?
VIZR Wall is used to manage multiple patients and large clinical teams. It is comprised of a large, wall-mounted monitor in each trauma bay, and a smartphone application. The monitor displays a large timer, as well as a one-line description of the trauma patient. The left side of the screen displays customizable, time-based protocols, which are specific to the clinical scenario. The right side of the screen displays a checklist that the trauma team leader "texts" to the wall using their phone, where it is then visible to the entire room. As tasks are completed, they are "checked off". The phone application demonstrates the timer, one line description of the patient, and the task list. The phone application can scroll between rooms to see where each patient is in their resuscitation, and which tasks are yet to complete.
This is particularly helpful in settings where one trauma team leader may be overseeing multiple resuscitations. It allows the team leader to maintain awareness of all the other patients, even if not in the same room. If the team leader is needed urgently in one room, VIZR Wall also has a "panic button" to alert the entire team to return to that room.
Where does the clinical and logistical information come from?
The software platform is licensed to clients, who then decide on the actual information included in the applications.
What about software updates and support?
The VIZR licensing agreement includes software updates, product support and ongoing product customization.
Who created VIZR?
VIZR was created by Alex Guerrero, MD MSc FACS. He is a trauma surgeon, based in New York City, who co-developed the first virtual department of Acute Care Surgery. In an effort to apply best practices, and standardize multiple physicians' practice patterns with the goal of improving quality, he combined 2 techniques. The first was a technique used by the Royal Army Medical Corps termed "10 seconds every 10 minutes". This allows the dissemination of crucial information on a periodic basis to keep the team synchronized, and to illicit critical information necessary for crafting a clinical care plan, even in the most chaotic scenarios. The second was using pre-printed 3x5 cards to apply best practices during massive transfusions, emergency cases and rarely encountered scenarios such as trauma in the pregnant patient.
The difficulty came in the fact that Dr. Guerrero was not able to combine these two techniques in such a way as to operate hands-free. Thus, while operating. He relied on auxiliary personnel to note the time and read the information. VIZR was developed as a way to employ the latest in mobile technology, such as Google Glass, to provide the optimal platform for having a timed reminder system that could be used in a hands-free manner and accessible without taking one's eyes off of the case.
The success of VIZR utilizing Google Glass led to VIZR Wall. The expanded platform is designed for hospitals that frequently managed multiple trauma patients, and where delegation and communication were the primary barrier to quality outcomes.
Where is VIZR being used?
VIZR is currently being used across emergency rooms and hospitals in Pittsburgh and by individual providers in New York City and Chicago.
Why are checklists so important for surgery or other complex medical situations?
Checklists have been used by the airline industry for decades. A written, standardized approach to different procedures has allowed pilots to maintain situational awareness and to manage complex systems, even during times of distress. Because of the success of checklists in the airline industry, it was subsequently applied to elective surgery. This led to a decrease in wrong site surgery and helped ensure that the necessary supplies were available for each case.
The challenge was to apply those same checklists in extreme emergency situations, such as trauma surgery because of the fast-paced nature and chaotic environment.
What is the importance of situational awareness during surgery or other complex medical situations?
Situational awareness is extremely difficult to maintain during a high-risk emergency operation since it requires a surgeon's focus. However, in that setting, it is often the simultaneous non-surgical logistics that are as just as important. For example, for an optimal outcome , a patient needs: blood transfusions in a very specific ratio, drugs given at a very specific time to allow the blood to clot properly, and the correct instruments to be available to ensure that the case is done quickly.
During emergency "damage control" surgery, VIZR provides a prompt every 10 minutes. At the prompt it reminds the surgeon of the time, encourages a brief status discussion with all the team members, and 3-5 logistic points to consider for that time block.
How does the VIZR system benefit hospitals and surgeons?
VIZR can be used in time critical situations to provide periodic reminders. This allows patients to be evaluated more rapidly and to ensure that the clinical reminders are provided specific to that patient's characteristics. This is particularly important in rarely seen scenarios such as pregnant trauma and pediatrics.
VIZR can also be used to demonstrate, in a hands free, first-person manner, how to perform complex, rarely preformed tasks. Some physician clients have used this to demonstrate peri-mortem caesarian sections for trauma, while nurses have used this to assemble rapid transfusion devices and dialysis machines.
What is an example of how VIZR is currently being used?
Here is a description by Dr. Guerrero, the creator of the VIZR system.
“I’ve been using it personally for about 4 years for my damage control cases. It helps me when a patient first comes into the trauma bay with a devastating injury such as a gunshot wound to the neck. I run a module that runs in my Google Glass for a difficult airway with exsanguinating hemorrhage.
First it reminds me to ask the nurses about the availability of equipment, specific to this patient's scenario before the patient arrives. (i.e. Where's the #11 scalpel? Let's have sandbags ready to hold the neck steady) Once the patient arrives, it runs a timer and every 2 minutes it provides 3-5 logistic or clinical pearls I should be considering. For example, letting the operating room know I will be bringing a very seriously injured patient soon, and that we’re probably going to need a bronchoscope to convert our cricothyroidotomy to a tracheotomy; and letting my backup surgeon know that we’re taking a case directly to the operating room.
Once in the operating room it runs a timer as well, and allows me to give the rest of the operating room staff an update on what I will be going be doing next, so that there is no delay at the end of the case. With VIZR, 40 minutes into the case the ICU bed is already there, the massive transfusion protocol is running on a 1:1 ratio, the cell saver is scavenging blood, an arterial blood gas was sent on time, and I actually know the results. It’s really improved the amount of time it takes to do an emergency case and has helped me manage the team appropriately.
Now, emergency cases run smoothly and I am more relaxed since I know that at the end of the case the patient got everything they needed, exactly when they were supposed to. There does not seem to be any other way to apply best practices to these complex situations”
How have patients reacted to VIZR?
Testimonially, patients are excited by this technology and believe it represents a new milestone in clinical care. At one facility there is a patient perception survey underway, related to Google Glass and VIZR. The complete results will be published in a peer review journal, but the preliminary data is positive.
How has hospital staff responded to VIZR?
VIZR increases communication; which allows a calm and systematic approach to typically stressful situations. Team leaders clearly communicate what is needed in an organized manner, rather than through urgent, pressured demands.
Staff education is key. Everyone involved needs to understand that when Glass is used with the VIZR platform, they are not able to record anything, including staff.
Is VIZR just a clinical application suite, or are there other uses?
The VIZR platform is completely customizable to various industries and uses. VIZR is the perfect solution to add checklists and reminders. It can also be used for any complex task that requires attention to detail and requires free use of both hands.
Industries that may benefit from VIZR:
• Warehouses and inventory
• Repairs (electrical, mechanical)
• Assembly of furniture or any similar product
Where can I purchase or request a demo of VIZR?
For more information about VIZR sales, please contact us and we would be glad to answer your questions, schedule a demo or put you in touch with any of our clinical staff.
Do I need to purchase Google Glass before purchasing VIZR?
VIZR Tech can supply you with Google Glass headsets upon sale, or can be used with existing Google Glass hardware.
In addition, Google Glass is not necessary to use VIZR software. Applications have been developed for Android devices including phones and tablets that are projected on external monitors. Our team can help you determine the VIZR set-up that fits your needs best.
Hardware & Software
What are the technical requirements to use VIZR or VIZR Wall?
Touch Screen Tablet
• Capable of running the Android Operating System 4.0 or higher
• WiFi compatible with hospital’s internal system
• If WiFi is restricted or unavailable, an Ethernet port capable of receiving a CAT 5 or CAT 9 Ethernet cable
• Display with a minimum of 1366x768 resolution Smartphone
• Running iOS 4.0 or higher or Android Operating System 4.0 or higher. WiFi enabled.
Does VIZR require Google Glass?
No. VIZR Tech has developed software applications that run on tablets and smart phones, as well as Google Glass.
There are a variety of hardware solutions that can integrate the VIZR system. Our team can help you decide which hardware platform may be the most appropriate for your facility.
Does my entire team need Google Glass?
VIZR can be set up and used by select team members; though most commonly it is used just by the trauma team leader, with the team viewing it on wall screens.
Do they still make Google Glass?
Google has ended the consumer-facing Glass Explorer Project; however industry partners can still purchase Google Glass.
Compliance & Patient Privacy
Is VIZR HIPAA compliant?
VIZR software does not capture or store any patient data. As such, VIZR is not a medical device and does not fall under the prevue of HIPAA
Google Glass has a camera, what about patient and/or hospital privacy concerns?
Google Glass provided in conjunction with VIZR software have been modified, in that the lens is actually covered with a cap so there are actually no privacy concerns. The lens cover prevents any image capturing, recording, or transmission of protected health information.