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Common questions aboutRevitalPro & CodeBlue IQ

Clinical Questions

What type of clinical decision support does RevitalPro provide?

RevitalPro includes selected critical alerts with the purpose of keeping teams on guidelines. Areas such as: re-starting chest compressions after a 10 second pause, reminding the team to shock every 2 minutes if defibrillation is indicated, providing Epi reminders at 3 minutes (and at 5 minutes if it wasn’t given at 3), and prompts to switch the compression providers every 2 minutes.

Other alerts include: prompting to sync when cardioverting, confirming correct placement of the endotracheal tube, reviewing the 6H’s and 6T’s, tracking the round of CPR, defibrillation, and epi that the team is on, and finally alerts associated with order items which have not been completed. There is both a pediatric and adult version of RevitalPro. Resuscitation medications, equipment sizes, and joule setting recommendations are also provided to support the team.

Can you describe the training process?

We work with you to design a training that fits the needs of your organization.  Code blue operations and team members can vary greatly between hospitals, and we will tailor the training to align with your organization’s current code blue processes.  There are several options that Format Health can provide, including in person training, live training through Zoom (has the ability to ask questions live), or online modules that can be completed at the trainee’s convenience.  We strongly recommend in person training, where we will complete “classroom time” as well as a practice mock code.

How can providers and organizations review both the patient care provided and the performance of their Code Blue Teams - both during training sessions as well as actual patient care.

Data is provided to the organization and providers in four forms. 
1. Data is securely imported into the electronic patient record as discrete data elements in a fashion similar to all other data collected during a patient encounter
2. A pdf of the Code Blue patient management record is instantly and securely imported as a single document into the electronic patient record to provide an overview of the care for patient handoff and team debrief
3. A pdf of a Quality Improvement record, which focuses on overall team performance, is securely imported to a secure organization server and is available for review by authorized personnel.
4. Code Blue IQ generates high quality analytics via interactive graphics which can focus on specific management issues such as time to first shock, time to first epi, switching of CPR providers as they relate not only to identified units and personnel and this data is restricted to authorized personnel only. 

Evaluation and Implementation Questions

What is the best way to schedule a clinical evaluation of the system?

For a clinical evaluation of the system (generally 2 weeks up to 1 month), we set up agreed upon metrics with the executive sponsor of the project (or whatever committee/budget would provide funds to approve a purchase). During the evaluation period, we compare against the previous 5-10 code records to establish a baseline, and then Format Health will help with the analysis of baseline to the team’s use of RevitalPro. We recommend that RevitalPro is used during simulations with trained RevitalPro users and that the agreed upon metrics are studied, at the minimum of 3-5 mock code events.  If RevitalPro is used during actual events, oftentimes security and IT may be required to review and can slow down the evaluation process.

Other alerts include: prompting to sync when cardioverting, confirming correct placement of the endotracheal tube, reviewing the 6H’s and 6T’s, tracking the round of CPR, defibrillation, and epi that the team is on, and finally alerts associated with order items which have not been completed. There is both a pediatric and adult version of RevitalPro. Resuscitation medications, equipment sizes, and joule setting recommendations are also provided to support the team.

What’s the best way to use RevitalPro during simulated mock codes?

RevitalPro can be broadcasted via Apple Airplay to a large monitor or TV to facilitate situational awareness for the other team members. After the event, during the debrief, the Navigator can broadcast the patient record or the quality record to review breaks in CPR and what occurred during that time, or items in the quality record like the difference between ordered and completed items.  

Can there be a phased approach to implementation?

Yes. Organizations can print records generated by RevitalPro as a first step and scan them into the EHR. With this approach, teams can immediately reap the benefits of the system’s guidance during a code, and a legible record is available for transitions of care.  Emailing the record is also an option–which will require IT security approval–but saves on EHR integration costs.  A phased approach can be helpful depending on the budget cycle, if the hospital/organization is changing EHRs soon, or the availability of the IT team.

Technical Questions

Can RevitalPro run on a smaller device?

RevitalPro can work on various tablet sizes. However, we strongly recommend a recent Apple iPad device with a screen size around 9”.
Other alerts include: prompting to sync when cardioverting, confirming correct placement of the endotracheal tube, reviewing the 6H’s and 6T’s, tracking the round of CPR, defibrillation, and epi that the team is on, and finally alerts associated with order items which have not been completed. There is both a pediatric and adult version of RevitalPro. Resuscitation medications, equipment sizes, and joule setting recommendations are also provided to support the team.

What EHR systems is CodeBlue IQ/RevitalPro compatible with?

CodeBlue IQ/RevitalPro is compatible with all major EHR systems, including but not limited to: Epic, Cerner, MEDITECH, McKesson, Allscripts, eClinicalWorks, NextGen, Greenway, and GE Healthcare.

What happens if WiFi is down?

The RevitalPro system is built to provide full support, even if it’s in an area without connectivity. As soon as the device is back within range, it will send the locally stored data to the CodeBlue IQ database and, if integrated, to the EHR. 

What is the RevitalPro EHR integration process?

For EHR integration, we work with you and your IT team to scope your integration needs, establish a secure VPN connection, configure the interface, test the integration, and go-live.

What is the workload on my hospital’s IT team?

Because of our cloud-based data architecture, the actual workload on the hospital’s IT team is minimal. We foresee a total of 3-4 hours for the IT team to review, test, and go-live with RevitalPro data integration:
  • Security and technology review (1-2 hrs)
    • Security audit: The hospital IT team will confirm that RevitalPro has appropriate logging, backup procedures, and other systems in place that complies with the hospital’s security and technology policies.
    • Protocol review: They will review with us their structured process for implementing a new project, and discuss necessary steps for data integration (e.g., authentication, interface setup, testing, production migration).
  • Interface setup and testing (1 hr)
    • Virtual private network (VPN): The data is stored and transmitted through a secure, virtual private network that limits unauthorized access. The IT team needs to exchange information (IP address, port number, certificate keys, etc.) with us and we setup the VPN.
    • Interface confirmation: IT team confirms that connection to our VPN is correctly configured.
    • Testing: IT team perform tests, such as submitting a test record from RevitalPro and verifying that the record is correctly uploaded to the EHR. IT might also perform their standard information security tests, such as penetration tests.
  • Production migration (1 hr)
    • Go-live: Once the interface is setup and sufficiently tested, RevitalPro can begin uploading real records and data to the EHR.
My hospital has an on-premise-only data policy. What is the workload on the hospital’s IT team in this case?
While we strongly recommend our secure, HIPAA-compliant cloud platform, we understand you might have existing IT policies at your institution. In addition to the 3-4 hours of data integration workload listed above, we foresee about 4 hours of your IT team’s time to set up the RevitalPro platform on your on-prem server:
  • Server setup (<4 hrs)
    • Server allocation and database provisioning: With on-prem servers, your IT will need to provide us with a server instance where we can deploy the RevitalPro web app and database on their existing infrastructure. This process should be standard and trivial for most IT teams.
  • RevitalPro web platform setup (< 1 hr)
    • Via secure remote-access, we can install our platform and web application with no additional burden on your IT team.
    • If your IT policy does not allow remote-access, we can provide your IT team with a build script and packaged container that the IT can use to install the components and software with minimal involvement.

Is there any additional burden on the hospital IT for ongoing maintenance?

For cloud deployments, Format Health is responsible for ongoing maintenance and compliance of the RevitalPro and CodeBlue IQ system, and does not require additional work from your organization’s IT team for normal operation

Where will the data be stored?

Data collected on RevitalPro are stored in two places:
  • The tablet device used for documentation
  • CodeBlue IQ database

On the tablet devices, each code record dataset is locally stored until the code record is submitted to CodeBlue IQ, the companion web application (hosted on secure AWS environment). Once the record is submitted, the data remains on the device for an additional 48 hours. During this time, the records can be accessed on the RevitalPro device via “Administrator Settings” button on the opening screen. 48 hours after the record has been submitted to CodeBlue IQ, at which point the data is permanently deleted from the tablet device. Data on the CodeBlue IQ database is secured using AES encryption with 256-bit keys and automated backups.

I can’t find a record on CodeBlue IQ.

CodeBlue IQ offers various filters and search functions to fit the clinical workflow of record management. On Codes menu of CodeBlue IQ, you will see various filter tabs, such as “Signature Missing”. You can also select “All” and use the search bar to search for records based on code leader name, code recorder name, patient name, or patient MRN. If the record has been archived, it may be under the “Archive” tab (records that have been archived do not affect the analytics dashboard).

References:

1. Merchant, R M et al. “Hospital Variation in Survival after In-Hospital Cardiac Arrest.” Journal of the American Heart Association 3.1 (2014): e000400.

2. “AHA Cardiac Arrest Statistics.” American Heart Association CPR & First Aid. 2016;

Benjamin EJ, Virani SS, Callaway CW, et al. . Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation 2018;137:e67–492; and 

Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. Epub 2022 Jan 26.

3. Unpublished abstract by Dr. Thomas LaRocca based on initial 6-month study at Stanford Children’s Hospital; additional research and submission for publication planned.

4. Grigg E, Palmer A, Grigg J, et al Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record Emergency Medicine Journal 2014;31:833-839. Note that this study was published under original prototype name “EventDoc” rather than RevitalPro.