Back in 2016, Dr. David C. Koronkiewicz, medical director of quality at the Goshen Health Center for Orthopedics and Sports Medicine, was tasked to research vendors for a secure messaging application to be used by the medical staff.

In the early phases, it was established that nursing administrators were interested in investigating IT that could assist them with nursing alarms and alert management. IT department leaders also were in preliminary discussions on updating the hospital switchboard networks.

A multidisciplinary committee that included physicians, nurses, IT personnel and administrators was created to evaluate the diverse IT applications that would meet the present and future needs of the organization. After an extensive vetting process, the DrFirst Backline Communication platform was selected to assist in transforming the way staff communicate at Goshen Health, formerly IU Health Goshen.

Demonstrating improved efficiencies

“During this process, I was enrolled in the Master of Healthcare Quality and Safety Management at the College of Population Health at Jefferson University in Philadelphia,” Koronkiewicz recalled. “As a requisite for completion of the program, a Capstone project needed to be completed. I was intrigued by the new secure messaging application and felt that I could demonstrate improved efficiencies on how we communicate at Goshen Health.”

Initially Koronkiewicz was planning to use the secure messaging application to demonstrate improved communication and satisfaction between physicians and nursing. However, the implementation of the secure messaging application to all nursing colleagues was delayed by more pressing IT projects.

The four physicians of Goshen Orthopedics and Sports Medicine were early adopters of this technology. Koronkiewicz personally began using the application to securely communicate with his postoperative patients. The response from the patients and their caregivers who used the application to communicate with him were all positive.

"Improving communication using secure messaging has been shown to improve efficiency and both physician and nursing satisfaction."

Dr. David C. Koronkiewicz, Goshen Health Center for Orthopedics and Sports Medicine

“This led to the conversation with my partners to use secure messaging with our patients during the perioperative period,” Koronkiewicz explained. “I felt improving communication during this critical period, we could ultimately improve the patient experience, decrease cost and improve patient outcomes. This is the foundation of the triple aim of healthcare. The project was titled ‘Enhancing Orthopedic Experience Utilizing Secure Text Messaging.’”

The old way: operators and pagers

Goshen in 2016 had an inconsistent and not universally used physician secure messaging system. Most of the providers at Goshen Health still used the hospital operator and pagers to initiate and receive messages and notifications.

Beeper usage in healthcare was becoming less popular because of the antiquated technology and its natural inefficiencies that can contribute to critical delays in patient care. Increased smartphone usage by the general public had been driving portable technology and applications for smartphones, including secure messaging.

“There were many complaints from clinicians and nurses who were using the then present secure messaging system,” Koronkiewicz remembered. “Many of the issues concerned poor performance and clumsiness of the application. According to the 2018 Black Book Market Research report, 30% of physicians receive unsecured text messages with patient identifiable information, which can place the organization at risk for HIPAA violations.”

Ineffective communication can result in patient harm. The Joint Commission reported that poor communication was the third most frequently identified root cause for hospital sentinel events through the end of 2015.

Texting brings big changes

“Text messaging has changed the way people communicate today,” Koronkiewicz said. “Patients are demanding instant access and are looking to technology to receive it. Healthcare organizations and providers began to question the status quo and began insisting on more digital technologies to connect with each other and with our patients.”

New technology has allowed innovation and more IT investments into the advancements of the HIPAA-compliant secure text messaging platforms. Employing a newer secure messaging system is providing Goshen Health an opportunity to expand on this common but underutilized form of communication, Koronkiewicz said.

“Goshen Health’s goal was to progress with messaging technology to improve communication between providers and nurses,” he said. “Improving communication using secure messaging has been shown to improve efficiency and both physician and nursing satisfaction. Ultimately, our patients will benefit with more timely and effective communication.”

Nursing administration was interested in reducing alert fatigue and improving efficiency of the nursing staff by eliminating waste in their everyday activities. Improving nursing processes will allow them to spend more time at the bedside for more effective patient-centered care. Being able to assimilate the numerous alert and alarm systems was a requirement for any new application.

Reevaluating systems and processes

The multidisciplinary committee was able to reevaluate present systems and processes before identifying areas of wants and needs for an integrated communication platform. Having key stakeholders (clinical, administrative and IT personnel) in the committee was crucial to identifying the organization’s current and future needs.

The IT department was very familiar with DrFirst because of previous work and experiences while working on the electronic prescribing portion in the organization’s Meditech EHR.

“DrFirst reviewed the current and the possible future needs of Goshen Health,” Koronkiewicz said. “They presented an integrated solution that would encompass secure messaging and alert and alarm management. The Akario Backline platform supports iPhones and Android devices and web-based desktop and tablet environments. As future needs are identified, DrFirst was interested in having Goshen Health assist them in developing these new opportunities and uses.”

Akario Backline connects care providers in real time to support patient care activities through one-to-one, group and patient-centered chat modes. The application supports documents, attachments, photos, video, audio files and documents. This application expands Goshen Health communication opportunities throughout the health system and beyond, Koronkiewicz said.

The next phase

“Initially, the providers and care coordination department were using this application for provider-to-provider and care coordination-to-provider messaging,” he explained. “The next phase, which began recently, included rolling out Zebra Technologies mobile phones to allow for current secure messaging and future alarm and alert management.”

Providing HIPAA-compliant secure messaging to all care providers at Goshen Health created opportunities for real-time communication while improving efficiency and improving patient care, Koronkiewicz said.

The new technology allows for secure messaging with external users through timed linked access. This capability has expanded the use to selected patients and caregivers by care team members. This is what was used in the above Capstone paper. The external user option has been used to obtain information (X-rays, labs, EKGs) from outlying emergency departments wanting to transfer patients to Goshen Health.

Presently, nurses, providers, administrators and discharge planning nurses are using the secure messaging platform. The hospital operators are using secure messaging to message and notify the enrolled users.

To date there has been no integration with the alarm and alert management systems. Integration with systems like Goshen’s Responder 5 nurse call and communication platform is planned for future implementation. Having a communication platform that can integrate technology systems, DrFirst provides healthcare organizations the capabilities to satisfy not only today’s technology needs for secure messaging and alert and alarm monitoring, but also delivers the capacity to support future applications and development, Koronkiewicz stated.

New technology shows results

“Good communication with both internal and external stakeholders is an important part of an organization’s culture and its success,” Koronkiewicz said. “In healthcare, communication plays a critical role in patient satisfaction and patient-centered care. In 2016, The Joint Commission reported that poor communication was the third most frequently identified root cause for hospital sentinel events through the end of 2015.”

The physician-patient relationship is built on a foundation of two-way communication between the patient and the provider. Good physician-patient communication has been shown in studies to improve patient engagement, medication and treatment compliance, outcomes, patient satisfaction, and the overall patient experience, Koronkiewicz said.

“The physician-patient relationship has traditionally been built on face-to face interactions,” he said. “Improvements in cell phones, internet and cloud-based platforms that are secure and HIPAA-compliant are becoming more popular. A transformation on how healthcare organizations, patients and providers will communicate is beginning to evolve.”

Text messaging is a popular and familiar form of communication. No additional education was required once the Backline link was established, making this real-time patient-centered communication convenient and a familiar way to communicate with the surgeon when questions or problems arise, Koronkiewicz said.

“A secure messaging perioperative project was designed to assess a new and innovative way for patients and physicians to communicate during this critical perioperative period,” he said.

High provider and patient satisfaction

The study using Backline secure messaging with patients/caregivers around the perioperative period resulted in 83% of users being very or extremely satisfied with the ability to directly communicate with the surgeon. Having the secure messaging application to communicate also resulted in 82.6% of the patients/caregivers being more relaxed knowing they have the secure messaging available to them.

Also, 90% of the surveyed patients would recommend that family and friends use secure messaging the next time they require surgery.

Finally, patients experience frequent frustration and dissatisfaction with not being kept informed of delays while waiting for healthcare services. Use of messaging to caregivers that surgery was beginning and ending improved the Press Ganey metric of being kept informed of delays with top box results (9s and 10s on a scale of 0-10) from 60.6% to a statistically significant 88.8%.

“Patients and caregivers often feel anxious and helpless on the day of surgery, and during the immediate postoperative period may also have unanswered questions,” Koronkiewicz said. “Having the ability to communicate easily in real time via text messaging with the surgeon who was personally involved in their care can improve the patient experience and reduce anxiety.”

Advice for other providers

Bringing together key stakeholders such as clinicians, administrators and IT leader to identify needs and wants for the organization’s technology improvements is important for success, Koronkiewicz advised.

“Working in silos can result in dissatisfaction, wasted time, increased cost and overall frustration with the process,” he said. “If key stakeholders are not part of the process, the result may be resistance to supporting and using the technology.”

It also is important to demonstrate to stakeholders how this new technology will improve workflow, reduce inefficient beeper technology and improve the overall care of patients, he added.

“Secure messaging provides healthcare organizations an opportunity to transform and redesign many processes that can deliver better patient care, while improving nursing, patient and provider satisfactions,” he concluded. “Embracing the secure messaging technology and unlocking its potential will only be limited by our imagination.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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