Timely and effective communication is absolutely crucial in healthcare. So making sure the technologies that support healthcare communication are working optimally is a key task for CIOs and other health IT workers.

Physicians and nurses must be connected at all times. Health systems must be able to link to all the various provider organizations that make up the delivery system. And clinical and business leaders must be able to efficiently converse with their teams, large and small.

Here, four experts from healthcare communications technology companies offer best practices for optimizing these technologies to work most effectively within CIOs’ and other health IT leaders’ provider organizations.

A current state analysis

More than 90% of hospitals will purchase smartphones in the next two years; however, less than 78% of them have a solid mobile communication strategy, according to Spyglass Consulting Group. To integrate smart technologies into the clinical environment requires that patient-to-caregiver communication tools are optimized for performance, reliability and flexibility.

“One of the most important things a hospital can do to optimize their communication technology is to perform a current state analysis,” said Kourtney Govro, vice president, business development, at Critical Alert Systems.

“This involves documenting their alarm notification technology workflow,” she said. “Using visuals, like flowcharts, will allow all stakeholders to understand how clinical workflow occurs and who within the care team performs each step. It seems like a very simple thing to do, but we often find it has not been done.”

"One of the most important things a hospital can do to optimize their communication technology is to perform a current state analysis."

Kourtney Govro, Critical Alert Systems

There can be questions about how a system is supposed to work versus how it does work. Oftentimes, with nurse call deployments, hospitals resort to “chasing lights” when they could be leveraging much more than just the basic signaling technology, Govro added.

“Examples include integrations with EHRs, smart beds, RTLS and more,” she said. “This would enable and empower the care team to engage more naturally with their patients, and each other, using the data from smart technologies.”

Emergency physician referrals

One overlooked area of clinical communication that can deliver a significant financial impact to health systems is communication between physicians in community hospitals transferring patients to the health system for emergent specialty care, such as traumatic injuries, surgery for an acute heart condition or a stroke, said Angie Franks, CEO of Central Logic.

“Health systems may not even be aware there’s an issue when referring physicians are frustrated with the transfer communication process, such as having to call multiple facilities, waiting on hold for answers, or waiting for return calls from consulting physicians as precious minutes tick by to grant an emergent admission,” she explained.

“These health systems may not realize how many times referring physicians just give up and call a competitor so their patient can receive needed care.”

"Health systems may not even be aware there’s an issue when referring physicians are frustrated with the transfer communication process."

Angie Franks, Central Logic

System-wide, integrated, consolidated and streamlined communication technology is an essential element in building a specialty center’s referrals, she stated.

“For example, health systems can leverage communications technology to consolidate transfer requests coming from community hospitals so referring physicians can call a single phone number,” Franks said. “That way they don’t need to guess about which departments or numbers to call to quickly obtain an admission for their patient.”

Data at their fingertips

The nurse or other clinician answering that call in the health system’s transfer center should have the data at their fingertips to offer the referring physician efficient guidance as to the relevant on-call providers to involve, and a definitive answer about facility capacity, she added.

“On that same phone call, the transfer center agent’s technology should have the capability to contact those consulting physicians and coordinate transportation without needing to hang up with the referring physician or require him or her to call another facility or physician,” she explained.

An investment in this type of streamlined communication process supported by integrated system-wide technology brings ROI in the form of an increased patient acquisition rate from community hospital referrals and improved retention if the patient is already in the network, she said.

“Each accepted patient not only presents an opportunity to provide revenue-generating services, but patients are generally transferred for higher-acuity services, shifting the effective hospital census toward a more favorable case-mix index,” she said.

“In addition, improved visibility over physician schedules and facility capacity eliminates the need for multiple phone calls – saving time – and prevents overburdening any single physician or facility with transfer requests, which reduces labor costs and wasteful steps.”

Managing multiple lines of communication

On another communications front, smartphones, mobile apps, email and portals are connecting businesses to caregivers, caregivers to other caregivers, and caregivers to patients. With messages coming in multiple forms from multiple directions, it may not be easy for clinicians to pick up on important communications while concentrating on patient care at the same time.

Unfortunately, missed communication puts patient safety at risk, and today’s provider organization CIO needs to prioritize the efficient use of resources, in terms of both people and dollars, to optimize clinical communications most effectively.

“There are four general pitfalls to consider when optimizing clinical communications technology,” said Jeff Brown, COO at PerfectServe. “By avoiding these mistakes, you won’t end up with more products than you need, expectations that are out of line with reality, or unhappy internal stakeholders who are wondering why the applications they asked for are not efficiently managing their communication needs.”

"To ensure that clinical communication tools can evolve at the pace of the organization, creating a formal clinical communication governance program is key."

Jeff Brown, PerfectServe

These common pitfalls, according to Brown, include:

• Having a primary goal of selecting the application, or suite of applications, with the most robust features at the lowest price point. Rather than focusing on single-purpose apps, create a detailed list of high-level requirements. One can then use this list of requirements as one matches existing tools with new investments. Ultimately, one should look for solutions that check more than one box and play well with any other systems an organization will continue to use.
• Implementing many applications with overlapping functionality to placate various internal stakeholders. Different departments have different workflows and priorities, and they may not be perfectly aligned on their solution preferences. Do not try to implement all of these solutions to satisfy every department individually – this adds cost and complexity, and one will end up with needless IT bloat.
• Thinking that a clinical communication tool will magically solve all of one’s process problems. Healthcare organizations have these tools in the form of software, and while the best vendors will lean in to their expertise to make sure implementation goes smoothly, it’s also up to everyone in an organization to ensure collective use and internal optimization of those tools.
• Choosing a tool because many other organizations use it and one does not want to fall behind. No two organizations are alike, and while a certain solution may be an ideal match for one setting, there’s no guarantee it will yield the same results in other settings. Effective healthcare technology is not about keeping up with the Joneses.

Communication outside the hospital

The importance of effective clinical communication within hospitals during critical care situations is well known, but communication outside the institution’s four walls is just as important.

A recent study published in the journal Circulation highlights this fact. Researchers found that when patients diagnosed with a stroke need to be transferred from a community hospital to a specialty center for endovascular treatment (EVT, mechanical removal of a blood clot that caused the stroke when medical therapy is not enough), treatment is often delayed. The study found that this delay also causes worse outcomes in these patients.

“However, emergent transfers for these patients remains a necessity: health system consolidation with a trend toward specialty centers; access to care issues in rural areas and other healthcare ‘deserts’; and community hospitals not equipped to perform EVT are just a few factors that will continue to drive this need for patient transfers in the future,” said Dr. Darin Vercillo, chief medical officer at Central Logic. “Statistically speaking, the vast majority of people who have a stroke will arrive at a hospital not equipped to perform EVT.”

Communication solutions to improve the speed to definitive care could include having communication protocols in place to streamline provider acceptance, leveraging technology and quality improvement programs that focus on reducing the time to treatment."

Dr. Darin Vercillo, Central Logic

An optimized transfer process that leverages centralized, integrated, system-wide information and communication technologies can get these patients to the right level of care, at the right facility, without delay, he said.

Communication protocols

“Communication solutions to improve the speed to definitive care could include having communication protocols in place to streamline provider acceptance, leveraging technology and quality improvement programs that focus on reducing the time to treatment,” he said.

“Using centralized and integrated communication methods to alert care teams so they are waiting and prepared at the stroke center arrival zone, bypassing the ED and ICU, and taking the patient straight to the neurovascular lab, with the stroke team also ready is an ideal example. Such an improvement could reduce the time to treatment by up to 45 minutes.”

Similarly, communication through images is just as crucial in these emergent transfers, Vercillo added.

“Health systems can optimize image-sharing capabilities so neurointerventionalists can better prepare, and so diagnostic tests will not be repeated prior to undergoing EVT at the specialty center, reducing overall cost of care,” he said. “The images should be transferred electronically and reviewed while the patient is en route, rather than arriving on a disk in an envelope lying on top of the patient.”

Establishing formal agreements and integrating communication technology with transport providers can mobilize ground, flight and emergency medical teams with fewer phone calls and less waiting, he added.

Informed governance

With a goal of successful optimization, implementing clinical communication technology takes considerable commitment. Although these are oftentimes considered “out of the box” tools, none of them are as simple as “plug and play.”

This is particularly true in the long term, where much of the “not doing it right” comes by way of improper management of the investment post implementation.

“To ensure that clinical communication tools can evolve at the pace of the organization, creating a formal clinical communication governance program is key,” said Brown of PerfectServe. “By placing forethought into clinical communications governance at inception, the organization can enter this change with the proper mindset.”

Ideally, a governance program can be created whereby the entire organization ceases old methods of communication and migrates to the new tool through the use of a strategic roadmap, Brown added.

“Informing this roadmap and governance plan requires forethought to make sure clinical communication tools are set up to meet the unique needs of your organization, and that means getting input from all interested parties, especially those who are participating in the daily workflows associated with administering care,” he said. “This won’t come as a surprise, but it’s important to assess the workflows of every department that will use a given solution to ensure it can meet their needs.”

Lastly, a governance plan needs to be assessed over time according to pre-considered success metrics, he stated.

“It is important to consider the way in which ROI will be tracked formally over time,” he said. “After all, if you can’t be sure a solution is improving workflows and/or patient care meaningfully, how do you justify paying for it in the first place? In the end, having definitive metrics makes it easier to fine tune the system as the organization evolves and see how those adjustments impact outcomes.”

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