Patient care teams at Yale-New Haven Hospital, looking for a faster, more efficient and more secure way to communicate with each other in the emergency room, have adopted smartphone applications to speed up workflows.

The changeover from stilted clinician communications and responsiveness as a result of the hospital’s emergency room reconstruction. At certain times, different areas of the department would be closed creating confusion and making it difficult to locate personnel.

In addition, the way the pediatric emergency department was logistically set up, the clinicians working there had no line of sight, making it hard for them to communicate with one another.

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Eventually, the hospital bucked its traditional methods, which included a public address system and a VOIP wireless phone system, turned to MH-CURE – for Clinical Urgent Response – a smartphone application from Waltham, Massachusetts-based Mobile Heartbeat.

MH-CURE offers care teams secure, single smartphone access to all clinical communications, pertinent patient information and lab data. Care team members have a choice of using their own smartphone or sharing hospital-supplied devices. It consolidates clinical communications, including alarms and notifications, pertinent patient information, lab data, texting, voice and photography.

Allen Hsiao, chief medical information officer and associate professor of pediatrics and of emergency medicine at Yale-New Haven, said adoption was easy and the staff realized early the power of having everyone on one platform.

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"We choose the ED because it's as a self-contained a unit as you're going to find in a hospital," said Hsiao. "We certainly have the dynamic need of trying to find the right nurse, the right physician, at the right time, they are often in different rooms out of sight."

So far, he said, the impact has been positive. "We're saving a lot of time. We used to play phone tag, used to get interrupted taking care of patients, having to step out to take a call or answering an overhead page. It's giving us back time with the patient at the bedside."

Hsiao said that if a doctor or nurse gets a text, they can glance at it very quickly without leaving the patient and they can decide whether or not they need to step away or if it can wait and continue to do what they were doing with the patient. In addition, their train of thought and conversation with the patient is not interrupted.

"Unlike a traditional text message I can see if another physician or nurse has read my text or not – they can tell if I read it or if it’s been delivered and not read yet," he said. "That helps a great deal. Then I know if they haven't read it and it's urgent, I can escalate with a phone call."

Hsiao said that with traditional text or pager you have no way of knowing if the receiving person read a text or not.

For example, if a lab sends critical lab alerts, instead of playing phone tag the alert is automated – so when something is critical, needs intervention right away, as soon as the result is back the text gets triggered right to a smartphone.

Hsiao said the effect on patient care has been positive.

"It cuts down on the delays between awareness of information and actual treatment."

Hsiao said adoption has been driven by the flexibility of the platform, such as the ability to use an Android or iPhone device, and integration with the electronic health record.

"All these features add to the functionality and the importance of the technology
so it becomes a secure HIPAA-compliant ecosystem for clinical tools, that is the wave of the future," he said.

According to a Mobile Heartbeat, an outside consulting firm conducted a study, before and after the MH-CURE implementation, to determine how long it took for the clinicians in the emergency departments to communicate with one another.

Results revealed that the amount of time required for clinicians to locate and transmit information to one another was greatly reduced, allowing staff to spend more time with patients and thus provide better patient care.

In a poll of clinicians, 75 percent said they now found it easy or very easy to communicate with colleagues with MH-Cure; just 24 percent felt that way prior to using it. Nearly 75 percent, meanwhile, reported that MH-CURE has improved patient workflow and patient safety.

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James Webb, vice president of strategic accounts for Mobile Heartbeat, said that the market for this smartphone technology is growing because secure texting is a major driver.

"What we're seeing at MobileHeart beat is that people do not want to lock in to just a secure text solution, they want a full communications package, clinical workflows and inputs and alerts from various systems in the hospital," said Webb. "We see a lot of sites looking at their mobility strategy and really the major thing for their apps is they have to be able to play well together."

Hsiao said that in addition to the adult and pediatric ED the smartphone app is now being deployed in its medical and surgical departments – and recently in intensive care units and emergency departments – at all of Yale's other hospital campuses, including the main campus in New Haven.

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