Optimizing clinician-to-clinician and staff-to-clinician communications has been problematic for hospitals and other patient care organizations throughout the history of healthcare. But at the 250-bed Orange Coast Memorial Medical Center in Fountain Valley, Calif., Scott Raymond, R.N., executive director, strategic innovation and information technology, has been leading an initiative to make the lives of that hospital’s clinicians easier and to boost productivity.
Raymond and his colleagues have been partnering with the Knoxville, Tenn.-based PerfectServe, and have implemented that company’s advanced clinical communication and care team collaboration platform, in order to speed and streamline communications. Since implementing the platform in 2012, Raymond and his colleagues have been able to document a significant reduction in communication cycle times. Prior to implementation, nurse-to-physician contact time averaged 45 minutes; post-deployment, this time period was markedly reduced to 14 minutes. Additionally, the number of steps to complete a communications event between nurse and doctor were reduced from 10 to one. Ultimately, Raymond and his colleagues are working to make the communications system patient-centric.
Recently, Scott Raymond spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the initiative. Below are excerpts from that interview.
Could you share with us the origin of this initiative, and your strategic goals going into it?
Certainly. So, about four years ago, I was asked to come up with a vision and a strategy for clinical communications going forward, and at that time, the iPhone had just come out—the iPhone 3GS, or a similar model. We’re an iOS company for management and senior executives, with about 2,500 iOS devices deployed. So we were initially looking at the iOS as the platform for communications; but we were using old technology in the clinical space, with nurses and ancillaries, using a stock VoIP phone. So I was asked to help develop a strategy for a unified system. So I was asked to develop a clinical communication and collaboration strategy. It’s becoming standard to bring clinicians onto a communications platform. So I came up with a vision statement and a diagram or graph of our system that had an iOS at the center of that platform, with a phone system, alerts and alarms, giving the clinicians presence, and other applications that would help capture rounds for nurses, and bring in alarms from patients.
So what we had had up to that time kind of looked like an octopus with multiple communications. And we didn’t want to have to cobble together a bunch of different applications, because just as it is with unified communications in a regular space, in this case, too, we didn’t want to have to do a lot of interfacing, integration, or pulling a lot of different applications together. It becomes very difficult and just doesn’t work that well. If you’re trying to seamlessly hand off phone types—if you had a phone call from a doctor and want to text him information or send it in other ways—that’s tough. You hear about a lot of point solutions like Tiger Text. But we didn’t want that, we wanted a unified communications system for the clinicians. And all the communication and messaging that comes from the hospital out to the clinicians outside the four walls has been difficult over the years, just with standard phones, so having a platform for getting the information to the clinicians in the ways they want to receive it, was important for us.
Then what happened?
Two things came together at once. I was looking at trying to enhance communications not only from inside the hospital but outside its four walls as well. And I was put in charge of clinical communications and collaboration form a hospital and system perspective. So first, we came up with that strategy. And right around the same time, I worked for our for-profit innovation fund that invests in healthcare IT, and I consult with that group, and they asked me to look at this from an investment standpoint as well.
So I was looking at this from two different angles. I looked at a large number of solutions providers. And we decided to look at PerfectServe, because they had a physician-centric system that they moved into a hospital-centric system, and that’s where we got involved with PerfectServe from a pilot standpoint and also from an investment perspective. So for purposes of disclosure, we’ve also invested in this.
So Orange Coast Memorial acted as the alpha site for the system?
They had other customers using their hospital system; we weren’t the first. But they we jumped in early on in that development. And they took a system that was physician practice-centric, and enhanced the software to make it possible for the hospital to communicate with physicians more directly. When we got cut off… the platform went from physician-centric to clinician-centric, and we’re moving towards patient-centric. Imagine the patient as being at the hub. So if I’m the nurse and need to contact a respiratory therapist, I find the respiratory therapist connected to that patient. And so if you have the hub, if you have the patient, it makes it easier to communicate. It becomes easier in an ACO model.
You’re in an ACO, right?
Yes, in an IPA and insurance company. But we’re also in Vivity, a joint venture with Cedars-Sinai, UCLA, and Torrance Memorial.
So tell me about the initial pilot.
It was in 2012 when we did our pilot; we implemented it here first at Orange Coast Memorial Medical Center here in Fountain Valley. We did an initial pilot, and then we rolled it out to the other hospitals, after about three years.
How many doctors, nurses, other clinicians are now making use of the system?
We have close to 3,000 physicians on staff, and about 11,000 employees. The clinicians are using it at all the hospitals, to contact physicians. In the current iteration of the software, it is a portal-based system that’s on the clinical computers we have in the clinical space, and is also connected to the regular phone system, so that you can connect that way, using an extension that dials directly to PerfectServe, and the user can ask for a clinician, and it finds the clinician, the way they want to be found. So if they want a call to go to their cell phone, it will go to their cell phone; if to their office, their office. If they’re not rounding, if they’re off, it can route the call to the person they’ve designed. So the nurse could still ask for me but it will route it to my partner, because there’s a rules engine that includes physicians’ preferences and their schedules, so it intuitively finds the right physician for the nurse to talk to.
Can you speak to clinician satisfaction results?
Well, the nursing satisfaction—being able to get to the right clinician at the right time, is a huge satisfier. And we have done published studies on efficiency. We get to the right clinician at the right time about 50 percent faster now.
That means physicians?
Yes, 90 percent of all physician communication is driven by the nurse, the nurse reaching out to the physician to get an order, or insight, or discharge instructions. Most hospital communication is driven from inside the hospital to the physician.
What’s your observation as a nurse and nurse informaticist, in terms of how all of the elements of this fit together?
I think it’s important that anytime I look at something, I try to put my nursing hat on and look at it from the end-user’s perspective. And it’s just like the EMR. The main consideration is workflow. If you put an EMR in but don’t consider all the clinicians’ workflows, you won’t get good adoption. So we’re very careful about the systems we choose, so that they don’t hinder workflow; and in the best cases, systems enhance workflow. Because the worst thing from an IT perspective is to give end users a tool and then have them reject that. It’s very difficult to recover from that. So we looked at this the same way we looked at EMR implementation. So we took time to consider this and put together a vision. And going slower was the right move for us, because this was an emerging market. Not many hospitals have clinical communication and collaboration. Not very many hospitals give smartphones to their clinicians in this way. So we wanted it to be usable. And it’s been three to five years, but we’ve made incremental progress towards our goal.
What have been the biggest lessons learned so far?
The biggest lesson learned is, choose wisely and carefully. You’re not choosing a point system, but a platform. And you want to choose a system to meet your criteria now, but also in the future. That’s why we’ve been a development partner with PerfectServe. And we’ve been working together to develop a solution. And the platform started out as physician-centric, but it is moving towards being clinician-centric, so nurses can call and text each other not only on the web portal we initially deployed, but now also via smartphones. So they can communicate easily not only within the EMR, but also via smartphones.
Do they all have smartphones now?
We’re in the process of buying those phones and implementing that. Just like everybody else, you have to come up with a business plan and get everything approved. And we’re buying the phones now. And it’s an emerging market, and the actual hardware for hospitals is not quite where it needs to be yet. And if you look at the market as a whole, some of the purpose-built phones aren’t up to the new technology—they don’t have the latest chips or software on them.
What kinds of phones are you getting for your organization’s clinicians?
We’ve looked at everything from Zebra phones to Spectra Link, and we’re an Epic shop, so we really need to choose something from that list. We’re moving methodically so that the decision we make now will still work in a few years. We’re looking to buy about 3,500 devices. There are five devices on that list: the iPhone, the SpectraLink phone, the Zebra phone, the new Honeywell device, and one other.
What would your advice be to CIOs and CMIOs around this kind of communications optimization work?
You want clinical input from the beginning, because you’re going to be giving a system and devices to clinicians to use, and if it’s not something that works for them from a form/function standpoint, but also from a workflow perspective… it won’t work. So you need the clinicians to be involved from the beginning, and invested in this with you. And you can go back in history and look at failed EMR implementations. This is exactly the same kind of thing. And also, you don’t want to cobble together point solutions. In healthcare IT in general, we’re looking at all or applications broadly, and it’s like a rainbow—you want as few colors as possible, so the fewer applications you have to manage, the better.
I would add that form is important. Leveraging a platform that allows multiple devices so that the physicians an bring in whatever they want, means that you can make sure they can carry the devices they want and get the messages the way they want, whether it’s voice-mail, a still or video image, a text, etc. And texting can really help transform communication, but you’ll still have to talk to clinicians sometimes when dealing with patient care, and a lot of these point solutions don’t consider that you’ll also need a phone involved that works inside and outside of the hospital.
Is there anything else you’d like to add?
I think the texting will make a difference. It’s going to streamline communications. There’s some feeling that the Joint Commission and CMS will allow for the texting of orders. And everyone’s worried that it will take place of the CPOE, but really, it would just replace phone orders. And that could speed things up and make it easier for the clinicians to get those orders quickly and process them in a timely manner so we don’t have to wait for phone orders to come back. So texting will streamline things, but you’ll still need the phone; you’ll still need to talk to each other.
