Putting the Pieces Together: IT’s Role in Care, Collaboration and Communication

Oct. 5, 2016
Breakdowns in communication, according to the Joint Commission, are the top contributing factor to delays in care. In the emergency department, the seconds it takes a nurse practitioner or on-call physician to review who should be contacted and how--could be the difference in a patient's outcome. Healthcare Informatics sat down with healthcare thought leader and PerfectServe CEO, Terry Edwards, to explore the role IT now has in facilitating collaboration, improving speed to care, the current state of the field, and why complimenting the EHR with supporting initiatives should be part of every IT team's goals in the future.

Communication and collaboration are at the crux of successful healthcare delivery in the value-based era. Clinicians need to be able to quickly — and securely — communicate with other care team members within and outside their home organization to ensure patients receive the care they require.

With this pressing need to connect clinicians, technology has advanced to the point where dozens of secure messaging solutions are now available. So why does it seem that true collaboration is more elusive than ever?

Terry Edwards, chief executive officer of PerfectServe, talks with Healthcare Informatics about the problem of fragmented healthcare communication, why secure messaging is only part of the solution, and how information technology that enables true care team collaboration is the “next frontier” in healthcare.

Healthcare Informatics: From your perspective, what is the state of healthcare communication and collaboration today?

Terry Edwards: It’s interesting that you posed the question with both communication and collaboration, because I believe there should be more collaboration happening within care teams that simply isn’t.  And the reason is that given the nature of healthcare and the differing workflows of the respective care team members, there has not been a successful technology solution that has been able to overcome all the long-standing obstacles to communication.

Unfortunately, today’s fragmented technology market only exacerbates this situation.  For example, communication vendors have tended to focus on only one aspect of the industry — providing solely a physician or nursing solution, or simply a nonclinical secure messaging product.  Consequently, there is a lack of a care team collaboration platform that is able to unite the entire care team, provide immediate connection, and facilitate timely interaction and collaboration.

Healthcare Informatics: PerfectServe recently commissioned a Nielsen study looking at healthcare communication and population health strategies. Did any of the findings really stand out for you?

Edwards: The Nielsen study confirmed things we had already observed, especially concerning challenges to care team collaboration and how that affects the emerging population of health-focused business models.  Accordingly, the overwhelming majority of physicians and nurses attributes delays in patient care and patient transitions to lower-cost care settings to communication obstacles. One of the main reasons is that more than 50 percent of responding clinicians stated that they didn’t even know who they were supposed to contact for a given clinical situation, while another 61 percent reported that they were erroneously contacted when they were not the right clinician for the particular situation. In fact, nurses and physicians both acknowledged that attempting to communicate with the care team consumes valuable patient care time.

One of the most surprising findings, however, was that only 12 percent of respondents cited use of the electronic health record (EHR) for communication across the care team. And when one clinician needs to coordinate with another clinician outside of his own organization, the EHR was very rarely used. The telephone was the primary means of communication. And we all know the frustrations of trying to reach people in real time by calling an office, facility or unit.

*Visit perfectserve.com/survey to download the full report and methodology.

Healthcare Informatics: Many healthcare organizations are exploring the use of secure messaging products. Is that the solution that will mitigate these communication challenges?

Edwards: Secure messaging is certainly part of the solution, but it is not the solution in and of itself. This is an area where the industry has been somewhat misguided. That’s been driven by the change in the HIPAA omnibus rule, which put more teeth into the rules around HIPAA security. It’s all good stuff, but it compelled organizations to seek a secure messaging solution to be HIPAA-compliant.

However, being HIPAA-compliant is much, much more than secure messaging. It’s about mitigating risk across all communication modalities, of which secure messaging is just one.

Importantly, secure messaging does not successfully address the recalcitrant communication and collaboration obstacles impeding care today. Specifically, secure messaging alone depends on clinicians being available 24/7 and wanting to be contacted by everyone in the same manner for all situations. That simply is not the case. Rather than facilitating the workflow, it can hinder it — creating more problems than it solves since it does nothing to provide connection to the right team member in the right manner for the given situation.

The good news for healthcare is that many of the providers that implemented a simple, basic secure messaging product have since realized that it neither meets their communication needs nor overcomes their collaboration issues. The market is shifting to the benefit of the patient.

Healthcare Informatics: Tell us more about dynamic intelligent routing and what it can do for the care team.

Edwards: The key to driving care team collaboration is facilitating communication-driven workflows for all members of the care team. And those members change, based on a host of variables such as time, day of week, clinical situation, urgency, call schedule, role and more. The workflows of physicians are different from the workflows of nurses, which are different from those of care coordinators, therapists, pharmacists, etc.

To address these challenges, PerfectServe developed Dynamic Intelligent Routing™. Dynamic Intelligent Routing analyzes the combination of variables for a given clinical event and automatically identifies and provides immediate connection to the right care team members based on those variables.

For example, consider two nurses in the same hospital who need to contact a hospitalist. One nurse is in the emergency department and needs to contact a hospitalist about a new admission. The other nurse is on a medical/surgical unit and needs to contact a hospitalist about an existing inpatient. These are two different communication-driven workflows that would result in different physicians responding to the patient’s need. A care team member simply needs to know only the name of the patient or the needed service in order for PerfectServe to automatically route the message to the right person who is needed to take action.

Healthcare Informatics: What does this kind of solution offer healthcare delivery?

Edwards: It allows clinicians to speed time to treatment. This is because effective communication and collaboration across the care team is at the very heart of care delivery. And it’s also at the heart of patient safety.  According to The Joint Commission, communication breakdown remains the primary contributing factor to delays in care that result in a sentinel event. So if you can improve the communications process and allow clinicians to connect more quickly, they can make decisions and take action.

We did a study with Ascension Health’s St. John Hospital and Medical Center in Detroit, Michigan, that focused on stroke diagnosis and treatment. By speeding the communication-driven workflows in the process of diagnosing and treating stroke patients, the clinicians at the facility were able to administer tPA to three times more patients, which gave those patients a better chance of walking out of that medical center alive.

Healthcare Informatics: How should communications work within the context of the EHR?

Edwards: I’ve had more than one person tell us that PerfectServe is the most important complement to the EHR. We all know that the EHR is the source of truth — it’s the clinical record of the patient’s care experience. However, given the unpredictable, unexpected and time-sensitive nature of healthcare, there is a need for immediate connection and collaboration. Together, PerfectServe and the EHR provide the necessary communication infrastructure for effective and efficient care.  Enabling productive care team collaboration is the future of successful healthcare delivery.

To learn more about PerfectServe and its Dynamic Intelligent Routing solutions, visit: http://www.perfectserve.com