Hospital compliance officers must think beyond “security” when it comes to text messaging

Today, hospitals know that they need to find HIPAA compliant communication solutions, but often to struggle to identify the right solution and/or to identify (or agree on) who is actually responsible for finding the right solution.

They are starting to realize that finding the right secure communication solution is more than just a technology decision. With ultimate responsibility for adherence to health care regulatory enforcement and compliance activities, more and more compliance officers are now finding themselves playing a key role in that decision-making process. In that new role, they typically work closely with hospital administrators, IT and physician leaders to choose a solution.

We recently spoke with compliance expert John Finley about this topic. His 15-year career has spanned a number of compliance and regulatory roles at WakeMed Health & Hospitals, CHRISTUS Health, Aetna and the FDA.

Finley says that while there may be some confusion around The Joint Commission’s recommendations, there is no official ruling that prohibits hospitals from using secure texting. He knows that texting is a reality of life, and that it has become a regular practice for physicians. He says that he and probably 90% of his peers support the use of texting, if it’s done in a secure manner and doesn’t result in a breach.

“The bottom line is that physicians are already doing it, and it can help deliver better care to patients. We just need to figure out the best way to support that, while minimizing a hospital’s risk and exposure,” Finley explains.

At a minimum, a secure texting solution should meet a checklist of basic security requirements including:

  • Encrypted at rest and in motion
  • Cloud based – nothing stored on phone
  • Secure messages pincode protected (not just phone code)
  • Ability to remotely wipe if lost/stolen

But, Finley emphasized that he and his compliance counterparts need to focus on more than just security and compliance, when thinking about text messaging technology.

We agree. While checking off a list of standard security requirements is a good starting point, choosing a solution can’t stop there. Hospitals still need to balance compliance and security with overriding business goals such as:

  • Improving care
  • Reducing costs
  • Increasing growth

To support these goals, hospitals should look for a solution that offers a number of other benefits including:

  • Inpatient/outpatient integration
  • EPIC integration – particularly for consult requests
  • Designed to stay compliant with all stark/anti-kickback regulations
  • Flat license fee with ability to broadly distribute
  • Implementation process that actively engages users to promote adoption
  • Offers a solution for physicians in the OR/procedure rooms
  • Message preference routing (includes residents, fellows, mid-level providers)
  • Integrates with nurse duty phones
  • Addresses call center and ED volume issues

Finley also emphasized that technology is only one part of a true secure messaging “solution”, and that hospitals need to implement policies and practices that support the use of these technologies. They are increasingly looking to vendors to help provide these “guardrails for proper texting” and to help them think through a number of “what if scenarios” to ensure ongoing compliance and usage.

It’s also important for hospitals to think about communication outside their own four walls. Implementing a secure communication solution becomes more complicated when it has to be managed across a wider care continuum. Today, hospitals must collaborate with multiple providers and rely heavily on physician referrals. As a result, they need to communicate and share patient information across numerous organizations.

A solution that supports in-hospital communication only or in-hospital workflows only, won’t truly address their communication or compliance needs, and won’t truly improve overall patient care. The right secure communication solution should support communication, collaboration and care coordination across the entire patient care continuum.

If you would like to learn more about how MD Interconnect does just that, or to learn how WakeMed addresses the need for HIPAA-compliant messaging, let us know. You can also read the WakeMed case study here.

Easing physician burnout with better physician-driven communication

Physician burnout is an increasing problem in US health care systems. In the MedScape LifeStyle Report 2017: Race and Ethnicity, Bias and Burnout of 14,000 physicians, 51% reported burnout, versus 40% in 2013, an increase of more than 25%. Among Family Medicine providers, the reported burnout rate is 55%.

An understanding of the causes and impacts of physician burnout can help health care systems implement solutions to better support their physicians so they can reduce burnout.

Causes of Burnout

Physicians simply don’t have enough hours in the day to meet all of the demands of their jobs.   A report from the Centers for Disease Control and Prevention indicates that physicians would need to work 21.7 hours a day to provide complete preventative, chronic and acute medical care to their patients. Add to that all of their administrative tasks, and the job can be overwhelming. In fact, the top cause of physician burnout according to the MedScape LifeStyle Report 2017 is “too many bureaucratic tasks” followed by “spending too many hours at work,” and “feeling like just a cog in a wheel.” Many physicians will indicate that they spend too little time taking care of patients and too much time on regulatory compliance, documentation and administrative tasks.

 Physician Burnout and the Impact on Care

Physicians experiencing burnout report being overwhelmed by their responsibilities and unable to successfully complete their jobs. This leads to increasing feelings of pessimism, hopelessness and emotional and physical fatigue. Their sense of what they can personally accomplish diminishes, as does their overall interest in work. Physicians who report burnout often have less energy, may start to question their abilities and may reduce their hours or stop practicing all together.

Not surprisingly, physicians with burnout report being more distracted and less able to focus on patient needs and may make more mistakes. Due to their experience of low energy, they also may take short cuts in patient care.

Addressing Physician Burnout

Health care systems recognize the problem of physician burnout, and some are implementing initiatives to address the issue. The Mayo Clinic is focusing on ways to build collaboration and companionship amongst physicians, while the Cleveland Clinic has implemented training sessions to improve patient communication skills. Addressing the challenges that physicians face in the workplace can yield positive results. Initial studies indicate that improvements in leadership, workflow and communication are helping to reduce physician burnout. Additional solutions include teaching physicians ways to deal with stress including mindfulness and stress reduction.

Solutions that improve communication and reduce bureaucratic tasks can also be helpful. Our RapidConnect secure messaging communication platform was developed by physicians to help alleviate some of the things physicians find frustrating and most wasteful of their time. RapidConnect reduces communication barriers and streamlines collaboration with other physicians and caregivers. It also gives physicians more control over how and when they respond, or even who responds on their behalf -- by working within their existing workflow and/or staff hierarchy. This improves overall physician and staff efficiency, freeing up time for meaningful patient interaction.

To fully address physician burnout, more initiatives are needed that will assist physicians with managing all of the demands on their time while reinforcing their sense of value in their work. The good news is that health care systems are recognizing the magnitude of the problem and more are working on initiatives to prevent physician burnout.


Improving quality and TCOC with better secure messaging

In July 2016, the US Government announced that the nation’s health care tab would surpass $10,000 per person for the first time in history. That spending is expected to increase an average of 5.6 percent annually through 2025, according to the Centers for Medicare and Medicaid Services. Of the total $3.35 trillion in healthcare spending each year, hospital care accounts for the largest share at about 32 percent.

With healthcare spending on the rise, affordability of care has become an increasingly important issue for health care providers, hospitals and patients. To address those concerns, an increasing number of hospitals and physicians are turning to value based contracts, with the goal of improving both quality and cost outcomes. Under these models, health systems and their affiliated providers are rewarded for collaboratively managing the total cost of care (TCOC), while maintaining or improving the quality levels of patient care.

For those organizations, efforts to manage total cost of care typically involve cost-cutting measures such as the use of generic drugs, shortening or avoiding patient hospital stays, avoiding costly Emergency Department visits, and the elimination of duplicative testing. All of these things have the opportunity to improve care and reduce costs.

One area that many hospitals neglect to consider is their secure messaging solution, which can help facilitate each of these cost-cutting measures and enable better collaboration between community-based physicians and hospital-based specialists to ultimately improve patient care.

To help demonstrate the role that secure messaging plays in the TCOC, we created the following infographic, which walks you through two different scenarios for a pediatric appendectomy. The elapsed time for that typical process is 23 hours. It presents a number of opportunities for both care improvement and cost savings, if the providers had better access to patient information and each other. As you can see, the alternative RapidConnect scenario dramatically cuts the total elapsed time down to 9 hours. It also creates a number of cost saving opportunities, including: the avoidance of an ER visit, a shorter Average Length of Stay (ALOS) and a less expensive (and safer!) imaging option.

Other benefits of the RapidConnect scenario include:

  • No delays in care due to the wrong person receiving the page
  • No need to call in the operating room team overnight for emergency surgery
  • Clarified direction on generic drugs (an additional cost savings)
  • Expedited and efficient communication back to the Primary Care Physician (PCP) on next steps (cost reduction and better continuation of care).

Using a secure messaging system of communication, like RapidConnect, across the inpatient and outpatient environment, enables the reduction of cost to the tune of at least $4200. And of course, the value of better, expedited, patient care is immeasurable.

The key is for health systems to implement a secure messaging platform that will be broadly used throughout the entire health system, including community based physicians and hospital based specialists.

This ultimately improves performance, lowers costs, and improves outcomes.

How does your secure messaging platform measure up, when it comes to Total Cost of Care? Let us know if we can help.

Healing What Ails Technology Adoption, Part 2

As discussed in our previous blog post, Healing What Ails Technology Adoption, MD Interconnect takes a two-pronged approach to successful technology adoption for secure mobile/web communication. That first post focused on designing a product with physicians in mind. Today, we will discuss the second part of that equation: building a successful implementation process. There are many critical factors that play a role in a successful implementation, but let’s focus on five key elements that lead to successful adoption.

  1. Communicate early and often. It is important to ‘set the stage’ with pre-launch communication in regularly distributed materials (i.e. publications, leadership emails, etc.) This can begin as soon as the selection committee (which should include physicians) has made their choice. It is critical to consistently outline what providers can expect in terms of process, timing, training, support and requirements. Providers must understand if any workflow changes will be required of them and why. Updates to implementation schedules/processes can all be communicated in regular briefings to the medical staff. In addition, getting to regularly schedule clinical service meetings to do brief demos of the product helps secure buy-in and reduces anxiety associated with a new technology,
  1. Partner with Physician Leaders Clinicians are more likely to embrace a new technology if their peers are positive about their usage of the product. Positive referrals are the most powerful engagement tool. Therefore, we start with a small group of healthcare providers and ensure they have a great experience. The small group is usually a relatively self-contained communication eco-system (i.e. Children’s Hospital within the Hospital). This allows us to work closely with the entire group and make sure we understand utilization issues that are unique to the individual hospital prior to rolling out to the entire system.
  1. Understand and integrate with physician workflows.

There are significant differences in how physicians work - no “one size fits all” approach will be successful All physicians have a unique workflow. When working with a complete community healthcare system, it is also important to understand the differences between inpatient based physicians (emergency, surgeons, hospitalist, etc) and outpatient based physicians (primary care, medical specialists, etc.) The needs on those two groups can be very different. In that same vein, differences between low volume and high volume users must be recognized and addressed

To better understand these specific workflow needs, we start with a survey of each practice about how communication is handled today, and what challenges each practice faces. Based on that insight, we build out “rules” for how RapidConnect will work to address those unique needs and integrate with their workflows.

  1. Prepare for the 20%

Physicians (like most of us) don’t like training. Burdensome training requirements can be the kiss of death for a new technology implementation.

RapidConnect was built by physicians to be intuitive and user-friendly, with no formal training required for end-users. 80% of users will be able to ‘download and go’. However, a secure messaging system is only productive if close to 100% of the physicians are using it. As such, its important to have specific strategies to support those physicians and clinicians that need assistance.

RapidConnect uses multiple techniques to achieve his. In addition to 24/7 help desk, online ‘how to’ videos and readily available ‘quick tip’ cards, we have a team of resources on site leading up to and during the ‘go live’ phase. These resources round on physician practices, spend time where doctors congregate (ED, OR lounge, physician dining, etc.) as well as participate in physician group meetings to address any issues or concerns. We also invest in training those that surround physicians – namely their nurses and practice managers. With specific training designed for them, clinical staff can support the implementation process. In addition a dedicated account manager will review message traffic, identifying those who seem to have long response times or regularly don’t answer messages. We will proactively reach out to those physicians and practices to address any issues that they may be experiencing.

  1. Facilitate ongoing user engagement

Every day, the RapidConnect support team will review message logs for failed messages or significant delays in response time.

This allows the support team to immediately address problem areas and respond, improving the performance of the product and physician satisfaction.  Poor response times and/or unread messages can jeopardize the adoption of the platform. Doctors in particular will become disenchanted and quickly abandon the new technology if the perceive flaws or unresponsiveness from others.

There have been numerous false starts and expensive failures in the implementation of secure text messaging platforms for healthcare. You don’t want to be one of those! To learn know more about how our RapidConnect secure messaging solution can help you avoid that fate, click here.

Are You Asking The Right Questions In Your Secure Text Messaging RFP?

As discussed in a previous post, there have been numerous false starts and failures in the implementation of secure text messaging platforms in the healthcare environment.  The landscape is littered with expensive solutions that have seen low utilization, projects being shelved and as a result patient health information continuing to be shared via unsecured methods.

The primary reason for this situation is poor adoption by physicians and subsequently inconsistent use throughout the system. Poor adoption leads to overall poor utilization and a lot of wasted time, money and energy.

But physicians and care providers aren’t to blame. The blame falls on the technology itself. Few of the existing secure messaging products were designed to work with physician workflows and account for physicians need to control accessibility.  Most physicians do not want others to have ‘open access’ to them, nor do they want to ‘sign in’ when they are available or remember to ‘sign out’ when they are not available.

While other technology vendors have provided public RFP templates for secure messaging, those templates focus primarily on the core functionality and the technical requirements of an individual product. They do little to highlight those functional features that will actually encourage broad physician adoption. So, while these templates are helpful, they do not necessarily help you achieve your goal of high user adoption.

With the goal of high user adoption in mind, here are seven key functionality questions you should include as part of your RFP for secure text messaging:

  1. Does the technology automatically route certain types of messages to the physicians designated resource? This might be a resident, PA, fellow, or other clinical staff member. Physicians need control over their access and most solutions don’t offer a way to integrate these physician preferences into their applications.
  2. How do physicians control their availability when they are not on call? Asking physicians to check in and check out every time they want to be unavailable is not a viable solution, and quite frankly, physicians won’t do it.  Look for a solution with one time availability set up that accounts for call and clinical duties.
  3. What happens when a message comes to a physician's phone when they are in the middle of a procedure?  This is one of the biggest complaints about secure messaging applications.  The application should have an ability for scrub nurses or other providers in the OR to proxy into the physician's account without having to access the phone. This allows timely response without the OR staff having to access doctor's personal cell phone and pass words.
  4. Does the platform allow for the user to identify and contact the patient's current care team (including currently attending hospitalists and nursing staff) through one click access? Having to sift through the frequently long and comprehensive ‘care team’ listing in the EMR does little to facilitate fast, seamless interaction to those who are taking care of the patient at the moment.
  5. Does the application integrate with call centers and other communication systems? Doctors don’t want to carry multiple devices. If secure texting is utilized as the primary method of contacting doctors (which increases adoption), the application needs to be integrated into the call center and function within the parameters of the call centers existing workflows
  6. Does the application architecture and pricing allow for broad distribution to outpatient-based physicians, including regional referring doctors without running afoul of anti-kickback laws and incurring additional costs? Many current technologies offer ‘per head’ licensing, which a) limits the distribution of the product, limiting the overall adoption (see point above). Also, the technical architecture needs to ensure the application can be provided to these referring physicians without fear of giving something of value to these doctors.
  7. Does the application integrate with nurse duty phones? Maximizing nurse/patient interactions is critical. If nurses have to use a desktop-based application, this reduces the available time for patient/nurse contact. Similar to the point above, if the system is to be charged for every downloaded application, adding the hospital-based nurses to the installation can be extremely expensive.  Evaluators should look for a product that not only encourages broad distribution, but facilitates that through enterprise-based pricing and integrates with nurse duty phones to maximize patient contact.

Healing What Ails Healthcare Technology Adoption

The marriage between technology and physicians is not always an easy one and there have been a lot of bad breakups over the years. After all, physicians went to medical school to treat patients, change the world, etc. They did not set out to learn a new technology every time they turn around and/or to play a leading role in technology implementations. Yet today, they are finding themselves playing that role and feeling the frustrations that go along with that.

There is no shortage of research that talks about the challenges vendors face when it comes to technology adoption with physicians (and healthcare in general). Look no further than the EHR (electronic health record) technology market to learn more about those challenges and the lessons learned from them. In a 2015 study by Physicians Practice, physicians cite a long list of technology challenges (many of which relate to their experience with EHR technology), including: a drop in productivity when rolling out new technology; lack of interoperability between technologies; meeting regulatory requirements; cost to implement and use technology; resistance to technology; security and training.

MD Interconnect co-founder Dr. David Hoover was all too familiar with those challenges, having been on the user side (the resistance side may be more accurate) of numerous technology rollouts. He knew that MD Interconnect had to do things differently to ensure successful adoption.

With this in mind, the MD Interconnect team took a two-pronged approach to adoption. The first approach may seem obvious: design a product that solves a meaningful problem, but design it with your users (i.e. physicians, etc.) and their workflows (maybe not as obvious) in mind. Surprisingly, many technology companies develop a product that solves the first issue (meaningful problem) but neglect to consider the second (user workflows and preferences). Consequently, they experience poor adoption, limiting and or even eliminating the product’s ability to succeed.

The second approach is equally important but often overlooked - build an implementation process tailored to address a physician’s unique objections/concerns with an understanding of their job, their workflow, their practice, etc. With that in mind, you need to make it as easy as possible for them to get on board (hand-holding as needed), quickly demonstrate the value of using the technology (what’s in it for them), and ensure that they are motivated to continue using it (continued engagement, tracking, etc.).

When it comes to developing a secure communication solution for hospitals, there are some basic features and functionality that every solution must have at its core. The solution must successfully facilitate the delivery of messages between users. And, the solution must address mounting security requirements that hospitals face, including the need for HIPAA compliance. There are a number of vendors that offer products that address those core requirements, but MD Interconnect created a solution that goes beyond these basic requirements to engage users and ensure adoption. You can learn more about the company’s physician-driven design in this previous blog post. Here are some of the factors MD Interconnect considered while developing a product with adoption and sustained engagement in mind:

  • Physician adoption is of the highest priority. Lead with them and the rest will follow.
  • You must make it quick and easy for messages to be read, and provide visibility to senders about that status.
  • You must consider a physician’s personal preferences about when they should be reached and when they should not.
  • Call schedules and call hierarchies must be integrated into the communication platform.
  • It should also support the teaching hospital hierarchy and include residents, APPs, fellows and attendings at the appropriate times.
  • You must consider times when a physician cannot safely respond to a message, making it easy (and secure) for a proxy to respond on their behalf. See this blog post on RapidPair to learn more.
  • You must address the differences between cell phones and pagers, as well as the unique challenges, benefits, and behaviors associated with each.
  • Your pricing model must encourage adoption by the entire patient care team/community.
  • The ability to easily forward a message chain to a support team, including clinic schedulers and bed management must be built into the solution.

With RapidConnect, MD Interconnect knew they had a great product that hospitals, physicians and patients would benefit from, but they also knew their job wasn’t done. See our next blog post on what it takes to ensure a successful implementation and ongoing user engagement.

Eliminating Distractions, Improving Patient Safety

Introducing RapidPair, the latest enhancement to RapidConnect secure messaging solution.

According to a 2000 report from The Institute of Medicine, To Err is Human, experts estimated that as many as 98,000 people died in any given year from medical errors that occur in hospitals. In 2016, after analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts published that more than 250,000 deaths per year are due to medical error in the U.S. In 2013, distraction from smartphones and other mobile devices was identified for the first time as one of the top 10 health technology hazards by ECRI Institute.

Hospitals and physicians recognize that electronic devices in clinical care environments have exploded over the last 10 years, resulting in an unprecedented level of distractions. They are committed to minimizing those distractions, especially in operating rooms and other procedure related areas, which are at especially high risk for interruption and distraction-related errors.

RapidConnect by MDInterconnect has risen to that challenge with the introduction of its latest feature, RapidPair. RapidPair enables physicians to quickly and easily allow a “proxy” to review and respond to secure messages on their behalf when they are otherwise occupied.
Imagine the following scenario.

RapidPair image 150A physician is in the operating room, performing a life-saving surgery. A message comes in to their mobile device. They know that a message has come in, but can they afford to stop mid-surgery to check that message and/or respond directly? Of course not!

Can they even afford to pause long enough to instruct the circulating nurse how to get into their personal device, to find the app and open the message using their personal PIN? Not really.

Other solutions on the market today claim to offer “proxy” or “delegation” type capabilities to address this problem, but create even more distractions by requiring multiple, sometimes complicated and inefficient steps be taken by the physician and/or circulating nurse.

If a so-called “solution” is too time-consuming, complicated or dangerous to use, how likely are physicians and/or hospitals to actually use it? Hospitals and physicians want a solution they can trust to make their job easier, and one that certainly doesn’t jeopardize patient care.

MD Interconnect took all of these concerns into consideration when developing RapidPair, and designed it to accomplish the following:

  • Require minimal disruption to a physician’s normal workflow
  • Ensure process does not rely on clinicians resetting status each time they 
enter procedure area
  • Ensure that on-call physicians can be reached at all times
  • Eliminate the need for “proxies” to access a physician’s personal device
  • Ensure rapid, secure communication

With RapidPair, the physician simply asks the proxy (i.e. circulating nurse) to check the incoming message. The proxy does this through any computer (not the physician’s personal device) by signing into their own RapidConnect account and accessing the RapidPair function. With minimal disruption to the patient or procedure, they can immediately see the message and respond based on the physician’s instructions. Each proxy can pair up to 10 devices at one time. The clinician is not required to change any settings or status on their own device.

RapidPair minimizes:

  • Distractions in the operating room and/or during other patient interactions
  • Changes to physician behavior and/or workflow
  • Security concerns, with the messaging platform itself and/or physicians’ 

RapidConnect gives physicians the flexibility they want, to choose the options that work best for them, and thus provide the best patient care possible. RapidPair complements other features like QuickCover, Read Notifications, Shift- based Roles, Message Routing, etc. allowing widespread adoption by clinicians enabling a system to implement a secure, team-based, collaborative and effective approach to patient care.

Creating a physician-driven solution to deliver more efficient and effective patient care

In this interview with co-founder and Chief Medical Officer Dr. David Hoover, we share how his personal experience drove the creation of RapidConnect and how that experience sets this secure messaging solution apart from others in the healthcare market.

In 2014, David set out to respond to a critical challenge that physicians face, and one that he had experienced directly; connecting the right physicians at the right time, to ensure the best possible outcome for patients.

As a pediatric surgeon, David relies on physician referrals to connect with patients in need of his specialized services. He realized that outpatient-based physicians (pediatricians, internists, etc.) had a hard time reaching specialists (like him) based on a confusing list of various numbers and instructions depending on day of the week, time of day, secondary contacts (such as a PA) and other variables. It was frustrating to say the least and was far from efficient and/or effective.

To address the problem, hospital administrators would often add yet another 800 number and hire additional call center staff members to handle the calls. “This was obviously not a satisfactory solution to improving patient care in the long-term. I just knew there had to be a better way.”

David decided to take on the challenge directly, and began by researching existing solutions on the market. “I found a few available options, but none of them allowed users to create physician preferences based on how they wanted to be contacted and/or how they worked.” David knew the ideal solution would help users connect with the right provider at the right time, in a streamlined manner that worked for all parties involved.

David created MDInterconnect and worked with his software development team to prototype what he thought that solution should look like. He pulled from his own extensive healthcare experience and understanding of how physicians and hospitals operate. He also leveraged input from other physicians, hospital administration, call centers, etc. to address the nuances for both in-patient and outpatient providers. “We really gave thought to a number of possible scenarios and how we would account for each one in our software.”

“We were very in touch with what would make this work for physicians and knew that we needed to make the technology easily accessible and user friendly. Our flagship product, RapidConnect, was built on that philosophy and continues to evolve with that in mind.”

While other solutions are technology driven, RapidConnect is the only solution on the market that is truly physician driven.  But, that is not the only thing that sets it apart. Secure messaging, call center components, ease-of-use, and delegation capabilities are just a few of the unique elements it has to offer. RapidConnect even offers built-in call scheduling functionality but also integrates with other industry-leading call scheduling solutions, such as Lightning Bolt.

David set out to improve communication between providers and to ensure the best possible patient care when they need it most.

“Better communication creates efficiencies around managing a patient’s care as well as the transition from one care setting to another. Treatments and meds are administered more quickly and effectively. The care team is engaged more collaboratively. The patient is managed more successfully. I wanted a solution that would lead to these outcomes.”