Converting Unread Messages Into Better Patient Care

The incredibly fast rise in smart phone use has caught many healthcare institutions off guard and in a reactionary mode as mobile phone ownership has risen from introduction in 2007 to over 95% by 2018. Televisions by comparison took over 30 years to reach over 90% homes (Pew Research 2018).

As a result, hospital leaders across the country are urgently weighing the benefits and the risks associated with system provided mobile devices and BYOD policies. As many providers put away pagers in favor of their cell phones, systems are left scrambling to understand the implications.

Added complexity and new risks

While discussions around security have been commonplace, conversations about system reliability and the effect of new devices on urgent messaging and response times are rising to the forefront.  Could the use of cell phones actually improve response times or would they complicate and negatively impact response times?

Pagers have owned the urgent messaging space and, while not always reliable, were seen as simple to use.   Mobile phones seem to get smarter the by minute, with increased functionality that could improve communication dramatically but they also bring a new level of complexity.

Taking a personal and proactive approach

When we launched RapidConnect, we knew that as a “pager replacement solution” our RapidConnect app needed to offer “download and go” simplicity, but also recognized that the support model behind it had to be highly engaged and proactive in order to address challenges users have with their smart devices.

Based on our direct knowledge of the healthcare environment, we knew that every single message has the ability to impact the care of one person’s life; and that reliability needs to be measured one message at a time, not in averages, and that a one-size-fits all approach to messages wouldn’t work. Many messages are urgent and need attention right away.  Some messages are for referrals and appointments, and need to be scheduled soon but not urgently.  All are important and impact a patient’s care.  Regardless of content and urgency, having a message go unread will delay care, create frustration and prompt users to find alternative methods of communication which may not necessarily meet HIPAA or institution compliance.

Relying on robust system alerts and automated notifications, account managers at RapidConnect reach out to users in order to avoid any missed communication.   Thousands of messages are sent through RapidConnect each day.  Messages are answered in a timely manner due to checks and balances built in to the system. However, on average MDI account managers are alerted to 15 messages each day that require their attention. Some of these 15 interactions are urgent.

Based on our experience providing proactive service to thousands of providers, we have uncovered the following common challenges that users face:

  1. Notifications are turned off on the phone
  2. They have lost or misplaced their phone
  3. They recently got a new phone and forgot to restore their apps
  4. RapidConnect email reminders have mistakenly been blacklisted from their office email system

We have found that users are very appreciative our follow-up, and that our assistance has helped create trust in us and RapidConnect.  In some cases, depending on the type of message, account managers may also follow up with not only the recipient but also the sender to let them know their message will be read shortly.  Proactive communication by our account managers also keeps users engaged and builds confidence.  Every user that remains highly engaged impacts every other user’s experience and has the ability to impact patient care in an arena where minutes really do matter.

As an added value, we also provide message traffic reports to some services.  RapidConnect, unlike most paging systems, provides detailed reports including volume of messaging by service, response times, follow up messaging, and analysis of use by time of day.

Providing impactful data ensures that each service or department can also work with their team to reduce response times.

Improved communication and collaboration

From a technology standpoint, our approach also increases user adoption as they grow to trust RapidConnect

Most importantly, that approach enables better collaboration across the entire care continuum, and ultimately results in better patient care.

CINs play a lead role in changing the future of healthcare

A few weeks ago, I had the opportunity to attend the Lurie Children’s Clinically Integrated Network annual meeting. Brent James, MD, known internationally for his work in clinical quality improvement provided the keynote. Also, presenting were Madeline McDowell, MD and Karyl Kopaskie, PHD of Sg2 and Toya Gorley, MBA from NRC Health.

It quickly became evident that this was not just a group gathered to sit back and idly listen to the speakers. These were providers and support staff from across Chicago, who had gathered to connect, share ideas, ask questions, and collaborate as part of a larger community. They were here to tackle problems from many different viewpoints - the analyst, the practice manager, the surgeon, the researcher, the pediatrician etc. For a few hours that day, I had a window into a group that is committed to keep at this, to iterate again and again as necessary – to ultimately seek a better way for patients and providers.

As a consumer of healthcare who is at the mercy of the institutions, individuals, technology, traditions and training that collectively create our “healthcare system”, I was encouraged to see that the human side of that system is alive and well. What I saw were people who stepped away from their packed day and obligations to actively participate in improving this system.

Brent James, while briefly lamenting the fact that the Senate Judiciary committee members in 2009 had enjoyed using his message to decry all the ills of our system, was energetic about the opportunities within reach … not dependent on correcting complex laws and payer relationships but actually within reach today for providers.

There was much talk and data supporting industry trends moving from pay for service to pay for value in a provider at risk financial environment. There were discussions around reducing the massive variation in clinical practices, increasing E&M virtual visits, direct employer contracting, consumer trends in social media usage for healthcare decisions and more – so much to digest and consider.

Ultimately, my biggest takeaway was an appreciation for the role the CIN plays in bringing together the people who actually embody “the system” and in providing pathways for these individuals to lead the way in improvements that can eventually impact us all.

I am excited about the work we do with Lurie Children’s Clinically Integrated Network, and look forward to being part of the change they are creating. You can read more about that in this case study or contact us to learn more.

Avoiding the best of breed vs best in suite technology trap

Have you ever heard your neighborhood barista ask, “would you like your coffee to be hot OR taste good”? Of course not! There is no sense spending the time in line or spending your money if the coffee is not both hot and good.

Unlike your neighborhood barista, many health systems are asking an “either-or “question when it comes to new technology - “do we go to a new vendor for full functionality or use a limited add-on offered by a current vendor?”

CIOs and CTOs have struggled with this same question for years. They often follow a well practiced analysis of best of breed vs best in suite (in this case probably your current system) by weighing the benefits and costs associated with implementation, integrations, security, networking complexity, user training, duplication of data and processes, timing of upgrades, customizations, flexibility of vendors, user- interfaces, and more.

While this approach may seem “tried and true” it can actually lead to a terrible waste of time and money. The best technology choice will only be found if you start with a entirely different question. Are you going to mandate the use of this technology or give users a choice?

If choice is permitted, then your evaluation process needs to start with user adoption in mind. In that case, here are some criteria to consider:

  • Ease of use- Can people easily understand purpose and use of system?
  • Ease of access- Can people easily find system and log on and off without trouble?
  • Clinical impact - Does using this system improve user ability to accomplish clinical goals?
  • System Support- Is system support uniquely attuned to the medical environment in terminology and speed?
  • System Flexibility- can the system be easily configured to meet unique needs of various service areas?

If you start by defining a platform or tool that your users will actually choose to use before thinking about vendor selection, you are more likely to see a better return on that technology investment in addition to higher user adoption and satisfaction.

If you would like to learn more about our philosophy on technology solution, or talk to one of our customers about their selection process, let us know.

Pagers Putting Hospitals (and Patients) at Risk

With the Kansas City Star article making waves across the nation, there is no excuse for thinking that pagers are still an acceptable option for sending patient health information (PHI). And no one can deny that healthcare workers routinely include PHI in their pages. According to 2017 study by the Journal of Hospital Medicine, nearly 79 percent of 620 hospital-based clinicians said they are provided pagers for communications, while 49 percent said they receive patient care–related communication through pagers.

As the IT worker in the Kansas City Star article demonstrated, anyone with $20 and TV antenna can now easily stumble over or intentionally access PHI. Awareness of the security risk posed by sending PHI via pager has increased nationwide.

What is being done about it?

Red flags should be flying. Not the kind with the white cross in the middle but the kind that indicate “Danger ahead. Stop, or proceed with extreme caution and at great risk!” Using pagers to send patient health information, as practiced today in most healthcare organizations, is unsecure, puts a system at risk for significant HIPAA violations and compliance fines and creates additional vulnerabilities for the patients themselves.

To further emphasize the importance and urgency of action, just last week an administrative law judge ruled that the MD Anderson Cancer Center in Houston must pay $4.3 million in fines over a stolen laptop and two lost USB drives; an amount that cannot be easily ignored.

So the question has shifted from “can we use pagers for sending patient health information?” to “how quickly can we move to an encrypted method of communication?”. Now, more than ever, speed of deployment is of great importance but training, reliability, accuracy, and patient safety cannot be short-changed. Traditionally, changing communication tools, workflows, processes and expectations in a hospital has been more like moving a barge than racing a speedboat. Speed was definitely not a top consideration option. Several high profile incidents have changed this. Speed is now required.

Finding a Balance

So how do you quickly provide a compliant system without jeopardizing patient care?

First, every system must immediately educate employees and providers on acceptable pager use and explicitly prohibit patient health information. Actions must be taken to monitor accountability to the policy. Informal polling often finds that there continues to be confusion over what information is considered PHI and if there are certain situations where it is still “OK” to use the pager for PHI.

Second, an encrypted method of communication must be made available to all providers. This method needs to be a simple solution for quick deployment, but also a robust system that can support increased usage and complex workflows in later implementation stages. The simplest solution will be a download and go mobile communication app, which encrypts in rest and in transit.

Finally, the chosen encrypted method of communication must be easily monitored and provide tools for accountability. Monitoring will need to include real time alerts, escalations and read times analysis in order to ensure the smooth and quick flow of patient care information.

There are many more questions to be asked and issues to be addressed in the months after initial implementation such as questions involving system integrations with call schedule and EHR systems, access points, and adoption by the referral community. These questions may need to work their way through hospitals at a more “normal” speed and will benefit from the deliberate and collaborative ways that change has been traditionally implemented in large systems. Finding that balance is key.

Let us know if you would like to learn more about secure communication alternatives that are designed for physician adoption, to support health system integration and to deliver immediate value.