Clinical Communication Must Evolve to a System of Record, Display and Action to Improve Efficiency


Aug 9, 2017 Brad Brooks, Co-Founder & CEO, TigerText

Originally published in Becker’s Hospital Review

It’s no secret that electronic health record (EHRs) still do not fit well with clinical workflows. This means providers often wait until the end of their shift to enter data, which leads to stale information for other care team members until the chart is updated. To mitigate that risk, they often carry their most recent patient information with them on paper or their personal mobile device.

Care team members then communicate that patient information through their devices’ messaging app, violating HIPAA and likely hospital policies. For all of these reasons and more, hospitals must evolve past this outdated, fragmented state to one that combines EHR data, imaging and clinical communication tools into a real-time, unified system of record, display and action.

Those elements in greater detail are:

    • Record: Point-of-care entry into the EHR to share data in real-time with care teams
    • Display: Accessing relevant EHR data, images from PACS technology and other information to collaborate with teams and move care journey forward
    • Action: After care teams have collaborated through secure, integrated text messaging across a unified platform, physicians and other clinicians can create orders, deliver care, or transition the patient to next phase

As a result of this more efficient communication that aligns with providers’ natural workflows, less time is wasted waiting to act, productivity rises, and both patient and provider satisfaction increases.

Timely data entry impacts clinical and financial outcomes
Despite these benefits, most organizations are stuck in environments of inaction. This is caused by disconnected communication exacerbated by hard-to-access systems and delayed charting. Care team members often do not have real-time information or the direction they need to deliver prompt, effective and coordinated care, which later impacts revenue cycle down the road.

For example, coders with questions about a procedure or treatment cannot submit a complete claim and must wait for the physician to add notes. Cash flow slows even further when the coder is unable to reach the provider due lack of updated contact information.

An integrated system of record, display and action allows physicians to complete necessary charting at or near the point-of-care in near real-time. Coders have easier, direct access to providers, likely through text messages, to answer questions and make documentation requests. This modern, efficient workflow enables prompt and accurate billing, speeding up cash flow and maximizing reimbursement.

Integrating imaging
Accessing and sharing messages and other patient data is the primary driver for care collaboration and communication. The ability to share images, however, is also crucial to help drive safe and effective clinical action.

Results from a 2015 survey show that 88 percent of the physicians indicate advanced imaging increases their diagnostic confidence, improves clinical decision making, and increases confidence in treatment choices; and 86 percent agree it shortens time to definitive diagnosis. Imaging data is so crucial that some hospitals even have a policy requiring the radiologist to contact the physician directly if there is an abnormal reading. This policy, while well intentioned, leads to phone tag and care delays.

With a clinical communication system of record, display and action, the radiologist can send the physician a secure text notifying him or her of the abnormality along with the image. The physician does not have to wait until the radiologist calls directly or access a separate PACS viewer to review the images. Through secure, mobile technology, the care journey moves forward, reducing costs for hospital and patient while improving satisfaction.

Identifying and connecting to revolving care team actors
The dysfunctional clinical communication among care teams that occurs in many hospitals is often attributable to shift-based scheduling. The constant cycling of providers makes a hospital like a 24-hour stage play with a revolving cast of actors, which can lead to confusion, errors and wasted time.

In healthcare terms, a nurse may not know who the on-call orthopedic surgeon is, so she searches a printed or whiteboard directory, which may not be updated. An integrated system of record, display and action, on the other hand, allows the nurse to search the automated electronic directory for the on-call physician’s mobile device number based on the physician’s title alone. The technology has the most updated contact information, so there’s no searching for the right number and the nurse can confirm if the text message has been delivered and viewed.

With such a system, users can also create care team group messages around individual patients or rooms to make handoffs easier and safer. New team members, for example, have immediate access to previous discussions between other members of the care team, ensuring no important information is missed.

Unifying care teams through unified communication
A system of record, display and action lets clinicians know what’s being done as it is being done, regardless of their location. Such a system centralizes and synchronizes patient information on mobile devices, enabling physicians, nurses and support staff to access a wide range of information that is normally accessible only at disparate workstations.

By evolving to this unified system, healthcare organizations can dramatically improve care coordination, providing a better experience for patients while also reducing operational costs and physician burnout.