The following is a guest blog post by Mary Hatcher, Vice President of Product Development at PerfectServe.
When multiple specialists and post-acute providers are serving the same patient, getting the right information to the right person in a timely manner becomes more challenging. Dozens of nurses and therapists. Several doctors. Various settings. The complexity adds up, and in these scenarios, communication breakdowns are more likely to occur.
The stakes are high when it comes to healthcare delivery, so these cross-organizational communication challenges affect the clinical care team, the patient and the patient’s family all at once. Family members are often active participants in care, and rather than operating in siloes, physicians and nurses have to coordinate with other members of the care team. Patient information must be available to all parties to ensure the best outcome.
In these complicated medical cases, clinical communication technology must be flexible enough to support all departments and organizations, as well as their associated messaging preferences. Consequences can include mismanaged meds, duplicate tests, unnecessary costs, inaccurate diagnoses, and in some cases, even death. That’s why, in the ECRI Institute’s survey of Top 10 Patient Safety Concerns for 2019, the solution for the number one concern—diagnostic stewardship and test result management—is to “recognize the importance of clear communication, both among caregivers and between caregivers and patients.”
When do challenges occur?
These complex communication challenges most often occur immediately after discharge or when a patient is moving from the hospital to another setting with a different care team. The point of discharge or transfer can be an abrupt and confusing experience in the patient journey. Some patients receive minimal information about appropriate next steps for their care, while others receive an overwhelming amount of information. In some cases, the primary care physician lacks sufficient information required to continue proper care. A recent study by the University of California, San Francisco highlighted the adverse effects of poor transitions, with more than a quarter of hospital readmissions observed in a group of 1,000 general medicine patients being attributed to insufficient communication.
Patients with overlapping chronic conditions that require multiple specialists are particularly at risk. For example, a patient with an acute exacerbation of adult-onset diabetes mellitus (AODM) as a primary condition could likely also have congestive heart failure (CHF), hypertension and myocardial infarction (MI) as concurrent conditions (comorbidities). While in the hospital, the patient could expect to be seen by an endocrinologist, cardiologist, pulmonologist and hospitalist who all need to coordinate care. Post discharge, the patient would likely be referred to a diabetes clinic with follow-up plans to go to cardiac rehab services, a cardiologist to manage heart function, as well as a primary care physician to monitor all other medications. Clinical communication technology supports and connects each of these providers during the inpatient encounter and throughout the patient’s post-discharge treatment.
What is technology’s role?
Some in the industry believe that EHRs are equipped to solve all communication issues, but that is a misconception, especially when complex care transitions are involved. Though the EHR plays a vital role in operational efficiency to improve outcomes, a platform with more robust cross-organizational capabilities is required to ensure time-sensitive, urgent, person-to-person communication is possible in the course of care delivery.
It is important that health systems be aware of the EHR’s limitations. The EHR messaging component is limited to acute care setting users, with no communication and collaboration capability beyond the hospital. Understanding complex workflows is critical to creating a clinical communications solution that enables clinicians and other members of the care team to effectively coordinate care across specialties, settings and post-discharge locations.
What does a connected care team look like?
Healthcare organizations need a standardized process with tools and infrastructure that connect all care team members. What does that look like?
- Integration with EHRs and other systems and applications is essential to efficient care coordination across all communication workflows and channels.
- The use of web and mobile applications facilitates communication and collaboration across settings in real time. For example, a nurse using a web app can easily direct communication to a doctor who uses a corresponding mobile app while away from a desk. The doctor can then take immediate action to ensure better, quicker decisions are made regarding the patient’s care.
When a patient moves from the hospital to a post-acute care facility, the entire care team must remain connected to ensure adherence to the care plan. With better communication across the continuum of care, both the patient and the patient’s family benefit through reduced readmissions and improved healthcare outcomes – even for the most complex cases.
About Mary Hatcher
As Vice President of Product Development at PerfectServe, Mary Hatcher is responsible for driving product vision, strategy and execution of the company’s clinical communication and collaboration platform. She leads PerfectServe’s high-performing development team responsible for product management, engineering and quality assurance, and has a proven ability to successfully create, launch and scale market-leading technologies. Mary joined PerfectServe in 2001 and served in leadership roles across client services, implementation and product management before assuming her current position. She designed the company’s Dynamic Intelligent Routing™ capability, a key differentiator of the solution’s single-platform architecture. She is a recipient of the PerfectServe Ambassador award, a testament to her contributions and the respect she has earned during her tenure. Mary earned a bachelor of science degree in engineering from Michigan State University.