Category Archives: Clinical Workflow

Terry Edwards

3 takeaways from HIMSS17

By Terry Edwards  /  28 Feb 2017

More than 41,000 healthcare IT and clinical leaders converged on Orlando last week for the annual HIMSS Conference & Exhibition. This event generates a lot of industry buzz and, for some organizations, sets the stage for the year in terms of strategic focus and planning.

As I looked through the educational sessions offered in this year’s curriculum, I found it striking that nearly half of the 20 education tracks elevated the need for secure, real-time and reliable clinical communication and collaboration.

From “The Business of Healthcare and New Payment Models” track to the “Quality and Patient Safety Outcomes” track, attendees received an abundance of information pertinent to the strategic goals the industry will focus on in the year to come — goals that need a foundational infrastructure of secure clinical communications.

Here are three areas that I see most affected by the need for improved care team collaboration:

  1. Care coordination, value-based care and population health

The level of care coordination needed to successfully adapt to value-based payment models requires interdisciplinary clinicians to easily and securely communicate within — and beyond — the walls of the hospital. Regardless of affiliated organizations or geographical locations, these clinicians need instant access to the broader care team — and the patient — and they must have the ability to quickly send and receive critical PHI. This will enable hospitals and large systems not only to succeed in value-based care, but also to reduce costs and lay the necessary foundation for true clinical integration and population health.

(I talk more about this in my blog post “Healthcare is ripe for tools to enable value-based collaborative care” — read it here.)

  1. Technology, infrastructure and security

To achieve the level of care coordination required to truly address value-based payment models, organizations have to build a secure and compliant technological infrastructure that supports device standards and the communication protocols of the various workgroups that make up dynamic care teams.

Privacy, security and compliance will continue to be important objectives; the foundation of these objectives is an infrastructure that meets requirements without impeding communication and collaboration. This means automatically and seamlessly sharing information through mobile applications that are easy to use and easy to incorporate into existing workflows. Only then will we have tools that will achieve the levels of adoption necessary to make them truly impactful.

It seems like an arduous task, but it’s one we cannot shy away from.

  1. Analytics, process improvement and clinician engagement

As a result of the digitization that has occurred over the past decade, the industry has amassed a significant amount of clinical data. The farther we go down the road toward clinical integration and real value-based care, even more data will be created. To make lasting improvements and affect positive change, we have to harness this data and make it useful.

By gathering and analyzing data related to patient conditions and behaviors, intelligent decisions can be made automatically via technologies that reduce the cognitive load on clinicians by presenting only the information that is relevant to them and requires their actions. This will support value-based care and patient compliance and experience, as well as reduce costs by streamlining workflows and better engaging physicians.

In the same vein, HIMSS17 attendees were heavily focused on the topics of cognitive healthcare and actionable intelligence. Keynote speaker Ginni Rometty, CEO at IBM, spoke about this new era of medicine and challenged healthcare leaders to step up and “build this world.”

“We’re in a moment when we can actually transform pieces of healthcare. It’s within our power,” Rometty said during her HIMSS17 keynote. “This era that will play out in front of us can change the world for the better.”

The industry is changing at a speed that we haven’t seen before. This really is the time for healthcare leaders to make their voices heard and to take part in shaping the future healthcare landscape.

And it’s exciting to know that PerfectServe is in the thick of it with you — building a foundation of secure and immediate clinical communications across the broader care continuum that’s needed to achieve the goals discussed in the majority of the educational tracks at this year’s event.

Looking forward to seeing you all again next year.

HIMSS18
March 5-9, 2018
Las Vegas, Nevada

Terry Edwards

Safeguarding security: 4 tactics for secure clinical communication and collaboration

By Terry Edwards  /  29 Jul 2016

I had the honor of speaking at the 2016 Becker’s Hospital Review Annual CIO/HIT + Revenue Cycle Summit, discussing the elements needed to truly secure clinical communications with some of the best minds in the healthcare world. With a number of recent high profile news stories announcing ransomware attacks in hospitals and health systems, security and the ability to secure clinical information is top of mind for many.

Those who oversee organizational data and IT systems recognize the importance of securing communication channels containing ePHI as they build a unified communications strategy. While security and regulatory mandates are essential elements of a clinical communication strategy, to create a truly successful strategy, the needs of those who provide care: physicians, nurses, therapists and others on the care team – in any setting – at any time – must be addressed flawlessly and securely.

To do so, there a few tactics to keep in mind:

Understand what the HIPAA Security Rule actually states – There’s been a lot of confusion in the industry when it comes to HIPAA compliance and communication. I often notice that many organizations think this is all about secure text messaging, which is incomplete. The Security Rule never speaks to a particular technology or communications modality, application or device. It is technology neutral.

HIPAA compliance is about the system of physical, administrative and technical safeguards that your organization puts in place to to ensure the confidentiality, integrity and availability of all ePHI it creates, receives, maintains or transmits. Because of this, there is no such thing as a HIPAA-compliant app.

Understand care team dynamics – Care team members are mobile and they employ workflows to receive communication based upon situational variables such as origin, purpose, urgency, day, time, call schedules, patient and more. The variables determine who should be contacted and how to do so for every communications event.

For this reason, third parties (hospital switchboards and answering services) and disparate technologies are used in organizations’ clinical communication processes. Understanding this variety of technologies and actors is key to accurately assessing your organization’s compliance risk. And, coming up with strategies to effectively address that risk is key.

Secure text messaging is essential, but it’s not sufficient – While secure messaging is an essential component of your overall strategy, it’s not sufficient because:

  1. it requires the sender to always know who it is they need to reach—by name.
  2. it requires the recipient to always be available to other care team members 24/7.

These requirements are inconsistent with the complexity inherent in communication workflows that enable time-sensitive care delivery processes, because they don’t address the situational variables I described above.

Secure messaging is only one piece of what should be a much larger communications strategy—one that should address clinician workflows and multi-modal communications channels for all care team members.

Your goal should be to enable more effective care team collaboration – Organizations often focus on achieving HIPAA-compliance. This is a flawed objective. The focus should be on achieving more effective care team collaboration. If this is done effectively, achieving HIPAA-compliance will come along for the ride.

Six essential capabilities – An effective secure clinical communications and collaboration strategy will include the following six elements.

  1. It will facilitate communication-driven workflows that enable time-sensitive care delivery processes. An example of a communications-driven workflow is stroke diagnosis and treatment. When a patient with stroke symptoms presents in the ED, one of the first things the ED physician does is initiate a communications workflow to contact the neurologist covering that ED at that moment in time, while simultaneously notifying and mobilizing a stroke team to complete a CT scan to determine if it is safe to administer tPA, the drug that arrests the stroke. Time is critical. Healthcare is chock full of these kinds of workflows, executed every day in every hospital by the hundreds and thousands.
  1. It will provide technology that automatically identifies and provides an immediate connection to the right care team member for any given clinical situation—this is nursing’s greatest need! Your strategy should be to bypass third parties and eliminate all the manual tools and processes used to figure out who’s in what role right now given the situation at hand. Ignoring this need means you won’t achieve adoption, which means your organization will still be at risk.
  1. It should extend beyond any department and the four walls of the hospital. It should enable cross-organizational communication workflows. This is increasingly important under value-based care where care team members must collaborate across interdependent organizations to deliver better care.
  1. It should secure the creation, transmission and access of ePHI across all communication modalities—not just text messaging. Enough said!
  1. It should integrate with your other clinical systems to leverage the data within those systems to facilitate new communication workflows. This is key to enabling “real-time healthcare.”
  1. It should provide analytics to monitor your communication processes and continuously improve those processes over time.

With these capabilities in place, secure clinical communication simply becomes another positive result of implementing a broader care team collaboration strategy, designed to address clinical efficiency and improve patient care delivery.

A senior doctor using a smartphone

Mobile charge capture: A simple change to your business practices with significant outcomes

By Michelle McCleerey, PhD, MA, MEd, MBA, RN  /  19 Jul 2016

While there are conflicting perspectives on the physician shortage, there is resolute agreement that the demand for primary and specialty care is growing due to the expanding older population. Concurrently, the challenges for physician practices, which are needed to provide that care, are also increasing. Older patients require 2–3 times the amount of specialty and primary care to treat and manage chronic conditions and age-related illnesses. Unfortunately, in today’s ever-changing healthcare environment, many practices are struggling to survive.

As has never been experienced previously, practices are facing daunting obstacles to care delivery due to rising operating costs, regulatory burdens and barriers to receiving pay/reimbursement. The cost to operate a practice has increased at twice the rate as the consumer index due to increasing rent, malpractice insurance, liability coverage, health insurance and personnel expenses. Mounting regulatory requirements have not only served to increase overhead, but have also consumed valuable patient care time with oppressive documentation and administrative requirements for HIPAA, Meaningful Use, prior authorization and quality mandates.

Now in the wake of the time-consuming and costly protracted transition to ICD-10 and EHR implementation, physicians are struggling to get paid. In part, this is due to the ACA which has introduced reimbursement cuts and increased penalties. Last year, the Centers for Medicare & Medicaid Services (CMS) began to apply the value-based payment modifier to adjust reimbursement amounts to reflect the quality and cost of care provided. Those practices not meeting performance standards will receive less reimbursement. In addition, this year, the penalty for non-participation in the Physician Quality Reporting System (PQRS) increased to a 2% reduction in the CMS market basket update. Further, the increased number of patients with insurance provided through state exchanges or the Federal marketplace has exacerbated the payment problem. These patients typically have very high deductibles, along with a 90-day window to pay premiums, posing more obstacles to the collection of co-pays and out-of-pocket expenses. Notoriously, it should be noted that the CMS also takes longer to reimburse physicians as compared to private payers. Moreover, the ICD-10 transition has resulted in increased claims denials, resulting in labor-intensive, time-consuming efforts to overturn the same.

Confronted with these challenges, paradoxically, many physicians have had to reduce the number of patients they see, further eroding financial return. However, for those struggling practices, indiscriminate cost slashing is not the answer as physicians must finely balance improved operational efficiency with the achievement of the aims of quality patient care. This is where innovative technology can play a key role. Smart investment needs to target technology that is able to:

  • Reduce operational expenses
  • Ease regulatory compliance and the documentation demand
  • Facilitate physician workflow
  • Increase patient care time
  • Generate more revenue

One such technology that meets the above criteria is mobile charge capture functionality within a secure messaging application. This would enable physicians to quickly and easily capture charges at the point of care and automatically and securely communicate this information to billing staff or a billing application.

To ensure there is no increased burden to physicians, this process must only take a couple “clicks” or a matter of seconds. For example, the application must have immediate accessible “favorite” codes composed of those services and diagnoses used most frequently and denoted by the terms most familiar to that particular practice, rather than formal codes and code definitions. Additionally, when needing to find a rarely used code not contained within favorites, the application should provide decision-support enabling the easy selection of the right ICD-10 code to be associated with the CPT code. Also, there should be code bundles available so multiple code combinations can be assigned to a patient in a single click.

This prompt and speedy process replaces the manual paper-and-pencil method in which physicians retrospectively attempt to make a note of the procedures performed —sometimes days or even weeks after the encounter. Consequently, quite often, not all services that were provided are recalled. These “notes” were then provided to the practice billing team who then must interpret the right procedure and identify the correct codes for billing purposes. Often because of the lack of detail within the notes, the specific details of the procedure are lost, reducing the amount of reimbursement received on top of the lost charges due to poor memory.

These issues could be virtually eliminated with smart mobile charge capture functionality. Additionally, this functionality enables the ability to easily add and document PQRS codes while facilitating patient rounding, with a customized patient list and direct access to previous charges, and with the ability to rapidly “clone” them for the day’s visit. This information would also be visible across the entire group of physicians, if desired.

By automating and expediting the charge capture process, there is a direct impact on the practice’s financial homeostasis:

  • The elimination of lost charges and improved coding specificity directly translates into higher revenue.
  • The coding decision support and the inability to mismatch CPT and ICD-10 codes mean reduced potential for costly and time-consuming audits and claims denials.
  • The easy documentation of PQRS avoids the 2% CMS penalty and facilitates compliance.
  • The immediate transmission of charges to billing staff speeds the time to billing, reducing the amount of time to payment received.
  • The number of FTEs required to support the coding and billing process can be dramatically reduced markedly decreasing operational expenses.

Most importantly, such technology can allow physicians to spend more time doing what they want to do and what we need them to do—caring for and treating patients.

real-time-healthcare

3 “must haves” for simplifying complex clinical communications

By Julie Mills, RNC  /  30 Jun 2016

Part 3 of a 3-part series in conjunction with our nurse leadership webinar series.

Imagine a world where you launch the EMR, review a patient’s chart, and want to discuss it with the covering cardiologist that day. You click a link for the cardiologist within the EMR and it references that provider’s group workflow processes, reviews their schedules and monitors their momentary status to direct you to the correct provider. Then you type your message. The patient’s information is pulled from the EMR and is securely routed to the recipient based on their contact preference in that moment. It can happen – but this is not the norm in most healthcare facilities today.

Practicing medicine today is complex – clinicians need to consider an ever-changing landscape, federal and state regulations, not to mention the many different innovations designed to help streamline everything from care delivery to reimbursement. Adding to the complexity are the many different providers treating patients, working across various care settings with large care teams.

Given the vastness of these care networks, it can be daunting – albeit necessary – to coordinate care. One way to help connect clinicians in all care settings and improve care team collaboration is through a comprehensive communication solution.

It’s important to first understand why clinical communication is complex and why many of the technologies implemented today aren’t solving the issues clinicians are facing. Factors such as the patient’s reason for contact, the physician’s location, team coverage, degree of urgency and unassigned ER calls all impact the communication process.

Looking across varied care settings, people, processes and preferences also differ. Between inpatient and outpatient facilities, medical group practices and post-acute care, there are many variations in care team communication strategies and approaches that make it prone to gaps and breakdowns. In fact, one of the most frustrating parts of a nurse’s job is the daily battle to determine the correct covering provider.

In this complex environment with so many participants, the continuum of patient care demands that communication solutions span much further than the four walls of a hospital or practice. And as healthcare delivery models change, it’s imperative that care coordination, and the communication that drives it, be streamlined and efficient across all of these settings. When looking for a platform to simplify clinical communication, healthcare organizations should keep the following three “must have” capabilities in mind:

  • Span the entire care continuum: A comprehensive solution must address the needs of all care team members across all types of settings – from a single hospital to a multi-site system, as well as outpatient practices and care settings. They all have different demands and communication requirements. For example, larger practices and hospitals need advanced directory capabilities to bring the opportunity to coordinate care based on facility, group or ACOs, with the appropriate workflow processes built in. In addition, the solution should have the ability to generate real-time patient updates – such as when the patient presents to the emergency department, is discharged home, or when important results are available. This is essential to timely coordination of care. Finally, it’s imperative that the communication solution connect to the organization’s other HIT systems to maintain integration for alarms and alerts, such as if stroke team is activated. It’s critical that covering providers respond quickly and that a back-up process is in place.
  • Provide a standardized, yet flexible way to communicate: Clinicians should have flexible, yet standardized communication options that allow their messages to be routed appropriately and securely, and account for today’s technology. Gone are the days of referencing binders, faxed schedules or notes taped to the wall or desk. Once the communication process is initiated, the process should seamlessly connect you with the correct covering provider for the clinical situation at hand – whether through call, text or via a mobile app.
  • Address process complexities with intelligent routing: Schedules, workgroup rules, team mobilization requirements and escalation paths should all be configured so that you are connected to the right care team member with real-time accuracy. A solution with dynamic intelligent routing is able to deliver messages at the right time, to the right person in any given clinical situation. Clinicians should be able to customize based on their device and delivery preferences, and make changes based on their activity (e.g., what to do with a call while in the OR).

The goal is simple: Remove the variability, the hand offs and the touch points that introduce risk and opportunities for communication breakdowns. Initiate the communication in the manner you wish, and let the process connect you to the correct covering provider for your clinical situation at any moment in time.

While efficient clinical communication is a challenge, the right solution can lead to tremendous benefits for every care team member, as well as the organization. The solution must be comprehensive, providing standardization and the ability to streamline the communications process. By implementing technology that addresses these three areas, healthcare organizations will not only be able to improve clinical communication, but will ultimately improve the experience for patients, and the extended care team.


Interested in learning more? Read part 1 and part 2 of this series on nurse leadership in care team collaboration.

Medical background with heart and icons Medicine

Nurses need innovative care team collaboration technology

By Michelle McCleerey, PhD, MA, MEd, MBA, RN  /  16 Jun 2016

Part 1 of a 3-part series in conjunction with our nurse leadership webinar series.

Six years ago, the National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), recommended that nurses lead inter-professional collaboration and healthcare delivery improvement and redesign. They noted that nurses are uniquely positioned to do this since, given the care setting, they are quite often the primary patient caregiver. As such, they serve as the virtual linchpin of care—connecting the various care providing professions while coordinating patient care across the entire care team. Toward that end, nurses are responsible for over 90% of physician communications while directing over 80% of their own communications to the broader care team.

While some inroads have been made in regard to this IOM recommendation, there are formidable challenges impeding significant progress. As the industry transitions to value-based-care, nurses are being held increasingly more accountable for patient outcomes and experience. Paradoxically, they are concurrently being asked to perform more indirect and non-patient-care tasks which reduce the amount of time at the patient bedside—one of the strongest predictors of positive patient outcomes and experience.

One such activity is care team communication.

Specifically, nurses have reported that difficulty communicating with the care team has decreased direct patient care time. One survey study found that 75% of nurse respondents reported wasting valuable care time just attempting to communicate with physicians and other care team members. In part, as 50% of the respondents acknowledged, this is because they are unaware of the right care team member to contact for the clinical situation at hand. The latter explains why the majority of physicians reported being frequently erroneously contacted when not the right physician for the situation.

These recalcitrant obstacles to care team communication and collaboration have served to delay patient care and prolong patient wait times. No one is more acutely aware of this than the nurse.

Nurses quite often find themselves waiting for physicians to return phone calls/pages while their patient needlessly suffers. As the nurse struggles to coordinate care, no one is more cognizant of the impact of missed care or delayed transitions on the patient and the patient’s family. Moreover, no one is more handicapped by the limits of fragmented communication technologies that have not successfully overcome these challenges because they only address a small component of the overall problem. And no one is in more need, than the nurse, for innovative technology that is able to immediately connect the right care team members to facilitate timely collaboration.

The good news is that this technology is now available. However, when evaluating the various care team collaboration platforms, it is important to avoid common pitfalls. Here are a few guiding principles to keep in mind:

  • While secure messaging is a salient feature of the platform, it is not wholly sufficient to address these communication obstacles since it is dependent upon two flawed assumptions.
    1. The recipient, such as the physician, must desire to be contacted at all times for all situations every day of the week.
    2. The sender, for example, the nurse, knows who to contact in every single situation.
  • All of the care team must be on the same platform. As the IOM noted, “True inter-professional collaboration can be accomplished only in concert with other health professionals, not within the nursing profession alone.” This holds true for any other profession.
  • Most importantly, the technology must be purposefully designed to overcome the known referenced obstacles. To do this, it must be able to automatically identify and provide immediate connection to the right care team member for that particular clinical situation. This type of complex logic requires that for every single communication by every care team member, the contextual variables of the particular message must be analyzed in real time to ensure the communication is routed to the correct individual.
  • The care team collaboration platform capabilities must transcend the walls of any one facility. Nurses, as well as physicians and other care team members, quite frequently need to contact team members who work in and across other facilities and locations. The platform must be able to support this communication and the intelligent routing capabilities must extend to provide immediate identification and connection to these care team members when needed.
  • Ultimately, the care team collaboration platform must have proven functionality to reduce communication cycle times. Reducing the time to connect and close the communication loop translates into care team efficiency and increased patient care time. As every nurse knows, this means speed to treatment, improved patient experience and improved patient outcomes.

Nurses are indeed perfectly positioned to lead inter-professional collaboration and healthcare delivery improvement. However, it is critical that they are provided with the technology that will allow them to overcome all the challenges this entails.

Let us not repeat the mistakes of the past—providing nurses with inadequate technology in response to which, they must find a work around—increasing their effort and workload in the endeavor. Quite sincerely, healthcare improvement and reform depends on it.


Interested in learning more? Read part 2  and part 3 of this series on nurse leadership in care team collaboration.