Category Archives: Healthcare

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.

A nurse’s intuition: Filling the gaps technology can’t

By Julie Mills, RNC  /  05 May 2016

As prevalent and useful as technology is in healthcare today, there are still areas and issues technology can’t effectively enhance, solve or replace. Each patient is unique, and comes with his or her own set of symptoms, pain points and responses, which can’t always be deciphered by even the most state-of-the-art technology.

I’ve been a registered nurse with a specialty in perinatal care for 14 years, and I’ve learned that nurses in particular play an irreplaceable role in getting to the heart of clinical nuances that are ever present in healthcare. Since we’re often the caregivers who have the most connection with our patients from end-to-end, we bring unique insight in viewing the patient holistically – which makes our perspectives and instinctive judgments important as it relates to patient care, and difficult for any machine to replicate.

As critical thinkers with a deeply grounded knowledge in providing care, nurses have the ability to take the various aspects of care and form a conclusion that technology may not be able to see. For instance, there are advances in technology that play a large role in the accuracy of patient observation; however, the observations from patient interactions made by nurses can share an equal amount of valuable information. This kind of thing can’t always be replicated by predictive analytics, sensors, monitors, etc. While protocols may dictate how I administer a medication, every patient is uniquely different in his response. The science of executing a protocol is not enough. In the art of nursing, nurses must evaluate the dynamic response of the patient and make slight adjustments that lead to the desired outcome–this is not something that is taught in a textbook or that can be ordered in the EHR.

As another example, if a patient has lab work done and the report is flagged as critical, it may go through the steps of an established protocol whereby notifications are made the appropriate physicians, regardless of context. A nurse who is familiar with the patient’s full history in this case, however, would be able to review the report differently by evaluating the context and then sharing that information as needed. By looking at the big picture, it could be determined this response is normal due to the specific treatment or condition – a judgment that could save valuable time and resources.

When caring for patients, there will always be a place for a nurse’s judgment. That human interaction is extremely important. While some might call this instinct nurse’s intuition, it’s a skill that continues to be valuable in the midst of all the technology that is coming into play. Combining nurse’s intuition with innovative technology is essential to providing safe, efficient, cost-effective patient care. Nursing truly is a work of art.   

Terry Hayes

A patient’s advocate: Nurses and technology

By Terry Hayes  /  07 Apr 2016

It’s easy for patients to feel lost in our healthcare system. Between multiple doctors, nurses in and out of exam rooms, tests, re-tests, a handful of prescriptions—not to mention the complex web of how to actually pay for care—patients can feel like they’re caught in a convoluted situation, with rules they don’t understand.

Patients shouldn’t have to feel this way. They should feel empowered to ask questions, express preferences on treatments and costs, and request their caregivers take time to explain a procedure. Of all of the care team members, nurses play the biggest role in making sure patients have a strong voice to be their own advocates in our complicated healthcare system.

I became a nurse practitioner because my passion is caring for people and advocating for them. A nurse is often the caregiver who has the most connection with the patient from end-to-end, allowing them to observe a patient’s care holistically. In some ways, the move to value-based care is really a switch in mentality to the way a nurse approaches healthcare: it’s about prevention rather than treatment of illness.

However, as the delivery of care shifts, nurses are facing an increase in responsibilities and patients, threatening to erode the core responsibility of advocating for a patient. It may seem counterintuitive, but technology can actually help nurses be more efficient so that they can still provide that critical role as patient caregiver.

For example, many nurses spend a significant amount of time in their day coordinating care, leaving less room for patient advocacy. Nurses often have to notify a full care team, which could require up to a dozen calls to identify the right clinicians. Technology makes it possible for nurses to send just one call or text to notify a full care team. For example, perhaps there’s a patient who is having a stroke. Instead of spending a half hour to find the correct care team members, a nurse can use technology to send a smart alert to all medical staff overseeing that patient – the neurologist, the pharmacist, the EEG technician – and mobilize the care team instantly.

Technology, too, can help transmit information in real time, so less time is spent in the back-and-forth of communicating. For instance, when I volunteered as a pediatric nurse practitioner for a homeless shelter, I occasionally came across a condition that I wasn’t familiar with. Video technology helped me quickly transmit images directly to a physician so that we could collaborate right then and there on what I was actually looking at so that I could continue to advocate for patients.

Adopting and implementing new technologies can be both time and cost intensive, but healthcare executives should consider the benefits and ROI the technology provides, especially as it relates to patient care. Nurses, who often know their patients best, should advocate for the technology they need and then provide leadership with first-hand testimony as to how it contributes to positive patient outcomes and recovery.

Terry Hayes

Balancing act: Making data security a priority in daily nursing routines

By Terry Hayes  /  24 Mar 2016

Regardless of the hospital or specialty office, nurses are an essential piece of patient-centered healthcare delivery models. As a former pediatric nurse practitioner, I know firsthand the amount of responsibilities nurses juggle, all while maintaining the personal, bedside manner needed to ensure patients and their families feel comfortable and knowledgeable about treatment and care. Nurses are often the first and last point of contact to provide care for a patient, and a critical part of the clinical communication process, especially in the digital age.

Unfortunately, as healthcare data breaches surge and the need to prepare for HIPAA audits increases, nurses must also factor data security into their daily routines. Since 2010, the HHS Office for Civil Rights reported more than 1,400 breaches of unsecured protected health information affecting 500 or more individuals, and this number is expected to escalate. Given nursing’s dynamic role in communicating with team members across the care continuum (physicians, other nurses, patients, etc.), it’s important that nurses, as well as other healthcare professionals, are provided the right levels of secure connectivity to deliver quality care for patients efficiently.

Nurse must also understand the need for security in many of their day-to-day activities. Here are a few areas nurses must constantly keep in mind:

  • Within the care setting – Can the patient information be viewed (or heard) by anyone besides the patient? Are the connected medical devices in use secured? Could another care provider or visitor access the device if the nurse steps away momentarily? With the growing use of telemedicine, does the patient have the right set-up to participate in portals, video calls, etc.?
  • Outside of a care setting – Are documents sent to the correct printer and/or fax, and are those documents picked up quickly? Can non-authorized personnel easily access EHRs and other technologies? Are any BYOD technologies secure? Does the outside setting have appropriate procedures in place to assure patient confidentiality and, if so, is it monitored?
  • During a care transition – Do the appropriate care team providers have access to relevant information? Are any others that participate in care that should be considered? If so, what level of information should be shared with those providers? Are all communications channels, such as a voicemail or email system, fully secure and HIPAA-compliant?

While education is critically important to ensuring nurses understand how to keep patient information secure, it’s also important for hospitals and other providers to identify processes and technological solutions to improve security, meet HIPAA standards and protect the confidentiality and integrity of patient data. This is particularly true as nurses (along with the rest of the patient care team face) more pressures to meet the demands of value-based care.

Nurses: how do you make data security a priority in your day? What challenges have you run into while balancing efficient and personal patient care with security?

Terry Edwards

Insights from HIMSS16: Four key takeaways

By Terry Edwards  /  14 Mar 2016

Each year, thousands of health IT leaders come together over one week to network, collaborate and shine a spotlight on industry accomplishments, challenges and innovation at HIMSS. I’ve attended the show for the past ten years, and I’ve seen trends evolve over time – some fading quickly, others becoming a constant theme throughout the years – all representing the ever-advancing healthcare landscape.

This year, as I walked the HIMSS show floor and had conversations with other executives, physicians and vendors, I noticed the following:

  • The market is shifting beyond secure messaging – For three years I’ve been talking about the fact that secure messaging is an essential feature of an organizations clinical communications strategy, but it’s not sufficient in and of itself. We talked to more than one organization that experienced a failed secure messaging deployment. Having learned, those organizations and others are realizing that a secure comprehensive communication solution that can improve workflow is what is required. (It’s about time!)
  • Security continues to evolve as a top priority – Healthcare CIOs are viewing security as a major challenge, and one that must be addressed holistically. I spoke with one CIO who shared that one set of lost physician network credentials caused through a phishing scam required the reset of 20,000 user credentials – a major disruption to the entire organization. We also discussed the challenges for keeping information protected; it’s clear that more comprehensive security solutions are needed to avoid the disruptions and other setbacks caused by breaches. Healthcare security today must extend past the surface level and become integrated into workflow, communications, technology, etc.
  • Moving beyond Meaningful Use to optimization – For nearly a decade, Meaningful Use was king. Now that most providers have implemented EMRs, the conversation has shifted from fear of non-compliance to how we can do more with the EMR. More and more providers are looking for ways to optimize their EMR investment to leverage data, extend its usage and refine the technology so that it works more seamlessly within clinician workflow. Workflow plays such a critical role in care and physician coordination, and providers need platforms that are smart and holistic – ones consistent with reality.
  • Shifting viewpoints on the future of the industry – Depending on who you talk to, conversations around the state of the healthcare industry and its future, which were in no shortage over the course of the week, differ in tone. With many factors, such as regulations, driving change in the industry, it becomes easy to take on a negative mindset – physicians in particular become frustrated with balancing patient care, compliance, data and technology. One notable challenge is providers are having to figure out how to take responsibility for a whole episode of care when the patient’s full team of physicians may not all be in one system. However, innovation continues to lead the way, and this, too, was reflected in many positive conversations about the healthcare landscape today.

Healthcare will continue to build on what we have today, optimizing our existing technology to address broader issues, and do so much more comprehensively – raising new trends and challenges just in time for HIMSS 2017. See you there!

Save the date: HIMSS 2017, February 19-23 in Orlando, Florida