Category Archives: Physician Engagement

Terry Edwards

Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

By Terry Edwards  /  08 Jun 2017

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.

Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

Terry Edwards

The role of secure communications in your clinical integration strategy

By Terry Edwards  /  14 Apr 2017

If you could take one solution with you on your journey to clinical integration, what would it be?

Clinical integration is the unification of healthcare data, services and coordination across acute, outpatient and post-acute care. It portrays an environment where waste and inefficiency are all but eliminated from healthcare communications, costs decrease and care improves. It’s the future of medicine.

You wouldn’t be far off course if your first thought was to rely heavily on the EHR to support your clinical integration strategy. While the EHR is a valuable tool for sharing patient information within hospital systems and broader care networks, it lacks a fundamental quality that bridges the gaps between Meaningful Use and true clinical integration.

Fully realized clinical integration can only occur when the barriers of communication have been broken down, and interdisciplinary clinicians can accurately and reliably coordinate care in real time across organizational and geographical boundaries. As with most things related to healthcare communication and the sharing of information across disparate networks, securing those communications has been and will continue to be a primary focus for healthcare IT leaders. In an environment where healthcare organizations are driving toward an end-goal of clinical integration, enabling secure communications alone just isn’t enough.

To achieve clinical integration, clinicians need a solution that enables immediate, accurate, reliable and secure communications.

Immediacy in healthcare communication

Real-time communication is a crucial element of delivering high-value care. In the most critical emergencies, every second counts. The time that clinicians waste identifying the right on-call care team member to contact, and then trying to reach that person, can quite literally be the difference between life and death. Even in non-emergent situations, early detection and treatment are well-known effective preventers of worsening conditions.

Yet it’s all too common for inefficient and broken communication workflows to create time-consuming hurdles for clinicians to clear—sometimes even to just begin the conversation.

Clinically integrated settings approach clinician-to-clinician communication with a sense of real-time urgency. That’s not to say that every message should be sent with an emergency status, just that the process of identifying the provider you need to connect to and the delivery of that message should be seamless and immediate.

Reaching the right care team member on the first attempt should be an important metric for all hospital systems. To keep performance numbers high in this area, you must ensure clinicians always know exactly whom to contact for any given medical issue.

However, most clinicians today initiate time-sensitive contact to the broader care team by thumbing through a lengthy paper-based on-call schedule, making a call, and then waiting to receive a response.

Real-time clinical communication and collaboration tools immediately deliver secure communications, and even allow the clinician initiating the communication to see in real time when messages are delivered and read.

Contact accuracy

Reaching providers on the first attempt is important, but it’s just as important to reach the right provider—the one who can act on the medical issue at that moment—via his or her preferred method of contact.

It’s not uncommon for providers to have a different preferred contact medium for every variance of their schedule. And it’s not uncommon for those schedules to change at a moment’s notice. Yet many hospitals, in both small and large systems, only print the schedule and patient assignment lists once per day.

Clinicians in this setting have no way of knowing if they are accurately reaching out to the right providers via the right contact method. Manually producing a list of whom to contact and how is a process riddled with opportunity for inefficiency and inaccuracy.

Dynamic Intelligent Routing™ eliminates those opportunities for communication breakdown. A distinct capability of PerfectServe Synchrony®, Dynamic Intelligent Routing analyzes workflows, call schedules and contact preferences, enabling clinicians to reach the right person at the right time with just the tap of a button.

Reliable communication workflows

If your clinicians depend on inaccurate call schedules or outdated, cumbersome processes to drive clinical communications, your communication workflow isn’t reliable.

When clinicians can immediately contact the care team member they need via that provider’s preferred contact method, communication workflows become reliable and trustworthy, which leads to high adoption and improved patient care, no matter the care setting.

From improved care coordination to reduced costs

Inefficient communication workflows not only interfere with the realization of clinical integration, but also they inflate healthcare costs. For example, if a radiologist identifies a critical result in an outpatient test, the radiologist needs to contact the patient’s PCP so action can be taken right away. If the communication is not immediate, accurate or reliable, the process breaks down and the delay could result in medical complications for the patient that end up costing more to treat.

Moving a patient safely through the admissions, treatment, discharge and post-acute care processes requires a tremendous amount of coordination, good communication and a sound clinical integration strategy. The tools you use to support that communication and collaboration will play an important role in your success.

If you enjoyed this blog post, you may also be interested in:

Healthcare is Ripe for Tools to Enable Value-Based Collaborative Care

Terry Edwards

How much is your answering service really costing you?

By Terry Edwards  /  16 Feb 2017

The inevitable mistakes made by a traditional after-hours answering service aren’t often attributed to significant costs that may be undercutting the success of your practice. But if you consider that quality communication between members of your staff and your patients—especially after-hours—is a fundamental pillar of patient care and safety, you’ll start to see that little mistakes can add up to big costs.

Physicians and group practice administrators throughout the country will attest that answering services make mistakes that cause clinical communication breakdowns. The human error factor in the answering service equation means lost or delayed messages, wrong patient names, inaccurate symptom descriptions and more. For a long time, it’s simply been considered the status quo. There didn’t seem to be any real way around it.

So an industry-wide acceptance that on-call duty will be frustrating for physicians, and that mornings—especially Monday mornings—will always present some answering-service-related issues for the practice administrator to handle has taken hold. And while these inconveniences may not seem like a big red flag, it’s wise to get a good look at how far-reaching the impacts really are.

Are your patients getting the best care, even after hours?

Patients will generally stay loyal to a practice because they trust their doctor. But if they feel like their medical needs are not given the same sense of urgency that they’re feeling—or worse, if their questions go unanswered—that trust can quickly dissolve into frustration and fear. For some patients, despite their relationship with the physician, this can be a reason to leave the practice and find a new provider.

So, while you may or may not lose the recurring revenue of a loyal patient, you have to consider the cost of that patient’s negative experience.

If one patient has had an unsatisfying experience with your answering service, others probably have, too. So the real question becomes: how much is your answering service impacting patient satisfaction?

Are you spending your time the way you want?

It’s difficult to tie a hard cost directly to the frustration of wading through miscommunications to get to the bottom of an issue. And it might not be possible to calculate the profit margin impact of the feeling that you cannot deliver the level of patient care you want because there is a weak link in your communications process. But the time you spend managing answering service mistakes is time that could be spent on patient care, so the equally important consideration here is the quality of that time.

The time you spend feeling frustrated and inconvenienced—by non-emergency after-hours calls, for example—does have a cost. It’s a personal calculation and it has a real impact on physician satisfaction.

Are you at risk for fines, penalties or lawsuits?

Some unlucky practices have discovered one of the answering service industry’s best kept secrets: subcontracting.

Some of the answering services that exist today are actually not answering services at all. They are simply businesses that subcontract the work out to another answering service—one that may or may not adhere to HIPAA compliance standards. It’s a risk that no practice leader would knowingly take. With so many unknowns, a practice in this situation is at real risk for fines and other breach penalties.

And then consider this worst-case scenario: a patient unknowingly suffering a stroke calls after hours to report blurred vision and confusion; but because the answering service’s on-call schedules are not accurate, the patient’s message isn’t delivered to the correct on-call physician for another hour. At this point, given the time sensitivity of this issue, the practice could be at risk for a malpractice suit.

An incident like this—however unlikely it may be—could mean a tangible financial loss for your practice.

But that’s not all.

Are you protecting your reputation?

Imagine a critical care surgeon with his own practice who routinely performed emergent consults for local hospitals…until they stopped calling. The hospital felt his answering service was unable to deliver messages in a timely manner, and so they found other practitioners to fill that need.

Your credibility as a caregiver in your local healthcare community can be negatively affected if outside consultants and hospitals cannot reach you quickly in times of emergency. The professional impact of a tarnished reputation is beyond quantifiable. And if the reason is answering service communication delays, it’s also unacceptable.

Are you sure you’ve uncovered the hidden fees?

Most answering services are up front about their fees, but physician leaders and practice managers seldom realize how many fee-based activities they’re actually charged for on a single after-hours call:

  • There’s a fee for taking the message.
  • There could be a fee for relaying that message to the right clinician.
  • There could be another fee for relaying the clinician’s instructions back to the patient, if that’s the case.
  • There could be yet another fee for recording and logging the conversation as a whole, or a fee for recording and logging each communication.

These little fees can add up over time to a surprisingly significant amount.

Are you ready for a better solution?

We live in an era of digital clinical communication, with automated tools that eliminate human error in after-hours communication, provide caller ID protection for physician contact information, and have the ability to recognize and defer non-urgent messages until business hours resume.

Imagine an on-call weekend when non-urgent prescription refill messages are deferred until Monday and the physician’s days are spent as planned (i.e., enjoying time off unless there are true emergencies).

Imagine walking into the practice every morning knowing that all your patients received the care or assurance they needed after hours and there will be no complaints to handle.

You can take a hard look at your answering service’s monthly invoice to understand the hard costs, but those are not the only ones to consider. The less quantifiable effect on your patient safety and satisfaction levels, your physician satisfaction levels, your compliance risk and your professional reputation are serious issues you should consider—because they really do cost your practice.

Liked this blog? You may also be interested in:

INFOGRAPHIC: Top 10 reasons your practice needs PerfectServe
PerfectServe Synchrony™ is the modern, secure call management platform designed to give you greater control over your clinical communications.

Jennifer DeBruler, MD

3 key learnings from implementing a care team collaboration platform

By Jennifer DeBruler, MD  /  11 Feb 2016

A recent survey of nearly 1,000 healthcare professionals[i] revealed that a majority of respondents require collaboration across the extended-care team to enable population health business models. However, results also revealed strong agreement that the current state of communication has been a barrier to achieving that collaboration. Furthermore, clinicians[ii] are waiting for more information before they take action—resulting in delayed care.

Advocate Medical Group (AMG) recognized these same issues. AMG is a physician-led medical group in the Chicago-land area, with more than 1,300 physicians and specialists at over 200 different practice sites. Our contact center currently serves about 500 physicians and 40 practice sites, and we needed a more efficient way to securely communicate with one another. Our outdated technology didn’t allow messages to be transmitted in a meaningful or a secure manner. There was also an unfulfilled need to facilitate real-time calls among physicians with secure voice and text messages. PerfectServe appeared to be the answer.

We implemented PerfectServe’s Synchrony platform in stages, which allowed us to teach our caregivers the features and customize the communication parameters for each physician. We adopted standardized processes for the entire group to help ensure the right type of information is being recorded and communicated to staff, and is consistent across the entire care team. The processes included creating standardized templates so our associates were sending the most essential information possible.

The implementation process taught us three key lessons:

  • Physician engagement upfront is key: We brought the appropriate operations and physician leaders in to the design sessions, and have solicited physician feedback after they go live with the platform. We also have weekly conversations with the practices to ensure everything is running smoothly, and physicians make it a point to call us at the contact center if there are any issues. Having these regular touchpoints have helped create a smooth transition and implementation.
  • Develop customized training materials for your system’s providers: In addition to using the training materials that PerfectServe provided, we realized we needed to customize parts of the implementation to standardize the platform for our specific practices and system. We didn’t want physicians to opt out of certain rules and workflows as that would interfere with the system. Customization was vital.
  • Set a timeline for gradual implementation: Implementing a platform across your entire network at the same time can lead to confusion, frustration and chaos. It’s helpful to set a timeline of gradual implementation dates before the project begins. Doing so affords hospitals within the system an opportunity to make sure all the settings are right and that the doctors have programmed their PerfectServe platform based on their preferences. If there are any major adjustments to make, they can be made before onboarding the next hospital.

Through adopting a staged approach, we have experienced a successful PerfectServe implementation to date. We have also noticed many improvements within our system since we began using the platform in January 2015. Physician contact management has improved throughout our network; we now have more than 4,000 physicians using the platform across 12 different Advocate hospitals. Furthermore, 96 percent of our AMG physicians who have downloaded the smartphone app are actively using it. Our practice communication management has also improved through PerfectServe’s algorithms, which direct calls to on-call physicians and can decipher covering physicians.

Through our real-time tracking and reporting we were able to see that with time comes comfort. In December 2015 alone, our physicians had more than 4,600 interactions on the platform compared to only 481 in January 2015, when we first implemented PerfectServe. Our physicians are using PerfectServe more and more to communicate with each other. Our tracking also shows that the majority of our calls are answered within 10 minutes. Additionally, 50 percent of the messages are retrieved in 5 minutes or less, which helps deliver communication and patient care more efficiently.

PerfectServe’s technology has helped AMG grow and succeed, thanks to its focus on collaboration, secure communication and improved patient care.

Check out this video about how clinicians at Advocate Health Care use PerfectServe to communicate easily.

[i] “Healthcare professionals” includes hospitalists, primary care physicians in large offices, specialists in both hospital and office settings, nurses in hospitals, case managers, hospital administrators and office managers.

[ii] “Clinicians” includes all physician categories surveyed, nurses and case managers, and excludes hospital administrators and office managers.

 

Terry Edwards

2016 Trends: What’s in store for providers?

By Terry Edwards  /  21 Jan 2016

As I mentioned in my post last week, despite healthcare’s slow-moving reputation, many of the players are moving quickly to re-steer the ship and transition to value-based population health management. Yes, population health an overused phrase with too many definitions, but it’s also the biggest change in healthcare since the invention of penicillin, and will form the backdrop for many of the trends that will change the way healthcare organizations operate and deliver care in 2016:

  1. Roles between payers, providers, vendors will blur. Consolidation in healthcare isn’t new, and I see this trend continuing into 2016. After all, consolidation is still the best strategy for organizations to get scale to reduce costs, freeing up more resources to increase innovation in everything from new modes of care delivery to payment models. As organizations grow, we can expect that the role of each player will shift so that the lines between payers, providers and even vendors, will blur to the point where they’re nearly unrecognizable. In 2016, more IDNs will create their own payer branches, and we’ll also see more large health systems develop their own proprietary technology, either on their own or in partnership with both startups and established technology vendors to help deliver their own population health strategy.
  1. The continuing shift to patient-centered care will bring patients and their families into the care team. It can be difficult for patients with multiple chronic conditions to navigate the complexities of follow-up appointments, medication regiments and other therapies. Their providers, who are often strapped for time and resources, can find it hard to coordinate patient care effectively. We’re going to see increased demand for remote care managers, who are responsible for hundreds of patients with chronic conditions. The remote care manager will be an increasingly important member of the broader patient care team and be able to remotely monitor all of their patients using sensors and analytics to identify each patient’s condition, enabling the coordinator to proactively reach out to patients and intervene before a situation becomes an emergency. Families and friends, too, will have a bigger role to play in a patient’s care. Providers will start using tools like text notifications and social media to loop in a patient’s support network so that they can reiterate important information, facilitate follow-up visits and help patients stick to their medication regiment.
  1. Providers will need to create new methods to provide patients and clinicians relevant information from ALL points of care. No longer do patients need to schedule an in-person visit with their primary care physician for a simple prescription. Retail clinics at CVS and Walmart – as well as virtual visits via telehealth – make it possible for patients to get care quickly. While the increase in access points to care is a positive development, it can lead to disjointed and fragmented care. In 2016, providers will continue to struggle with how to manage all fragmented patient visits (after all, that’s what the acquisition of PCPs was supposed to resolve.) One option to corral all of these independent visits will be a new kind of patient portal—or rather, a wellness application—that gives patients and clinicians information from all points of care, whether it’s a hospital, PCP, specialist, retail clinic or other emerging care delivery method. This new kind of wellness application will tether multiple existing portals and make it possible to aggregate information from all providers, regardless of their healthcare system affiliation, which may help prevent medical mistakes and duplicate testing in addition to providing much needed increased convenience.

The next few years are going to be an exciting time to work in healthcare. What trends and changes do you see on the horizon? What did I miss? Let me know here, or via Twitter @PerfectServeCEO