Category Archives: Process Improvements

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 Hayes

Optimize rapid response team efforts with automated, real-time communication

By Terry Hayes, MSN, CPNP, CNOR  /  12 Jan 2017

Agnes Cappabianca worked as a stroke nurse manager at NYU Lutheran Medical Center, a Brooklyn-based teaching hospital. She was in the middle of a shift when the unthinkable happened—she suffered a stroke and found herself admitted to the hospital as a patient in her own ward.

The hospital’s rapid response team (RRT)—one that Agnes had helped train and prepare for these critical situations—sprang into action. Within 30 minutes, the team had final results of her CT scan and blood tests and began to administer tPA treatment.

Her role in advocating advances in stroke care within the hospital seems to have saved her life.

The primary goal of rapid response

The American Heart Association and the American Stoke Association® have warned since 2010 that “the benefits of tPA in patients with acute ischemic stroke are time-dependent.” The associations’ guidelines recommend a door-to-needle time of 60 minutes or less for the treatment to be effective.

In most hospital settings, the process for communicating the needs of a newly admitted stroke patient to care team members is manually intensive. These workflows usually have many steps, numerous decision points and multiple handoffs—creating many opportunities for communication breakdowns and delays in a situation in which every second counts.

One of the primary goals all RRTs strive for should be to reduce the number of steps in the communication process—including the number of decision points, communication handoffs and number of people involved in transmitting the information.

Some hospitals have achieved this goal by implementing a unified communication and collaboration solution that automates many of the steps in the RRT process, such as sending notifications to all team members—including team leadership—at the same time. With just one call, schedules are analyzed and the appropriate care team members are identified and contacted simultaneously—based on their preferred contact method.

This eliminates numerous steps and players from the communication processes and makes significant strides toward improving patient outcomes by speeding time to treatment.

Building an effective rapid response protocol

Pre-planning is required for a communication platform to optimize the capabilities of RRTs. Evidence based guidelines and individual hospital protocols determine the number and composition of responding teams. Some hospitals assign different care team members to different teams depending on urgency levels.

For example, Henry Ford Macomb Hospital in Clinton Township, Michigan, has two RRTs. One is dedicated to Level II traumas and does not include an anesthesiologist in the alert system because Level II trauma patients rarely require advanced airway management. However, the Level I trauma RRT—the team assigned to the most critical cases—does include an anesthesiologist.

Deciding whom to alert depending on the urgency of the situation is a key factor in RRT success.

Another important factor is identifying timelines for each care team member’s arrival at the patient’s bedside. For St. Rita’s Medical Center, a 419-bed hospital in Lima, Ohio, the pre-set arrival time for the rapid response nurse is three minutes; it’s five minutes for their 4A nurse. St. Rita’s also set guidelines for both the physician arrival and ordering of the CT scan at 10 minutes.

An effective communication platform feature that aids RRT outcomes is an automated callback and escalation process. This eliminates critical minutes being wasted on resending notifications and manually escalating the issue to another provider when team members do not arrive on time.

The proof is in the results

St. John Hospital and Medical Center (SJHMC) in Detroit aimed to comply with the guidelines set by The Joint Commission and the American Heart Association/American Stroke Association, all of which call for having CT scans interpreted within 45 minutes of the patient’s arrival and having treatment administered within 60 minutes.

SJHMC implemented PerfectServe Synchrony™ and used the flexibility of the platform to develop its stroke team protocol. The protocol called for alerts to a multidisciplinary team of nurses, physicians and staff from neurology, the ED and neurosurgery, as well. Each team member’s preferred method of contact was configured in PerfectServe Synchrony so that when a stroke alert is sent from the ED, each member (or their on-call counterpart) is contacted via their preferred method.

The ability to contact team members directly on their personal mobile devices, as opposed to using overhead paging systems, eliminates the potential for missed pages.

After the system and process were implemented, SJHMC saw significant improvements in time to treatment for its stroke patients. The on-call neurologists’ response times dropped 90%, from 22 minutes to just 2 minutes.

Graph 1

Their door-to-CT scan completion time decreased 41%, from 78 minutes to 46 minutes.

Reduce communication times

 

 

 

 

 

 

Additionally, SJHMC was able to administer life-saving tPA to three times more stroke patients than they were before.

Making lasting, life-saving process improvements

Most hospitals in the Unites States have some version of an RRT in place for major medical events. Some hospitals have even included local EMS organizations in their rapid alert processes in order to improve speed-to-treatment times.

There’s no question that streamlined and automated communication aids RRTs in their work to lower mortality rates for stroke patients and other traumatic injuries.

Rapid response alerts have proven benefits for clinicians, too. Having a rapid response alert program in place eliminates stress and frustration for the ED staff, which usually has the primary responsibility of initiating treatment to stroke and trauma patients.

In addition to simultaneous instant alerts to appropriate response team members, PerfectServe Synchrony’s rapid response alert system also sends activation notices to hospital leadership. These notices include the time the alert was activated and the time each care team member arrived (as input by the nurses involved). This additional insight into rapid response operations gives healthcare leaders the opportunity to identify problem areas and make lasting process improvements that ultimately save more lives.

 

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When communications work, patients win
In every hospital, communication is at the heart of what care teams do. Physicians need to communicate with one another for consultations; nurses need to reach physicians to update them and receive treatment order. Case managers need to communicate with nurses and physicians to ensure on-time discharges and proper care transitions.

Terry Edwards

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

By Terry Edwards  /  29 Dec 2016

Game-changing value-based reimbursement models are radically altering the healthcare landscape. CMS’s new program, Medicare Access & CHIP Reauthorization Act of  2015 (MACRA), along with the expanding Bundled Payment for Care Improvement Initiative (BPCI) are dominating headlines, calling into question physician and organizational readiness and the ability to address complexities that impact the revenue cycle.

These new payment models will require clinicians to collaborate around their patients in ways that they have not done so in the past. Increased collaboration is necessary to effectively coordinate a patient’s care among care team members who cross ambulatory, acute and post-acute care settings and organizations. To quote one esteemed health system nursing executive, “If you can’t communicate and exchange information with all of the people involved in an ACO or other new risk-sharing model, you can’t deliver quality care.”

However, many obstacles exist – brought about by healthcare’s fragmented cottage-industry structure – which critically hinder efficient care team collaboration. Inefficiencies are inherent in this siloed work culture, which if left unaddressed can lead to compromises in patient safety and employee relationships. The inevitable lack of communication, coordination and access to critical information points to our most prevalent problems with patient care.

Collaborating under one payment model, one price

This concept is best illustrated by Michael Porter and Robert Kaplan in an article from the July-August 2016 Harvard Business Review in which they offered a simple analogy between buying a car and paying for healthcare services. According to the authors, consumers do not buy the motor, the brakes, the seats, the wheels and other individual parts from different suppliers. Instead, “They buy the complete product from a single entity.”

Like the automotive industry, our healthcare system comprises different suppliers – different healthcare professionals employed by different organizations who provide components of care in a single episode of care. However, unlike the automotive industry, patients rarely, if ever, pay for all of these services from a single entity. Bundled payment aims to change this paradigm.

However, numerous navigational barriers exist in provider-to-provider communication, primarily because each organization possesses different workflows optimized around their own needs for how they receive communications. This ranges from identifying and coordinating the right specialist for a consult, to arranging physical therapy and tests.

To echo Porter and Kaplan, it just makes good sense to collaborate under one model and one price where all suppliers unite to assemble a car—or administer care—in the most efficient manner for the consumer/patient, which is where value-based payments come into play.

Rethinking strategies and tools for bundled payments

Under the new bundled payment model for as many as 48 clinical conditions, CMS will disperse one lump sum to the health system or hospital covering a patient’s entire episode of care. This means that organizations must rethink the most effective strategies and supporting tools to coordinate care activities among a network of acute and post-acute provider participants in a community—and pay them.

Without a doubt, efficient care team collaboration and patient-centered coordination are the nexus of transformative change. To accelerate this level of collaboration, innovative communication technologies are necessary to support this new era of incentivized care. But these communication technologies must be purposefully designed and extend beyond the EHR (and the hospital).

Transforming care with communication technology

The level of collaboration required means that providers need communication technology that transcends geographic and organizational barriers. It must enable and expedite contact among care team members who work in and across multiple coordinating facilities and locations.

In addition, this communication technology must be able to identify and provide immediate connection to the “right” care team member for a given clinical situation. This type of logic requires that—for every single communication by every care team member—the contextual variables of each interaction must be analyzed in real time to ensure communications are routed to the correct individual based upon the recipient’s workflow.

Bottom line: MACRA, BPCI and other market forces are imposing high demands on the care team in making clinical communication and collaboration even more critical for success under value-based care. Leaders in medical practice can take heart in the creation of a permanent impetus that meets the needs of the patient to achieve stronger correlation of the best health outcomes, while rewarding their care services. Assessing communication technology and business processes is a logical place to start.

 

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.