Improving communications among clinicians is becoming more urgent by the day, as both nurses and physicians experience more intense, task-packed workdays, and as inefficiencies and delayed care become literally more expensive for patient care organizations moving into value-based healthcare delivery and payment.
Clinician leaders at Advocate Health Care, based in the Chicago suburb of Downers Grove, and which is one of the largest integrated health systems in the Chicago metro area, were facing the same challenges as everyone else, when they first began looking at some of the communications breakdowns in their organization. The average turn-around time at Advocate hospitals was 20 minutes for a doctor, nurse or other care team member to get in touch with a fellow clinician in order to coordinate patient care. Clinicians had also voiced difficulty tracking their attempts at communicating with care team members. With awareness of the national evidence caused by communication breakdowns, coupled with their own need to align patient safety with consistent clinical communications, Advocate Health Care completed implementation of an enterprise secure clinical communications solution in 11 hospitals in 2014. For the next deployment phase, the largest health system in Illinois rolled out the solution to its 1,200 employed physicians who used Advocate’s call center.
To speed up clinical communications and drive enterprise acceptance of the solution, Advocate IT leaders launched an “optimal enablement” initiative that measured three parameters of adoption success. If all three parameters are met, physicians are deemed fully compliant using the solution. As a result, the following innovations have taken place:
> Hospital-based clinicians are now able to contact physicians and advanced practice clinicians through the software without going through a third party.
> Physicians use the platform to communicate with colleagues and vice versa.
> Any care team member can initiate and receive clinical communication via an iPhone or Android device using a smartphone app.
Secondly, to maintain its optimal enablement initiative driving adoption, Advocate IT leaders went a step further improving upon this metric. They’ve developed a three-pronged sustainability strategy to maintain adoption momentum necessary to achieve compliance of seamless and secure standardized clinical communications across the continuum. That strategy encompasses the following:
> Instituting a governance structure. Advocate formed a hospital steering committee comprising acute to post-acute network stakeholders: administrators, hospitalists and employed physicians, nurses, clinicians representing multiple disciplines, and IT professionals. As the foundation for sound decision-making and ethical practice, a governance structure is paramount to ensure asynchronous communications. The steering committee promotes mandated tool adoption and user accountability in the communication of care management.
> Maintaining metrics and reporting. To ensure fine-tuning and usage of the tool, Advocate established key performance indicators (KPIs) and key result areas (KRAs) to achieve clinical communication goals specific to each user. For example, Advocate measured response times from initiating to receiving messages between physicians and nurses and vice versa.
> Determining future goals. Advocate plans to tackle utilization management for chronically ill patients, ensuring providers are communicating frequently with them to help reduce preventable overuse of care services, such as ED visits. Advocate also will enroll more community care managers and advanced practice clinicians onto the platform.
Advocate leaders report the following results from implementing an enterprise clinical communications solution, provided by the Knoxville, Tenn.-based PerfectServe, to support this initiative:
> With the solution designated the standard method for physician communication, primary care physicians, hospitalists and specialists report enjoying more efficient and speedy communications across both the acute and post-acute network.
> More than 95,000 secure messages per month equating to roughly over a million annually are read within 10 minutes of receiving—a dramatic decrease in response time. Advocate is experiencing steady improvement in this metric.
> Physicians and nurses using the solution’s mobile app can verify if a message has been read or not, thanks to an auto indicator within the message thread. Having this notification empowers clinicians specifically to quickly communicate necessary clinical information and feel confident that their message is being read and addressed.
> All data regarding attempts for contacting physicians are recorded.
Recently, Healthcare Informatics Editor-in-Chief Mark Hagland spoke with two Advocate Health Care leaders about this initiative: Chris Jamerson, M.D., vice president, clinical informatics-Advocate Medical Group; and medical director of informatics-Advocate Children's Hospital; and Dennis Giles, director, Support Services, Tech Help Desk, Communication, and Information System, for Advocate Health Care. Below are excerpts from that interview.
Dr. Jamerson, could you tell me a bit about your involvement in this initiative, and your role at Advocate Health Care?
Chris Jamerson, M.D.: I’m a general pediatrician, have been with Advocate and Advocate Medical Group for over eight years. A year ago, I stepped into the role of the CMIO, essentially, for the ambulatory side. So I’m responsible for the EMR; I’m kind of the interface between the providers and the IT team, around the EMRs.
And you, Mr. Giles?
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