Healthcare organizations trying to reduce the rate of medical errors often overlook a common but important factor within their systems—communication between physicians, nurses, and clinical care staff. Effective and efficient communication is a critical component for improving collaborative care delivery among different healthcare providers who work in mobile and time-pressured environments.
The Joint Commission, a healthcare system standards and oversight organization, has indicated that nearly 80 percent of serious medical errors and medical mistakes are caused by poor communication between healthcare providers or healthcare teams, especially when a patient is transferred from one facility to another.
What’s more is that many of these medical errors caused by lack of or poor communication can be prevented, and it all starts with fixing provider-to-provider communication, which can prove to be a critical first step, as it is a bottleneck preventing other major improvements in care coordination.
“The medical errors that happen due to poor communication can be due to a few things, says Joseph Kannry, M.D., lead technical informaticist at the New York City-based Mount Sinai Medical Center. “One is interrupt errors—I’m doing something and you’re interrupting me. I have to address it because I’m not sure why you’re contacting me. And I have to scroll through devices that haven’t been updated [in years], since there is no pager hardware market. You are bound to get distracted.”
There are also handoff-related errors, explains Kannry, which occur when one person needs to communicate something to another person, but never gets a hold of him or her, ends up forgetting, and ultimately, the message never gets transmitted. Finally, there is the issue of contacting someone at the wrong time, leading to either an inappropriate response or no response, Kannry says.
A PROBLEM-SOLVING APP
To help fix these problems that could end up being very costly—both financially and clinically—Mount Sinai has adopted an enterprise-grade care-coordination mobile app called Cureatr, which was designed by a resident at the Mount Sinai Hospital, Joseph Mayer, M.D. The cloud-based mobile app, designed for use with iPhones, Androids, tablets and other hand-held devices, employs a special HIPAA-secure group text messaging system that improves communication between team members who coordinate care of patients with complex medical conditions.
The app was pilot-tested for months by Mount Sinai clinicians in a pilot program at the hospital, and is also used at The Institute for Family Health (IFH), a Mount Sinai affiliate. Cureatr enables both intra- and inter-institutional communication, users at affiliates such as IFH and large group practices are able to securely message Mount Sinai practitioners for referral and follow-up care.
Mayer developed the app to solve the day-to-day challenges he and his colleagues experienced while treating patients, including reaching the right care-team member at the right time and communicating with him or her effectively, and navigating the many complex day-to-day clinical workflows at a hospital such as Mount Sinai. “Outside of the electronic medical record (EMR) system, physicians, nurses and other care team members have no mobile tools built specifically for their care coordination challenges,” Mayer said in a statement released by Mount Sinai, which plans to get as many providers as they can on the app within the next month or two.
One of the most important features about Cureatr, says Kannry, is that it is tied into work schedule and call coverage. “If I’m told, for example, on my day off, that a patient’s potassium level is too high, I’m still medically and legally responsible for that information since it was told to me. That’s a dangerous exercise. With this app, if I send you a message, I can see if you’re on call or not or I can find a person on call and send that message to him or her. The problem with most communication solutions in healthcare is they assume that point-to-point is the best model, but it’s not. It’s really role-to-role, or provider-to-provider, based on time of day, care setting, etc. And that’s what most places struggle with.”
Cureatr will also alert the user if the message has been read, and it does so in a HIPAA-compliant fashion, something that Kannry stresses is extremely important, as routine communication via non-secure and undocumented channels such text messaging and e-mail is rampant. HIPAA-violations with a risk of fines up to $50,000 per violation occur frequently, according to some studies. “[That] is something that happens more frequently than you imagine,” he says. “Text messaging is very prevalent. The problem in healthcare is, due to complexity, people will approach third party solutions that HIT solutions have yet to solve. Ultimately, that’s a failure of us not delivering the right solution, not anything else.”
There are some issues concerning physicians putting this app on their personal devices, but Kannry feels there are ways to work around it. “My expectation is that the younger physicians who have their own personal devices will ask, ‘Why are you [affecting] my personal device for this app?’ But those are probably the same people who are texting now,” says Kannry. “There will be some physician pushback with areas such as locking phones and putting security codes in, but these are not insurmountable challenges.”
But eventually, Kannry sees the potential of Cureatr to overtake pagers as the main method of communication for clinicians. After all, a recent Ponemon Institute study found that U.S. hospitals are losing $8.3 billion annually due to the use of pagers and outdated communicates technologies. These technologies, the study’s authors say, decrease clinician productivity and increase patient discharge time.
Kannry asserts that it’s more about understanding workflow instead of technology, however. The key, he says, is penetration. "If anyone you want or need is on it, you are going to use it. We expect to see better care coordination, faster response to things, you will no longer be searching for people, waiting for answers, finding out it’s the wrong person, things like that. Cureatr is just the beginning of applications like this.”