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October 27, 2014 Readers Write 1 Comment

Hospitals Move to Define Role of Secure Texting in Clinical Alarm Management
By Todd Plesko


In 2010, The Joint Commission identified improvement in staff communication as a National Patient Safety Goal. A recent Spyglass survey found that 67 percent of hospitals, despite forbidding the practice, report that nurses are using personal smartphones to support clinical communications and workflow because they are dissatisfied with the options provided by hospital IT.

Of those exchanging data, 80 percent of the messages are not secure nor HIPAA compliant. Hospitals found guilty of a data breach can be fined $1.5 million per incident, so it’s not surprising that hospitals are acting swiftly.

There are more than 70 vendors today competing to solve this need. They are primarily segmented by the markets and users they are targeting; e.g. physician-to-physician, physician-to-nurse, physician-to-patients. These single-function secure text messaging apps were initially an attractive fix to HIPAA anxieties because they are cheap and quick to implement, but their myopic view of communications often contributes to the burgeoning problem of alert and alarm fatigue.

As of July 1, hospitals seeking accreditation from The Joint Commission are required to prioritize clinical alarm safety. Even though the new National Patient Safety Goal recommends that hospitals begin with the largest offenders – patient monitors and medical devices – forward-thinking hospitals are taking a closer look at the full gambit of interruptions experienced by front-line nurses and asking how solutions designed to address alarm fatigue will impact overall clinical workflow.

Alarm fatigue is rooted in more than just patient monitors and medical devices. It is the result of multiple systems communicating alarms, alerts, text messages, and phone calls simultaneously without regard to priority or urgency. Really, “interruption fatigue” much more accurately describes today’s care environment.

Hospitals have traditionally viewed alarm fatigue and secure text messaging as two unrelated pain points with separate solutions. This has resulted in an accidental architecture embodied by multiple solutions with overlapping functionality that have become increasingly difficult for hospital IT and users to manage.

Single-purpose integrations often lack sophistication and the intelligence necessary to serve as the traffic cop between multiple systems that compete for attention, interrupt workflows, and contribute to alarm fatigue. They are concerned with the singular goal of delivering the alarm, alert, or text message they were designed to transmit.

Consider that most clinically relevant communications originate from a patient event: a nurse call alert, a smart IV pump, a patient monitor alarm, a bed exit, critical lab, or stat order alert. When a clinician is texting about a patient, they must ensure that the subject of the conversation is properly identified, an important feature that single-function texting apps are incapable of providing automatically. All text messaging apps targeting healthcare are secure, but few are centered on the patient and their role in the overall communications workflow.

If a healthcare provider organization is going to be successful with patient-centric text messaging, then this is only possible with an enterprise platform that delivers relevant information with patient context along with the alarm, alert, or text message that the recipient receives. Optimally, alarms and alerts would include a dynamically-generated list of possible staff members to call or message about the patient event to further enhance communications. Patient-centric messages need to be displayed properly based on priority level and integrated into the overall communications workflow to ensure that the recipient is able to identify and respond effectively to the most critical needs first.

Hospitals are beginning to recognize that identifying improvements in staff communications and managing the interruptions generated by alarms, alerts, and text messages are twin problems that should be addressed as a single project. A next-generation alarm safety and event response platform is required to support this level of clinical collaboration.

Todd Plesko is CEO of Extension Healthcare of Fort Wayne, IN.

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Currently there is "1 comment" on this Article:

  1. I think a patient “data custodian” model would solve many of these problems. By having a single source of patient PHI, the custodian platform can act as a go-between and secure and private central messaging center. If the custodian platform also implements a publish/subscribe messaging model, then providers, nurses, patients, et. al. can be alerted appropriately.

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