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It’s Time to Bring Back the Noise
By Andrew Mellin, MD
A very memorable moment for me at one of the first go-lives for a hospital EHR was when I stood on the unit and realized there was an eerie silence. While the beeps of the monitors and the drone of the overhead pages continued, the buzz of the caregivers talking to each other was gone as everyone was staring intently at a computer monitor.
As an implementation team, we quickly learned we needed to frequently remind the caregivers to keep talking to each other as part of our go-live training for future sites. But years later, it is clear the EHR has fundamentally changed the dynamics of how providers and care teams communicate.
The impact of this dynamic is well recognized. The change in communication patterns, sometimes called the "illusion of communication," is identified as one of the key unintended consequences of implementing an EHR. With today’s EHRs, we now have all the information we need at our fingertips, yet the ability for care teams to collaborate in an ongoing, continuous dialogue is not well supported by the systems’ encounter, inbox, and order-based models.
We still have noisy hospitals, but now we hear the wrong kind of noise: the sounds that keep patients awake and require caregivers to respond to beeps emitted from devices in stationary locations that make it difficult to find a real signal that requires action.
It’s time to bring the right kind of noise back to patient care. Not the auditory noise that we hear, but the cognitive buzz that is generated when high-functioning teams are communicating in an effortless, asynchronous manner.
Think of how communication models like iMessage, WhatsApp, and SMS have changed the way we communicate in our personal lives. There’s very low effort required to initiate a simple message. We have the ability to share rich information — such as images, videos, or voice — as well as expressive notifications. We even have an ongoing transcript of the conversation and acknowledgement of message receipt.
Healthcare communications benefit from the same communications models, but require HIPAA compliance, message traceability, integration to other initiators of messages (e.g., the hospital operator), and EHR integration.
The actual messaging app, however, is simply the user window into communications technologies that not only improve care team collaboration, but more importantly, drive improved care team efficacy and patient outcomes.
For example, physicians work in shifts that are largely defined by an on-call schedule. When I worked as a hospitalist on weekends when the staff frequently changed, I needed to find an on-call schedule to determine which specialist would see my patient that day (usually I just asked the nurse or HUC to page a person for me because it was too hard to figure out who was on call.)
To solve this problem, a healthcare communications platform needs to support messaging to a role that resolves to their correct on-call individual. And secure mobile messaging is not only about person-to-person communications — rather it is a way to notify an individual of any important piece of information about a patient, whether it is generated by a machine or a human.
For example, when a CDS alert in an EHR is triggered to indicate that a patient may be becoming septic, a rapid response team can be automatically and immediately notified. When a device triggers an alarm, instead of a loud beep that has to be interpreted, the specific, detailed message with patient context is sent to the right person’s device with the appropriate sense of urgency.
All technologies have limited value unless directly leveraged to improve organizational goals, and communication tools are often an underrepresented element of process improvement initiatives due to the limited modes that exist without a modern communication infrastructure. I’ve seen dramatic operational and clinical improvements achieved when these tools are embraced, such as 30-minute reduction in admission times from the ED and material improvement in HCAHPS scores.
These tools do not eliminate the phone call that is essential in a complex situation or the need to document the care plan in the EHR. Rather, these tools augment the EHR and elevate the quality and cohesiveness of the care team collaboration. The magnitude of the value of healthcare communications is under-appreciated: One large academic medical center sends over 150,000 messages to the caregivers and support staff in their organization every week.
It’s time to give caregivers the communications tools they need to improve the patient’s care experiences and outcomes and care team efficacy while eliminating the auditory noise where care is delivered. And it’s time to bring in the kind of high-value noise where caregivers are rapidly interpreting and responding to targeted messages on the go on their mobile device.
Andrew Mellin, MD, MBA is chief medical officer of Spok of Springfield, VA.