At Greenfield, Indiana-based Hancock Health, the HIPAA laws became such that staff could no longer use alpha pagers to communicate clinical information .
This prompted a multiyear search for other options. Initially, it was all about simply communicating test results or minimal clinical information.
Additionally, staff conducted an internal study and confirmed that physicians have their focus altered six to eight times per hour and about 63% of these communications were not urgent enough to have interrupted the physician, but there was no alternative option available to clinical staff.
“As we explored the issue in more detail, we recognized the opportunity for other types of communication and other formats of data sharing that would be of high value, such as lab results, clinical images, diagnostic images, EKGs and more,” said Dr. Mike Fletcher, vice president of medical staff services and chief medical officer at Hancock Regional Hospital.
So Hancock Health pulled together a multidisciplinary Six-Sigma team to address this problem. It determined that the best solution was a secure mobile communication platform that permitted communication of PHI.
“We also noted that in addition to resolving the initial problem of simple text communication, these solutions also permitted images, voice, etc.,” Fletcher said. “We also determined that our true solution was to develop a culture of communication and that the technology was a tool in the toolbox of clinical communication.”
The key with communication is not too much, nor too little, he added. Early in the process, staff added to the hospital strategic plan the importance of clinical communication, which made finding a solution an organizational priority. This made it easier to obtain funding and buy-in from leadership.
Staff did an analysis of multiple key vendors, and for a variety of reasons it chose Diagnotes, a developer of mobile and web-based communications applications for healthcare professionals and patients.
There is a variety of care coordination and communication systems on the market today, with vendors including DocbookMD, Doc Halo, Imprivata, Klara, Lua, QliqSOFT, Spok, Telmediq, TigerConnect, Voalte and Vocera.
MEETING THE CHALLENGE
One important aspect of this initiative was that it be led by clinicians and not by IT, so this helped with clinical buy-in, Fletcher said.
“We developed a policy for communication using technology and worked to develop processes around using Diagnotes for communication,” he explained.
“Creating a culture of communication happens over time and with the support of a dedicated team to implement, support, teach and work with the various departments across the institution.”
Dr. Michael Fletcher, Hancock Health
“We then started with several physicians who had an early adopter mindset and gradually brought on more physicians,” said Fletcher. “We found that most physicians can see a value proposition in clinical information they want to receive, or to be collegial with physicians who want to easily communicate with them, or in sharing info they wanted to be able to send to others.”
Hancock Health slowly added more and more physicians. It had very few physicians who preferred not to use it, but also had many who sought it out. Many physicians have eliminated their pagers and use only their smartphones for direct phone calls or communication via Diagnotes. Staff then eventually began to bring on other hospital associates, such as pharmacy, hospice, home health, etc.
Hancock Health’s home health agency, which has about 80 nurses on staff, started using Diagnotes to communicate with its field clinicians about patient care and discharge instructions.
“Their interventions help prevent about 150 hospital readmissions for us annually, which translates to about $1 million a year in reduced costs for us,” Fletcher reported. “I also know of situations with cardiologists who ask the hospitalists to take pictures of an EKG strip to determine if we need to refer a patient out of network to a cardiac specialty hospital.”
Patients have told Fletcher that they love seeing how quickly their care is being coordinated.
“Also, Hancock was the victim of a ransomware attack,” Fletcher said. “All our systems were down for several days, including the phones, internet services, email, and our EHR. I used Diagnotes, which is hosted by AWS and wasn’t affected by the ransomware, to communicate with all the physicians about what was happening. We were able to continue providing care using paper charts to document care and Diagnotes to communicate and coordinate care.”
Currently, Hancock Health is working to integrate Diagnotes with its Meditech EHR to make it easier for staff to see patient information without leaving the Diagnotes app.
“This integration will also make it easier to initiate a communication about a patient from within the EHR,” he added. “Simple things, like what room number is a patient in, make a difference when you’re waiting on a consult from a specialist.”
ADVICE FOR OTHERS
“Diagnotes by itself didn’t create our culture of communication,” Fletcher advised. “We had to first make it our goal to improve our communication standards and then adopt a tool that would help us reach that goal.”
Hancock Health took the approach of helping the medical staff understand the value of the new technology and make it their choice to use the tool instead of mandating it, he added.
“It was amazing to watch the creative ingenuity of the various stakeholders as they found highly effective uses that we had not anticipated,” he said. “One example is the ultrasound techs in diagnostic imaging. They had been preparing to purchase a $75,000 imaging station to view the mammograms to see the area that the radiologist wanted to ultrasound.”
Instead, they use Diagnotes to send a screenshot of each mammogram with the name showing and the area of concern highlighted to a group with all of the ultrasound techs. They were then able to use these images to complete the breast ultrasounds very efficiently.
“Creating a culture of communication happens over time and with the support of a dedicated team to implement, support, teach and work with the various departments across the institution,” Fletcher concluded.