real-time clinical communication and care coordination
DESCRIPTION
health care, communication, care coordinationTRANSCRIPT
clinicalMessage transform care through realtime communication
Abstract clinicalMessage® is a robust Provider-centric communication platform that
facilitates realtime care collaboration across the entire interprofessional frontline
clinical team. clinicalMessage® is not a solution to substitute for pagers or to
replace the essential Electronic Health Record(EHR). However, clinicalMessage® is
a pragmatic solution that fundamentally transforms how clinicians communicate in
the patient care setting and enables a streamlined processes through the use of best
practices, and secure Smartphone information technology.
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Copyright © 2014 iCareQuality Inc.
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Document No. 08201405
Published by iCareQuality Incorporated® in 2013, 2014
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Table of Contents
Abstract ................................................................................................................ 1
Problem Background with Rising Cost and Complexity ................................... 4
Transform How Clinicians Communicate ......................................................... 5
clinicalMessage® Built-in Capabilities ............................................................... 7
Mobile Communication and BYOD .................................................................. 7
Patient Handoff and Care Transitions .............................................................. 8
Closed-Loop Messaging Communication ......................................................... 8
Enhanced Patient Experience ............................................................................. 9
Industrialize Evidence Based Practices .............................................................. 9
Performance Measurement and Business Analytics ....................................... 10
Access to Expert Community for Learning ...................................................... 10
clinicalMessage® Architecture .......................................................................... 11
Deployment Options ......................................................................................... 13
Summary and Call to Action ............................................................................. 13
References .......................................................................................................... 14
About iCareQuality Organization .................................................................... 15
About Our Team ................................................................................................ 15
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Problem Background with Rising Cost and Complexity
In considering the home care, primary care office, patient
centered medical homes, hospital or long term care setting,
the need to communication and collaboration can occur in
the management of urgent medical issues when a clinician is
needed in a real-time. They can also occur in non-emergency
situations when multiple members of the interprofessional
care team contribute to resolving a patient’s issue such as,
diagnosis, care plan, discharge planning etc. Depending on
the complexity of the patient’s condition, care must be
coordinated across multiple disciplines and specialties. This
includes the nurse, the pharmacist, and other allied health
staff, along with the various specialists involved such as
cardiology or critical care and often family members. Most of
this communication is facilitated through the use of numeric
pagers and so it is inefficient and interruptive. Transfer of
care from one shift to another occurs multiple times a day for
a patient and so is another source of errors when
communication breaks down.
The literature has also suggested that eliminating these
communication inefficiencies and failures will significantly
improve patient safety and quality of care. [1-4] Poor
communication in hospitals also contributes to a significant
burden of rising healthcare costs. A 2009 report estimated
that communication inefficiencies among care providers in
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U.S. hospitals cost the country $12 billion per year.[5] In
Canada over the last decade, the government’s federal health
care expenditure has more than doubled from $97.6B in 2001
to a forecasted $200.5B in 2011. Per capita spending during this
same period has increased from $3174 to $5811 per person
(84%).[6] In comparison, the GDP for Canada across all
industries between 2001 and 2010 increased at a rate of 19%
($1041B to $1234B). [7] Research indicates that the greatest
sources of waste in healthcare – time and money (54%) – are
largely due to increases in patients’ length of stay that stem
from poor care coordination and slow discharges.
In the midst of these economic challenges, the public still
expects to receive high quality health care, with greater
quality of life, increased safety and shorter waits. Therefore, a
new approach is much needed, and research highlights that
investing in healthcare information and communication
technology (ICT) solutions that dramatically help streamline
communication among caregivers as well as patients and
families; and can improve the quality of care while shifting
the cost curve downward at the same time.
Transform How Clinicians Communicate
clinicalMessage is a robust provider-centric communications
platform that facilitates care collaboration across the entire
interprofessional frontline team. clinicalMessage is not a
solution to replace pagers. However, clinicalMessage
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fundamentally transforms how clinicians communicate with
one another by enabling streamlined processes through the
use of information technology. The real-time system was
designed by experts from the University Health Network
(UHN) in Toronto, Canada that have been developing and
evaluating communication solutions for the past eight years.
Key principles that have guided the development include:
Patient Centred: The solution is designed with the patient at
the centre of all interactions and functions, rather than the
clinician.
Focussing on the Process: Most of the issues relate to the
complexities inherent with interprofessional collaboration
and technology is simply an enabler.
Intuitive and Easy to Use: The application must be simple and
intuitive enough that a clinician who has received no training
can immediately use the primary functions of the system. This
is critical in an academic teaching environment where the
clinicians are very transient.
Extensible: The solution can be easily and quickly modified to
support innovation and the development of new care
processes.
Engaged Stakeholders: improvement is not limited to selected
few, all affected stakeholders including care givers, patients,
family members and vendors must have the ability to suggest
improvement. These opportunities must be processed
through active Learning Organization.
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Real-Time Evidence of Success: To improve adoption, the
system must show evidence of success through real-time
dashboard that is based on data collected through natural
workflows.
clinicalMessage® Built-in Capabilities
The specific capabilities that clinicalMessage has been designed
to enable include:
1. Mobile Communication
2. Patient Handoff
3. Closed-Loop Messaging
4. Enhanced Patient Experience
5. Industrialize Evidence Based Processes
6. Performance Measurement and Business Analytics
7. Expert Community for Continuous Learning
Mobile Communication and BYOD
Mobile devices, particularly Smartphone’s, are becoming an
integral part of healthcare and clinicians have adopted their
use to improve productivity. Clinical Message supports the
mobile clinician and provides the primary functionality on
any device. Advancements in mobile device technology
requires the solution to be device agnostic (ie. not associated
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to any single platform), ensuring it can be adopted by a large
academic teaching hospital or a small community based
hospital.
Patient Handoff and Care Transitions
The patient handoff module supports the transitions in care
that occur between clinicians at shift change. This solution
supports the physician sign-out process, nursing handover,
huddles, rounds and facilitates key interprofessional
communication activities that were traditionally facilitated
through the nursing Kardex. clinicalMessage facilitates the
communication of key summary information data to ensure
everyone in the patient’s circle of care can make timely
decisions when an issue arises. It also ensures everyone is
aligned regarding the patient’s overall care plan, improving
efficiencies and expediting the discharge process.
Closed-Loop Messaging Communication
The messaging module facilitates communication between
healthcare providers for coordinating patient care. However,
it is not simply a feature that allows text messaging. It utilizes
rules and logic to separate urgent and non-urgent
communication to ensure critical issues are addressed
immediately while at the same time allowing less critical
issues to be addressed with less priority. The closed loop
feature allows notifications to be sent when less critical issues
remain unaddressed, ensuring nothing “falls through the
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cracks.” This reduces the amount of interruptions experienced
by clinicians, improving their overall efficiency and
productivity.
Enhanced Patient Experience
The Patient Experience module would introduce patients to
their clinical team so they know who is caring for them. It
would provide patients and their family and friends a high
level overview of the care plan so they can remain informed
and be active participants in the care being provided. There is
the ability for the patient to provide real-time feedback to the
clinical team on the quality of care being provided, allowing
changes to occur while the patient is still in hospital. The
module would also provide an interface for the patient to
remain connected with family and friends when they are not
in hospital for added support.
Industrialize Evidence Based Practices
Evidence-based practices are available to promote the
standardization of care, improving the quality and safety of
care provided. clinicalMessage® employs the use of checklists
to facilitate alignment of patient care activities with best
practices and scorecards to measure performance and
adherence to these best practices. Rules and logic are used to
provide reminders when a best practise is not being followed,
allowing clinicians to adjust their care on a real-time basis.
For example, if an intravenous line has been in place for more
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than 72 hours, the nurse will be reminded that the site of an
intravenous line needs to be changed every 72 hours to avoid
phlebitis (inflammation of the vein).
Performance Measurement and Business Analytics
Key performance metrics and data required for regulatory
reporting is captured, monitored and tracked in real-time,
allowing issues to be identified and interventions employed
before issues arise. Operational inefficiencies can be more
readily identified, allowing process improvement activities to
be focussed on areas of primary concern for the organization.
Functional dashboards and business analytics tools provide
many views and approaches for organizations to improve
their operational effectiveness. For example, various metrics
around the emergency department disposition process can be
monitored and if a bottleneck is identified, such as an
inpatient service delaying consultation, escalations to the
service’s clinical director to remove this bottleneck can occur.
Access to Expert Community for Learning
clinicalMessage® is not just a communications solution, it is
also a community of experts that collaborate to improve the
quality and efficiency of patient care. While every
organization may face similar communication challenges, the
priority associated with each challenge may be different. One
organization may focus on improving one process, while
another organization focuses on improving another. By
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creating a central knowledge base that allows healthcare
organizations to learn from one another, everyone benefits
and can improve their processes in a shorter period of time.
clinicalMessage® Architecture
clinicalMessage® allows patients, families and clinicians to
collaborate both in synchronous and asynchronous manner
using their own mobile or desktop devices (see Figure 1).
Collaboration initiator decides on when the response is
required. If an urgent response is required, the system alerts
the parties via SMS (no PHI information is transported via
SMS), otherwise message is posted in responder’s inbox and
alerts are sent as requested by the responder.
Integration with Hospital EHR: clinicalMessage integrates
with multiple EHR solutions and pulls the data using HL7
standards.
Third Part Mobile Apps: QRS provides a secure and reliable
integration mechanism for third party apps such as blood
pressure, diabetes, patient location applications etc.
SMS Gateway: Built in SMS gateway enables secure
transmission of all messages at significantly reduced cost than
cellular carrier.
clinicalMessage® does not require real-time integration with
core hospital systems. This reduces the complexity and cost
yet provides most critical information to all stakeholders in
real-time.
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Figure 1: clinicalMessage Integration Architecture
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Deployment Options
Public Cloud: leverage the QRS managed cloud in your
jurisdiction and interact with clinicalMessage™ using your
own mobile device
Private Cloud: let us build and maintain your own private
cloud
In-House: Deploy clinicalMessage in your own datacenter
Summary and Call to Action
In summary, clinicalMessage® is not a replacement of the
Electronic Record System (EHR) or the traditional pager
system, but an adjunct to both systems. Having a complete
patient record is critical for appropriate care delivery. The
accuracy of a patient record is important and the entire
patient experience should include BOTH the EHR and the
clinical communication record. Thus with a complete record,
it is important to manage costs and to make the patient
electronic health record available to essential and care team
Providers in realtime.
Thus, access to real-time essential information helps improve
quality of care, patient satisfaction, staff satisfaction and
brings real transparency and accountability of care delivery.
With clinicalMessage® deployment, healthcare leaders can
accomplish this without investing millions of dollars in a risky
EHR enterprise rollout.
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References
1) Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Consensus
Report: National Academy of Press, Washington, DC.
2) The Advisory Board Company (2012). Strengthening Interdisciplinary Collaboration, Best
Practices for Enhancing Partnership and Communication. Nursing Executive Center,
Washington, DC.
3) M Smits, M Zegers, P P Groenewegen, D R M Timmermans, L Zwaan, G van der Wal, C
Wagner1,, Exploring the causes of adverse events in hospitals and potential prevention
strategies, BMJ, Qual Saf Health Care, 2010
4) Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to
medical mishaps. Acad Med 2004 February;79(2):186-94.
5) Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J et al. The Canadian Adverse
Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ
2004 May 25;170(11):1678-86.
6) Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication
inefficiencies in U.S. hospitals. J Healthc Manag 2010 Jul;55(4):265-81.
7) Canadian Institute for Health Information. National Health Expenditure, 1975 to 2011. Nov
3, 2011. Available:
http://secure.cihi.ca/cihiweb/products/nhex_trends_report_2011_en.pdf
8) Statistics Canada. Gross Domestic Product by Industry, 2001 to 2010. Available:
http://www5.statcan.gc.ca/ bsolc/olc-cel/olc-cel?catno=15-001-X&lang=eng&chropg=1
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About iCareQuality Organization
iCareQuality, Inc. is a benefit corporation registered in state
of Delaware United States with head office in Springfield
Pennsylvania. We believe systematic engagement of care
providers is key to building a sustainable healthcare system
globally. To support our mission we build provider
engagement tools, enable care providers develop new
knowledge and freely disseminate this knowledge to care
providers globally. As a benefit corporation, we pledge 40%
of our profits to our providers, 50% for reinvestment and 10%
for our investors.
About Our Team
Chief Architect
Jason Uppal, P.Eng.
Clinical Support
Kate ONeill, MSN, RN
Sales and Business Development
Bryan Weston