Tips for structuring a successful device pilot

One of the most common mistakes hospital systems make when implementing a mobile device strategy is choosing the wrong devices. Problems like devices not roaming well from access point to access point, or even simple manufacturer quality issues, can sabotage a strategy’s success.

It’s easy to assume that if a device costs upward of a thousand dollars it would meet almost any need a clinician could have, but many hospitals have found out the hard — and expensive — way that a high-dollar price tag doesn’t guarantee the best device for their user groups.

The best way to avoid this risk is to pilot any device before making a big purchase.

The importance of end-user input

The most important thing to keep in mind when piloting a new device is to conduct the pilot in real-world situations. There is a greater chance of a successful pilot if the devices are put right into the hands of end users and are used throughout the day within normal workflows.

Most end-user groups in hospital settings are very mobile by the nature of their jobs. Clinicians must be in many different places throughout the facility at many different times of day. And it’s necessary to make sure their devices roam effectively throughout your facility, without falling off the network.

For example, be sure to test the user experience at somebody’s desk, in a patient room, and in common areas of the hospital such as hallways, cafeterias and conference rooms. Don’t forget about areas outside the hospital, if personal devices are going to be included in your strategy.

Also, have a variety of end-user groups — e.g., nurses, ER directors, residents — test the devices. Apply as many variations as possible to the pilot process to increase the probability of finding a deal-breaking oddity. This will help you avoid purchasing and deploying expensive devices that aren’t going to work well within your hospital’s workflows.

Consider maintenance needs along with functionality

When it comes to workflows, test the devices against IT’s own needs. Think about the IT team’s ability to maintain the agreed-upon devices and policies, as well as manage them. The devices and the device strategy need to work just as well for IT as they do for the end user.

Another critical but sometimes overlooked element of the pilot experience is to test installation of commonly used applications. The goal here is to avoid any showstopping surprises after the devices are purchased and in the hands of hundreds, maybe even thousands, of end users. There are application limitations that are common to certain operating platforms, and if these limits are not tested before a device is selected and purchased, a breakdown in workflows and strategy adoption is likely.

For example, there’s a common assumption that by purchasing an Android device, end users will be able to run any app from the Google Play Store. The reality, though, is that some of these devices are on old versions of Android — i.e., 4.9 or lower — or they are heavily modified versions of Android that don’t support the Play Store or don’t support Google Cloud Messaging.

Since Google Cloud Messaging is used for push notifications, that’s the default push notification mechanism. If devices don’t support this feature, then extra work will be required.

You want to be as informed as possible about what you’re buying and how it’s going to work in real-life scenarios within—and beyond—your hospital walls.

 

 

Higher MIPS scores and positive CMS adjustments

Technology helps us do so much more than we used to be able to do on our own. If there’s anything we’ve learned in the last decade of technological innovation it’s that “there’s an app for that” when it comes to just about any goal you want to accomplish.

This absolutely includes the financial goals you’ve set for your practice, which you’ve probably had to re-evaluate recently due to the uncertainty surrounding CMS payment adjustments under MACRA.

Healthcare IT (HIT) will play a major role in your MACRA compliance efforts. In addition to automating some of the more tedious processes the new regulations require, HIT can help physicians score high under the Merit-based Incentive Payment System (MIPS), which is necessary to receive positive payment adjustments from CMS beginning in 2019.

Here’s how HIT, especially tools that enables efficient and timely care team collaboration, can boost scores in each of the four weighted MIPS performance categories:

Cost

The processes and treatment plans used by clinicians to deliver patient care are directly tied to costs. In the face of potentially negative payment adjustments, it’s more important than ever to realize cost savings, a feat that will be heavily impacted by providers’ ability to manage chronically ill populations. Success in population health management is highly dependent upon efficient communication, collaboration and care coordination across all care team members and care settings. Communication workflows and unified communication tools need to be assessed and implemented to improve the speed and efficiency with which disparate care team members can communicate with each other to coordinate care.

Quality

Clinicians have a lot of personal freedom when it comes to the quality of the care they deliver. One of the more manageable ways to improve the quality of healthcare is to overcome communication obstacles that have long degraded and delayed care. Obstacles such as not knowing who to contact for a given situation; searching for and struggling to find contact information and leaving messages with intermediaries; never knowing if the right message will be delivered to the right recipient, thus suspending and disrupting care, etc., are easily overcome with the help of intelligent communication routing and automatic escalation tools.

Advancing Care Information (ACI)

EHR functionality is a key component of ACI, but an EHR’s capabilities to support care coordination are limited. Care team members in a physician’s network may or may not share the same EHR, and the need to seamlessly communicate with them — and those outside of the network who are even less likely to have the same EHR — is equally important. There’s an increased need to implement a system of secure communications that transcend disparate EHRs to ensure timely bilateral exchange of patient information. Interoperability is an important factor for the ACI performance score.

Improvement Activities

Clinicians who utilize patient-centered approaches to achieve better, smarter and healthier care will perform well in this category. Implementing tools that enable patient-centric communications is one step toward achieving a high score in the Improvement Activities performance category.

More than 600,000 clinicians will be responsible for reporting MIPS performance criteria for at least 90 days this year. MIPS reporting is complicated, complex and extremely important to understand because it will impact CMS payment adjustments beginning in 2019.

The threshold to receive a positive payment adjustment has been set very low for 2017, so there’s less financial risk for eligible clinicians in the first year. The clinicians who want to cross the low composite score threshold to receive the maximum positive adjustment possible in 2019 need to score high in the performance measurement areas of Quality, Advancing Care Information and Improvement Activities. Reporting in the Cost category will begin in 2018.

Care team collaboration and communication platforms like PerfectServe® help clinicians decrease costs and improve quality by eliminating inefficient and time-consuming communication processes that delay treatment. Our cloud-based architecture allows clinicians to transcend the communication capabilities of the EHR and securely coordinate care with disparate interdisciplinary providers regardless of their location; and the patient-centered communication capabilities neatly fulfills all of the criteria for the Improvement Activities performance category.

Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.

Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

What to expect from MACRA: The early years

MACRA legislation passed in April 2015. When the initial version of the rule came down, the industry collectively braced for declining revenues, the avalanche of administrative paperwork and the increase in overhead costs that would be required to comply.

When the final rule was issued in October 2016, the tempered requirements seemed to point toward fewer projected negative payment adjustments in 2019, the target year for MACRA’s first Quality Payment Program distributions, and the tension subsided a little.

Even with the new allowances in reporting and threshold scores, the MACRA structure makes clear that there’s an abundance of work to be done, especially around efforts to promote care coordination and communication.

Year 1: 2017-2018

Now that we’re already into 2017, the first official reporting year, tensions are rising again because, even though most physicians acknowledge they are going to participate, the majority have not yet plotted their course or defined a compliance strategy.

And if you’re in the group that hasn’t figured it all out yet, the good news is you’re not alone.

According to a recent poll conducted by The Health Management Academy, almost half of the physician and practice leaders who participated are not moving very quickly toward adopting value-based payment models. In fact, only 4% claimed to be moving “very quickly” while almost 40% admitted to moving “very slowly” toward value-based care.

Somewhat surprisingly, the same is true even for large hospital systems. These organizations are perceived to be the driving force, the ones moving the fastest toward the end goal of value-based care, and yet, per a similar poll, few of the large systems are moving very quickly.

Only 8% of large hospital systems polled are moving swiftly toward implementing value-based payment models. – The Health Management Academy, 2017

The Quality Payment Program, however, is going to be the catalyst for healthcare organizations, both large and small, moving more aggressively toward these models in the next couple of years.

The MACRA structure and how you fit in

By now, you know that reimbursements are going to be variable based on performance, even if you’re still practicing in a fee-for-service structure and, like most, have not yet begun practicing in the more advanced tracks.

There are four participation categories, which fall underneath two broad tracks—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) track.

The four MACRA Quality Payment Program participation categories. – The Health Management Academy, 2017

The two categories in the middle of the chart are bridge areas, and won’t apply to many providers right now, but they can be considered as stepping stones from MIPS to the Advanced APM track.

The MIPS track equates to fee‑for‑service, and most physicians will, at least initially, fall into this track. They’ll balance their steps toward embracing more downside risk by continuing to practice fee-for-service medicine, and so they must prepare to report performance metrics and have payments adjusted based on those metrics in 2019.

On the other end of the spectrum is the Advanced APM track. To reach “Advanced APM Qualifying Clinician” status, physicians must engage significantly in certain downside risk-bearing payment models. In this track, participating physicians will enjoy fewer reporting requirements and more financial incentives, while still being held accountable for delivering high-value care. The only way to sustain a profitable practice in this track is to eliminate wasteful workflows that result in inefficient and unreliable communication processes among all members of the broader care team, even if they are not directly affiliated with your practice.

Year 2: 2018-2019

In the first months of 2018, physicians practicing in the MIPS track—again, that will be most of you—will be required to report metrics in three performance categories based on at least 90 consecutive days of work. This should come as more good news, because if you haven’t started measuring yet, or you’re not impressed by your initial metrics, you still have time to pivot before the data is due in early 2018.

CMS will use that data to give each physician a composite score, which will determine the payment adjustment he or she receives in 2019.

The Quality Payment Program’s initially proposed rule was accompanied by disheartening projections in terms of payment adjustments, particularly for solo physicians and small practices. While the finalized October 2016-issued rule basically guaranteed that all physicians who submit any performance data will receive at least a neutral payment adjustment, physicians are still bracing themselves for less-than-average profit margins.

As MIPS is largely a budget-neutral program, less risk equals less reward. Since fewer physicians will be subject to negative payment adjustments in 2019 (see Image 3 below), fewer dollars will be available to distribute to those who perform well.

Only 20%—versus 87%—of physicians in smaller practices are projected to experience negative payment adjustments in 2019. – The Health Management Academy, 2017

Simply put, the best way to ensure your adjustment is as high as possible is to garner a high composite score.

Effectively coordinating care with your patients’ broader care teams as accurately and efficiently as possible to reduce waste and unnecessary overhead costs is a good first step toward achieving high scores in all four MIPS performance categories.

Back to the present

One of the goals of MACRA is to drive the costs out of treatment while still providing high-value care. Physicians will be in a much better position to deliver this dichotomy, and advance to a more rewarding reporting track, when the barriers to real-time care coordination have been broken down.

Seamless care team communication and collaboration among interdisciplinary, and often disparate, providers will be a foundation on which you can lay the groundwork for improved care coordination, which leads to less waste, improved efficiencies, and ultimately better outcomes, all of which underlie value-based care and the successful reduction of healthcare costs.

Source: “Making Sense of MACRA” webinar. The Health Management Academy and PerfectServe. March 2017. 

Watch the full webinar to learn even more about MACRA and how it applies to your practice.

The role of secure communications in your clinical integration strategy

If you could take one solution with you on your journey to clinical integration, what would it be?

Clinical integration is the unification of healthcare data, services and coordination across acute, outpatient and post-acute care. It portrays an environment where waste and inefficiency are all but eliminated from healthcare communications, costs decrease and care improves. It’s the future of medicine.

You wouldn’t be far off course if your first thought was to rely heavily on the EHR to support your clinical integration strategy. While the EHR is a valuable tool for sharing patient information within hospital systems and broader care networks, it lacks a fundamental quality that bridges the gaps between Meaningful Use and true clinical integration.

Fully realized clinical integration can only occur when the barriers of communication have been broken down, and interdisciplinary clinicians can accurately and reliably coordinate care in real time across organizational and geographical boundaries. As with most things related to healthcare communication and the sharing of information across disparate networks, securing those communications has been and will continue to be a primary focus for healthcare IT leaders. In an environment where healthcare organizations are driving toward an end-goal of clinical integration, enabling secure communications alone just isn’t enough.

To achieve clinical integration, clinicians need a solution that enables immediate, accurate, reliable and secure communications.

Immediacy in healthcare communication

Real-time communication is a crucial element of delivering high-value care. In the most critical emergencies, every second counts. The time that clinicians waste identifying the right on-call care team member to contact, and then trying to reach that person, can quite literally be the difference between life and death. Even in non-emergent situations, early detection and treatment are well-known effective preventers of worsening conditions.

Yet it’s all too common for inefficient and broken communication workflows to create time-consuming hurdles for clinicians to clear—sometimes even to just begin the conversation.

Clinically integrated settings approach clinician-to-clinician communication with a sense of real-time urgency. That’s not to say that every message should be sent with an emergency status, just that the process of identifying the provider you need to connect to and the delivery of that message should be seamless and immediate.

Reaching the right care team member on the first attempt should be an important metric for all hospital systems. To keep performance numbers high in this area, you must ensure clinicians always know exactly whom to contact for any given medical issue.

However, most clinicians today initiate time-sensitive contact to the broader care team by thumbing through a lengthy paper-based on-call schedule, making a call, and then waiting to receive a response.

Real-time clinical communication and collaboration tools immediately deliver secure communications, and even allow the clinician initiating the communication to see in real time when messages are delivered and read.

Contact accuracy

Reaching providers on the first attempt is important, but it’s just as important to reach the right provider—the one who can act on the medical issue at that moment—via his or her preferred method of contact.

It’s not uncommon for providers to have a different preferred contact medium for every variance of their schedule. And it’s not uncommon for those schedules to change at a moment’s notice. Yet many hospitals, in both small and large systems, only print the schedule and patient assignment lists once per day.

Clinicians in this setting have no way of knowing if they are accurately reaching out to the right providers via the right contact method. Manually producing a list of whom to contact and how is a process riddled with opportunity for inefficiency and inaccuracy.

Dynamic Intelligent Routing™ eliminates those opportunities for communication breakdown. A distinct capability of PerfectServe, Dynamic Intelligent Routing analyzes workflows, call schedules and contact preferences, enabling clinicians to reach the right person at the right time with just the tap of a button.

Reliable communication workflows

If your clinicians depend on inaccurate call schedules or outdated, cumbersome processes to drive clinical communications, your communication workflow isn’t reliable.

When clinicians can immediately contact the care team member they need via that provider’s preferred contact method, communication workflows become reliable and trustworthy, which leads to high adoption and improved patient care, no matter the care setting.

From improved care coordination to reduced costs

Inefficient communication workflows not only interfere with the realization of clinical integration, but also they inflate healthcare costs. For example, if a radiologist identifies a critical result in an outpatient test, the radiologist needs to contact the patient’s PCP so action can be taken right away. If the communication is not immediate, accurate or reliable, the process breaks down and the delay could result in medical complications for the patient that end up costing more to treat.

Moving a patient safely through the admissions, treatment, discharge and post-acute care processes requires a tremendous amount of coordination, good communication and a sound clinical integration strategy. The tools you use to support that communication and collaboration will play an important role in your success.

How much is your answering service really costing you?

The inevitable mistakes made by a traditional after-hours answering service aren’t often attributed to significant costs that may be undercutting the success of your practice. But if you consider that quality communication between members of your staff and your patients—especially after-hours—is a fundamental pillar of patient care and safety, you’ll start to see that little mistakes can add up to big costs.

Physicians and group practice administrators throughout the country will attest that answering services make mistakes that cause clinical communication breakdowns. The human error factor in the answering service equation means lost or delayed messages, wrong patient names, inaccurate symptom descriptions and more. For a long time, it’s simply been considered the status quo. There didn’t seem to be any real way around it.

So an industry-wide acceptance that on-call duty will be frustrating for physicians, and that mornings—especially Monday mornings—will always present some answering-service-related issues for the practice administrator to handle has taken hold. And while these inconveniences may not seem like a big red flag, it’s wise to get a good look at how far-reaching the impacts really are.

Are your patients getting the best care, even after hours?

Patients will generally stay loyal to a practice because they trust their doctor. But if they feel like their medical needs are not given the same sense of urgency that they’re feeling—or worse, if their questions go unanswered—that trust can quickly dissolve into frustration and fear. For some patients, despite their relationship with the physician, this can be a reason to leave the practice and find a new provider.

So, while you may or may not lose the recurring revenue of a loyal patient, you have to consider the cost of that patient’s negative experience.

If one patient has had an unsatisfying experience with your answering service, others probably have, too. So the real question becomes: how much is your answering service impacting patient satisfaction?

Are you spending your time the way you want?

It’s difficult to tie a hard cost directly to the frustration of wading through miscommunications to get to the bottom of an issue. And it might not be possible to calculate the profit margin impact of the feeling that you cannot deliver the level of patient care you want because there is a weak link in your communications process. But the time you spend managing answering service mistakes is time that could be spent on patient care, so the equally important consideration here is the quality of that time.

The time you spend feeling frustrated and inconvenienced—by non-emergency after-hours calls, for example—does have a cost. It’s a personal calculation and it has a real impact on physician satisfaction.

Are you at risk for fines, penalties or lawsuits?

Some unlucky practices have discovered one of the answering service industry’s best kept secrets: subcontracting.

Some of the answering services that exist today are actually not answering services at all. They are simply businesses that subcontract the work out to another answering service—one that may or may not adhere to HIPAA compliance standards. It’s a risk that no practice leader would knowingly take. With so many unknowns, a practice in this situation is at real risk for fines and other breach penalties.

And then consider this worst-case scenario: a patient unknowingly suffering a stroke calls after hours to report blurred vision and confusion; but because the answering service’s on-call schedules are not accurate, the patient’s message isn’t delivered to the correct on-call physician for another hour. At this point, given the time sensitivity of this issue, the practice could be at risk for a malpractice suit.

An incident like this—however unlikely it may be—could mean a tangible financial loss for your practice.

But that’s not all.

Are you protecting your reputation?

Imagine a critical care surgeon with his own practice who routinely performed emergent consults for local hospitals…until they stopped calling. The hospital felt his answering service was unable to deliver messages in a timely manner, and so they found other practitioners to fill that need.

Your credibility as a caregiver in your local healthcare community can be negatively affected if outside consultants and hospitals cannot reach you quickly in times of emergency. The professional impact of a tarnished reputation is beyond quantifiable. And if the reason is answering service communication delays, it’s also unacceptable.

Are you sure you’ve uncovered the hidden fees?

Most answering services are up front about their fees, but physician leaders and practice managers seldom realize how many fee-based activities they’re actually charged for on a single after-hours call:

  • There’s a fee for taking the message.
  • There could be a fee for relaying that message to the right clinician.
  • There could be another fee for relaying the clinician’s instructions back to the patient, if that’s the case.
  • There could be yet another fee for recording and logging the conversation as a whole, or a fee for recording and logging each communication.

These little fees can add up over time to a surprisingly significant amount.

Are you ready for a better solution?

We live in an era of digital clinical communication, with automated tools that eliminate human error in after-hours communication, provide caller ID protection for physician contact information, and have the ability to recognize and defer non-urgent messages until business hours resume.

Imagine an on-call weekend when non-urgent prescription refill messages are deferred until Monday and the physician’s days are spent as planned (i.e., enjoying time off unless there are true emergencies).

Imagine walking into the practice every morning knowing that all your patients received the care or assurance they needed after hours and there will be no complaints to handle.

You can take a hard look at your answering service’s monthly invoice to understand the hard costs, but those are not the only ones to consider. The less quantifiable effect on your patient safety and satisfaction levels, your physician satisfaction levels, your compliance risk and your professional reputation are serious issues you should consider—because they really do cost your practice.

How to increase the impact of smart mobile devices

Post originally published on HIT Think from Health Data Management.

For the usage of smart mobile devices to make a real impact on clinical care, hospitals and health systems must extend their concept of enterprise mobile communications to a holistic strategy—one that evolves around the end user, workflow, data, applications and other factors.

Tough challenges lie ahead for IT departments tasked with refining their enterprise mobile device strategy to grow with future needs.

Here are 10 “tried and true” recommendations to support greater levels of mobility, care team adoption and efficiency, and patient care.

1. Request the certified communications/smart device list from your electronic health record vendor. Most EHR vendors can provide this as a starting point to build or refine your enterprise mobile device strategy. The list ideally ranks the computing power of the device and its ability to access clinical data within the EHR.

2. Understand the market for shared mobile smart devices in the acute care setting. This market is in its infancy, with less than 10 percent of U.S. health systems having deployed shared mobile smart devices in their patient care settings. Be aware that many devices designed for healthcare are first-version releases and will rapidly evolve pending real-world clinical experience.

Two challenges commonly experienced by early adopters include learning to operationally deploy and manage devices exclusive of evidenced-based best practices and proven tools; and discovering that your expensive device investment is unexpectedly outdated and financially unfeasible due to the rapid technology evolution.

3. Compare iOS-based devices to Android-based devices. Key differences exist between the iOS and Android device landscapes. Apple’s iOS devices are consumer devices, whereas some Android devices are built purposely to support healthcare and other rugged environments. Notable differences are also found between consumer-grade and enterprise-grade devices.

4. Review devices that include VoIP phone capabilities. Ascom, Motorola and Spectralink are three such manufacturers.

5. Explore adding VoIP capabilities to a smart device lacking native VoIP support. Some ruggedized device manufacturers do not include native VoIP phone capability, including the Caterpillar CAT s50c and Honeywell Dolphin CT50H. VoIP phone capabilities can be added to devices by using an app offering “softphone” capabilities.

6. Consider the product lifecycle of a smart device. Purchasing a device in the first half of its lifecycle enables an organization to maximize its usefulness and longevity. For instance, if a device is in its fourth year of a five-year product lifecycle, the device most likely has a processor architecture that is four years old. In its second year of use, that processor architecture will be more than six years old. This may result in care team users decrying the devices are slow to use—especially as more apps are added through the years. Before making a significant investment in an older processor, research the timing of the next release.

7. Examine the performance of the device roaming across wireless access points. Most healthcare organizations have a high volume of wireless access points situated across multiple facilities. As a result, a device’s usability and performance in managing patient handoffs between access points is influenced significantly. To prevent problems, providers can question the device manufacturer for details on the work completed to ensure frequent access point transfers do not disrupt care operations. For example, find out how often device access points are checked for changes, as infrequent device polls increase the probability of certain access points being no longer in range. Likewise, count the number of access points in a 15-second walk in the facility.

8. Understand the difference between Android apps in the Google Play Store and Android devices. Several device manufacturers have modified their operating systems such that some functionality has been removed. Both the Motorola MC40 and the Ascom Myco, for example, offer custom versions of Android that no longer support the Google Play Store or Google Cloud Messaging capabilities. Thereby, apps leveraging push notifications can fail to work unless the app developer adds those capabilities. Question those differences, including the device’s Android consumer version.

9. Determine if your Android device choice supports Android for Work. Android for Work is a new enterprise program enabling consistent IT management and secure app distribution through an ecosystem of MDM vendors. It provides IT with a unified way to secure enterprise apps, manage disparate devices, and separate work and personal data at the OS level. Android for Work is the industry standard for app vendors providing capabilities to leverage a facility’s MDM and requires the Android device to be version 5.x or greater. For those device versions 4.x or less, the app installation and subsequent future upgrades must be completed manually.

Manufacturers that develop Android devices built purposely for commercial settings have a device lifecycle that better aligns with health enterprise expectations as opposed to consumer expectations. Consequently, while most consumer Android devices in use are version 6.x, the healthcare purpose-built devices are typically 4.x.

10. Make a well-researched device choice. Providers do not have to choose a single smart mobile device for enterprise-wide adoption among all care team members. In making your device selection decision, consider the care team member’s role and respective needs such as workflow. For example, deploying a device featuring VoIP phone capabilities for nurses—and other direct care personnel—may make more sense for accommodating workflow, as does selecting a less expensive device without VoIP capability for clinical support service staff.

Building an effective care team collaboration strategy: 4 focal points

Part 2 of a 3-part series in conjunction with our nurse leadership webinar series.

The need to unify physicians, nurses and other care team members through effective communication at the point of care is growing in significance. According to a 2015 Gartner report, 80 percent of providers report deploying fragmented communication technologies, which results in degraded care team communication and collaboration.

Collaboration is both a process and an outcome. It affects the patient experience, outcomes and care occurring across a variety of settings in an increasingly complex and mobile environment.

To resolve the fragmented and non-secure communication encountered in healthcare, true care team collaboration is dependent on consolidating disparate technologies into a single solution capable of directly addressing the communication obstacles degrading patient care today.

To some, this may sound like an unachievable goal, but with a strategic plan focused in areas that facilitate workflow processes and communication leading to improved patient care, it is attainable.

You may wonder, where do I even begin? Many organizations, in response to specific challenges, have deployed single-point technologies that provide only incremental gains. True communication and collaboration requires a comprehensive strategy, and to begin you must carefully evaluate your entire communication landscape. You’ll need to assess your current technologies, HIPAA compliance plan, near miss or sentinel event occurrences, nursing time to reach providers and consult notifications procedures – all of which will highlight your communication strengths and weaknesses.

Developing a comprehensive care team collaboration strategy spans four major areas of consideration. Failure to address any one of these areas may leave you with an incomplete solution. Each organization is unique, certainly, but departments and organizations must work together to create an environment ripe for collaboration.

  • Clinical – Mobile technologies are becoming more prevalent in healthcare settings, thus the need to leverage these technologies to facilitate secure communication amongst the care team is becoming increasingly important. A clinical communications solution should enable communication-driven workflows to facilitate timely care team communication. The solution should facilitate direct conversations among nurses and physicians via the preferred mode of contact – be it a mobile phone, pager, email or office land line. By triaging incoming calls and applying personalized algorithms for call placement, care team members reach the correct physician without searching through call schedules.
  • Operational – Once your plan is in place, bringing it to life warrants consideration and considerable forethought. A well-defined adoption strategy will be key to a successful implementation. Clinical champions help drive decisions and engage end users. Leadership engagement is often the most essential driver of adoption of any initiative, plan or policy. You should also consider and plan around timelines, specific tasks and resource requirements.
  • Technical – To achieve success, understanding and addressing technical infrastructure is a must. The strength of your Wi-Fi and cellular networks should be evaluated. Does your organization have a device strategy or do you have a BYOD policy? Do you desire integration with clinical systems and is the solution you are considering interoperable?
  • Financial – In any financial consideration, ultimate ROI and total cost of ownership are needed to justify approaches. When you close communication gaps across the extended care team to facilitate patient care collaboration, you can potentially improve referral revenue, decrease readmissions and avoid penalty costs. The ability to do mobile charge capture at the bedside, and to quickly and fully document exam and procedure details at the point of care will result in revenue recognition and improved cash flow for physicians.

There is no short list of considerations when it comes to building an effective care team collaboration strategy. However, if you focus on these four areas, gain support of leadership and identify a solution that hits these marks, you will be well on your way to effectively addressing your communication and collaboration needs.


Interested in learning more? Read part 1 and part 3 of this series on nurse leadership in care team collaboration.

The impact of a unified communications initiative on a health system

Listen to the podcast here, or read the transcript below. 

Introduction: You are listening to Health IT voices. Broadcasting live from Chicago, Illinois, and direct from the HIMSS15 exhibition. HIMSS – transforming health through IT. Today’s show is brought to you by Health IT Outcomes, bringing you the latest on the technology and people driving health IT. And now here are your hosts, Todd Schnick and Kelly Riggs.

Todd: All right, good afternoon and welcome back to the show. I’m your host Todd Schick, joined by my friend and colleague, Kelly Riggs. Good afternoon to you sir. They have saved the best for last.

Kelly: Oh yeah, we’ve put a little pressure on him as well, but I’m looking forward to a great interview.

Todd: It’s going to be a great conversation. Before we go there, Kelly, a quick shout out to Health IT Outcomes for making this great day possible.

Kelly: You bet. Really appreciate them having us as a part of the show, and you want to make sure you check them out. HealthITOutcomes.com.

Todd: All right. Let’s get to this great conversation. We’re now joined by Terry Edwards, the CEO of PerfectServe. Terry, welcome to the show.

Terry: Thank you. Glad to be here.

Todd: Glad to have you. Thanks for carving out some very valuable time at the end of a long day. I’m sure it’s been a good day for all of us. Before we get into our conversation, take a quick second. Inform the audience a bit about you and your background, and then give us the 10,000 foot view of PerfectServe. What do you do? How do you serve your market?

Terry: Sure, sure. Well, I’ll maybe start with a little bit of a story here. I got involved in interactive voice response technology back in the 1990’s and when I got involved in that industry, my wife is a registered nurse, and she went to work for a solo practice pediatrician, and I used to observe how she would manage the call process. She would take calls for this doctor on the weekends occasionally, and I would observe how the process worked with patients needing to connect with her around an urgent situation, and how convoluted it was. And so, that led to an identification of this problem around communications in healthcare and me then founding PerfectServe. So today, PerfectServe is a pretty meaningful company in the space. We essentially are a communication and collaboration platform that’s focused on uniting the care team members – the physicians, nurses, and other providers.

Todd: We talked a little bit before the interview and you were explaining to me it is an enterprise resource type of application. Clearly, it has to be very extensive to begin to mold so many different disparate pieces into one arena. How do you implement?

Terry: Yeah. The heart of the platform is its ability to enable what we refer to as a communications-driven workflow. And so, let me explain what I mean by that. Let’s say that you were to show up in an emergency department, and the doctor thinks that you might be having stroke symptoms. So, they’re going to then kick off a workflow that’s based on stroke diagnosis and treatment. And that involves reaching out to the neurologist who’s covering that emergency room at that time. There might be a whole stroke team who has to get in to perform a CT scan for you. And this is important, because there’s a drug that arrest stroke called TPA, and there’s a certain time window when that drug has to be administered. And if it’s not administered in that time window, bad things happen. So, an example of the communications part of that is contacting the on-call neurologist and mobilizing that team and getting them to come together to provide the care that’s necessary. So, PerfectServe would automate that kind of a communications process, for example. So that’s what we do.

Todd: You said earlier that your role is to unite the care team members. Now I think the average consumer out there would say, ‘Well, wait. That’s not happening already?’ I mean, how big of a problem is that?

Terry: It’s a big problem. In fact, we conducted a Harris poll survey that we released this week, and we surveyed nearly 1,000 providers. I believe about 750 were actual clinicians. The others were administers of large practices or hospitals. But of the clinicians, 54% of them, or 53% of them, often times don’t know who the right care team member is in a given clinical situation, and that’s because the workflows are complex. So much of healthcare is role-based communication, and who is in this role. Like, I talked about the neurologist. Who is in the role of the neurologist providing care at this hospital right now? Because that changes.

Todd: Well it’s interesting that you use the phrase communication and collaboration, because basically what we’re talking about is a variety of silos that, if they don’t hand off and transition well, you can lose a lot of valuable information along the way.

Terry: That’s right. That’s exactly right. So, communication to me and to us is a part of collaboration and this notion of collaboration is really more important as the industry shifts to value-based care models, and it’s not about the doctor or just the patient anymore. It’s about the whole care team. And so we’re really focused on trying to bring the care team tools that will allow them to be effective at collaborating with each other.

Todd: Well, you were reading my mind – the value-based delivery. That becomes a significant aspect of this. It’s really difficult to even drive that without the collaboration.

Terry: Yes, yes. Under a fee-for-service model, there’s not an incentive for providers to communicate with each other in many cases. But, if you have multiple providers who are all under, say, a risk-based sharing contract for a population of patients, then that’s going to drive new communication work flows and youth cases that aren’t occurring today. And there, you know, like contacting the neurologist. Some of them are very difficult to implement in an efficient way.

Todd: Absolutely. Well, lest you think I missed it, I did pick up on your secret weapon that Mrs. Edwards is a registered nurse. How critical has that been? Because they’re a critical link between the patient and the doctor. How valuable has her insights been to help you understand what really needs to happen here?

Terry: Well, she’s not practicing anymore, but she was integral to allowing me to, you know, to see the problem. But even as she describes it, within healthcare, I remember somebody asked her the question, ‘How bad was it?’ It’s kind of like, well, you don’t really know how bad it is until you have a solution, and then it’s like, how did we live without this before?

Todd: Hey, I want to get a little bit specific with you Terry. Let’s talk a little bit about PerfectServe. Talk about some of the features that you offer healthcare providers in a unified communication platform that other vendors may not.

Terry: Sure. Well, I’ll start maybe just talking about texting, because it’s been a segment that’s been emerging and it’s being driven by the rise in smartphones and, you know, we’ve all adopted it from a consumer perspective, and we incorporate those capabilities, but a true platform to really be comprehensive has got to bring in voice, it needs to bring in voice messaging, it needs to be multi-mobile. You’ve got to be able to initiate a communication via the phone, via a mobile app, via the web. It’s got to connect up to the primary clinical systems, so we receive data out of different systems, for example, and we’ll route that data accordingly. Say, a lab result, for example, or a new admission notification. So the other thing is, as you think about all these different modes, and then you have to do the various routing, you have to make sure that they’re all secure. So the issues around security aren’t just secure text messaging. It’s secure communications. And that, you know, in addition to the workflow capabilities that I talked about earlier, the ability to secure all the communications at an enterprise level is, we think, distinctive to the PerfectServe organization.

Todd: IT departments hyperventilate when you change their worlds, the finances of provider are very sticky and tricky and they’re limited with resources. How do you overcome some of those challenges?

Terry: Well, you know, within the hospital enterprise or large integrated delivery networks, you know, IT organizations, you know, they have their own way of buying and things like that and the buying processes and evaluation processes can be very, very challenging, but we have been able to work with some of the largest and most prestigious systems in the country, like Advocate, for example, here in Chicago. One of the leading health systems in the country – a leader in value-based care and we’re deployed across that entire system, and we’re employed across the entire system because we’ve been able to meet their needs, both from an IT security standpoint, and as well as a workflow standpoint.

Todd: So here’s an interesting question for you. We talk about outcomes. What physicians care about, ultimately, is outcomes. Is that the perfect metric to validate the efficacy of a system like yours or is there something else that we can measure and understand?

Terry: Well, what we’re doing is we’re enabling clinicians to speed the time to treatment, ok? So if you speed time to treatment, that will have an impact both on quality, as well as on operational efficiency. Now, there are a lot of other things that can contribute to both of those factors, but we’ve been able to do studies, for example, from an operational efficiency standpoint, where we’ve been able to improve throughput for example, in emergency room. We’ve been able to see hospitals see a reduction in code blue events. That stroke example that I gave, St. John Hospital and Medical Center, part of the Ascension health system in Detroit, when they implemented the process that I described, they were able to administer TPA to three times more patients who presented with stroke than they did the previous year even though the patient population was the same. So, by improving that communication-drive workflow, more patients walked out of that system alive who presented with stroke.

Todd: Sure. Speed becomes a very interesting metric. I agree.

Terry: Yes, yes. And we’ve been able to prove, we’ve done studies where we’ve definitely proven a reduction in cycle time. I had the opportunity to give a presentation earlier today here at the event with Memorial Care, and we did a before/after time motion study of nurse to physician communication cycle time, and they experienced a reduction in average cycle time by about two thirds. From 45 minutes on average down to just under 15.

Todd: Wow. Wow.

Terry: And the thing that’s interesting is these kinds of communications are occurring hundreds or thousands of time every day in a given hospital. So in Memorial Care’s case, I believe they’re probably about five to six hundred times a day.

Todd: Wow. Unbelievable.

Terry: And this is all about the care delivery process, and it’s the interaction that occurs in those communications that determines the, you know, the action that needs to be taken to provide treatment.

Todd: Well we’re here at HIMSS15. Is PerfectServe making any key announcements we should be aware of?

Terry: Yes, yes, yes. So we just announced our broader product development strategy and we’ve introduced that under the PerfectServe Synchrony brand identity. And that effort is about expanding from the communication-driven workflow for doctors to the entire care team, like we’ve described. So, we’re going to be rolling new capabilities out next quarter, and then those capabilities will be available by the end of the year or early the first of next year. And Memorial Care, who I talked about earlier, will be one of the first systems in the country to deploy this comprehensive solution. There’s not another one like it. Fantastic market. So, we’re excited.

Todd: Yeah, congratulations. We look forward to talking about that next year.

Terry: Great, great.

Todd: Terry, we’re out of time. Before we let you go, how can people get in touch with you should they have questions and where can they learn more about PerfectServe?

Terry: Sure. Well they can learn more about PerfectServe at www.perfectserve.com. I can be reached directly at 865-212-5700 or terry.edwards@perfectserve.com.

Todd: Terry Edwards, the CEO of PerfectServe. Terry, real pleasure to have you. Thanks for stopping by and joining us.

Terry: Thank you.

Todd: All right. Well that wraps our day one coverage here from HIMSS15. This has been Health IT Voices broadcasting from HIMSS live from Chicago. On behalf of myself, my cohost, Kelly Riggs, and all of us at Health IT Outcomes, this is Todd and Kelly signing off. Healthcare IT Voices will return tomorrow. We’ll see you then.