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.

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.