Patient Benefits of an Advanced Automated Answering Service Solution
Patient experience is the most important factor when it comes to patient retention at any medical practice. An essential touchpoint to optimize in modern medical practices is to standardize the way your patient calls are handled. The right 24/7 answering service solution can free up valuable provider and staff resources to focus on patient care while reducing unnecessary interruptions and ensuring urgent messages reach the right provider at the right time—every time.
Removing human error and delivering an automated and reliable service for both providers and patients, advanced answering service solutions are being implemented by more and more practices to enhance both patient and provider satisfaction.
Here are just a few key patient benefits of an ideal automated answering service solution:
Your patients have busy lives but your practice is busy, too. If your practice experiences call volume congestion, your patients still need to be able to reach you without being put on hold. The right answering service solution will differentiate messages based on urgency and use your on-call schedules to accurately route communication to the right provider based on escalation policies set by your practice, speeding time to treatment.
Efficient practice operations help decrease the time patients spend waiting during appointments and on hold when they call your practice. Automation allows patients to reach your practice at any time, during any circumstances to get the answers and help they need. The best answering service solutions offer smart routing that ensures providers are only interrupted to address urgent requests that require responses in a timely manner.
24/7 Care Access
Although many answering services are only used for after-hours coverage, an automated answering service solution delivers around-the-clock coverage as needed. Just because you don’t see your patients on a 24-hour basis does not mean it shouldn’t be easy for them to manage their appointments and make routine requests such as medication refills whenever they think of them, which might not be during regular office hours. An automated answering service solution can support call volume overflow when the main line at your practice is busy and serve as a 24/7 backup during emergency events when your practice is closed.
Better Onsite Service
Your staff need to be able to do their jobs, but when they face constant interruptions and take on the additional task of call filtering, concentration is broken, efficiency is lost, and providers can become unable to best care for their patients. Implementing the right automated answering service solution can free up your team to focus more on what they do best—patient care.
If providing an excellent patient experience and running an efficient medical practice are priorities for you, an advanced automated answering service solution might be just what the doctor ordered.
Let’s discuss more about how the ideal automated answering service solution can benefit your patients.
4 Simple Steps for Reducing Third-Party Vendor Costs
In the era of nonstop mergers and acquisitions, healthcare organizations are taking on immeasurable costs in the form of third-party services. When a health system acquires a private or independent group practice, the health system inherits all the practice’s employed third-party services and systems, including:
Electronic Health Record (EHR)
Revenue Cycle Management
Medical Answering Service
Security, Maintenance, and More
When healthcare organizations merge, issues with purchased services compound as the health system takes on all existing service contracts from the practices affiliated with the previous organizations. Purchased services represent as much as 20% to 25% of an organization’s annual spend,1 so consolidating services is a valuable opportunity to save on spending.
Standardizing third-party processes and technology can be an untapped source of savings across the healthcare supply chain. To help you identify areas in need of improvement, here are four steps that can help successfully lower your organization’s purchased services costs:
Step One: Mine the data.
For many healthcare organizations, simply gaining visibility into third-party contracts and expenses can be challenging. Contracts are often managed by various people throughout healthcare organizations, or even services outside organizations, such as group purchasing organizations (GPOs).
Start gathering the actualities by creating an inventory of all third-party vendors used throughout your organization, as well as the associated stakeholders and contracts. It’s important to speak with each stakeholder and review each contract thoroughly.
Next, collect all financial data for your vendors. Check with your accounts payable department and take a look at current and past purchase orders. While purchase orders won’t tell the whole story, they are a good place to start to get an idea of total cost. Many third-party vendors have variable costs that make it difficult to get an accurate account of how much they’re really costing. Reviewing your general ledger will help you uncover variable costs.
There are a few key questions to consider when reviewing your service contracts:
What rate is this vendor currently charging me and how often?
Is there an auto-renewal in place? If so, when?
What are the scaling terms and are there fees associated with scaling?
Are there termination clauses? If so, what are they?
Place vendors into categories to get a more accurate picture of how much your organization is spending in specific areas. You may find that the individual costs of many of your third-party vendors are relatively small, but when aggregated by category, the numbers compound quickly.
Step Two: Gain Executive Buy-In
Equipped with your data, it’s time to engage your decision makers. Engaging organizational leadership early in the process is a great way to build a case to move forward. Speaking with executives can help you understand the different viewpoints and situational nuances in your organization, which helps you navigate roadblocks and build the business case to make changes.
Step Three: Evaluate Performance
Analyze vendor and service performance in three key areas:
Evaluating the Quality and Effectiveness
Some vendors charge hidden or variable fees, so looking at one month’s service charges can be misleading. Look at each vendor’s historical cost, trends, and variability. Then, consider local benchmarks: What prices are other vendors in your area offering for a similar service?
Another important aspect to consider is utilization. Here are a few simple questions that can help you assess your organization’s use of a particular service or vendor:
Who is actively using the service/vendor?
How is the service/vendor being used?
Could the service/vendor be used more efficiently?
Finally, do some digging to find out your staff’s level of satisfaction with the third-party service/vendor:
What level of results is the service or provider currently delivering?
Are your stakeholders satisfied with the performance?
What kinds of performance metrics can the service or vendor provide?
Does the service or vendor meet your organization’s performance metric needs?
Does the service or vendor make your staff’s job easier?
Step Four: Consider Standardization Options
Completing steps one through three will give you a firm grasp on the types of vendors you have and the services you’re paying for, how they’re being used throughout your organization, and your staff’s readiness to try new solutions.
If you consider replacing multiple similar vendors with a single standardized solution, make sure the solution you select does the following:
Addresses all stakeholder needs and goals.
Decreases (and if possible, helps to standardize) your organization’s overall spend.
Contributes to your organization’s strategic objectives.
When your organization undergoes a merger or acquisition, it’s more important than ever to conduct a high-level review of the spending and operating efficiency of the larger organization. At the end of your evaluation, you should be better prepared to make specific service and vendor selections based on your analysis and your organization’s strategic priorities.
5 Warning Signs Your Answering Service Might Be Hurting Your Practice
Medical answering services are essential to modern practices for triaging patient calls, delivering urgent messages at night, and allowing receptionists to focus on imperative tasks during business hours. An effective answering service solution can help practice managers, providers, and staff improve the overall patient experience and increase patient satisfaction.
Unfortunately, some medical answering services are susceptible to manual errors and environmental challenges. Routing mistakes and connectivity issues can negatively impact both patient and provider satisfaction.
Here are five warning signs your medical answering service might be negatively impacting your practice:
1. Poor Provider Satisfaction
Your providers’ wellbeing is essential to their satisfaction, livelihood, and ability to best care for patients—yet provider burnout is on the rise. Key contributors to burnout include receiving non-urgent calls after hours, getting unnecessary interruptions while caring for patients, and dealing with other communication challenges that interfere with providers’ daily workflows.
Contacting providers at the wrong time is a common mistake. When the answering service makes an error and contacts your provider at midnight on their Saturday off or interrupts their time with a patient for a non-urgent or routine message, it brings down the provider’s satisfaction and makes it more difficult for your practice to retain top talent.
Providers who are unable to work at their best due to unnecessary interruptions and complicated communication workflows may experience burnout and decide to leave your practice. Losing providers reduces patient satisfaction, lowers revenue, and increases your recruitment and onboarding costs.
2. Declining Patient Experience
It’s important to let patients know they are being heard and cared for, not ignored, yet missed and lost messages are another common issue with medical answering services.
If your answering service loses patient messages, fails to take thorough notes during a call, delays sending urgent messages, or sends messages to the wrong provider, your patients will begin to feel frustrated and undervalued.
3. Negative Impacts on Your Practice’s Reputation
To your patients, your answering service is a representative of your medical practice. Errors and poor patient encounters with live answering service can be harmful, and even detrimental, to your practice’s reputation in providing quality patient care.
It is imperative to ensure that your answering service—which many patients do not know is a third-party service—is delivering the quality of care and experience you want your patients to expect from you. Keeping your patients satisfied and confident in their care is the key to patient retention.
4. Fluctuation of Practice Operating Costs
Your medical answering service may be costing you much more than you originally intended. Many answering services have hidden fees and charges based on call volume and duration, causing practices to spend much more on the service than was budgeted. For a more accurate account of how much your medical answering service is really costing you, look at your month-over-month charges and take note of the fluctuations. Hidden fees can add up quickly when practices don’t pay close attention and consistently follow up on billing.
5. Inability to Support Patients During Emergencies
Healthcare can’t stop when inclement weather, natural disasters, or other emergencies happen. Keeping lines of communication open between your providers and your patients is essential, especially during times of uncertainty. Your medical answering service must be available and connected to take patient calls and route messages correctly and quickly at all times.
If your medical answering service depends on live operators, a natural disaster or similar emergency could make it impossible for agents to receive or answer your patients’ calls. You can learn more about identifying risk to prepare for unprecedented circumstances from our related blog post and our Medical Practice Disaster & Emergency Preparedness Checklist.
Not all medical answering services provide the same level of service and support.
Use the factors above to assess your current medical answering service vendor and decide if it’s time to look for another solution that can better protect your medical practice.
Consider how an automated medical answering service solution can help strengthen your practice.
The right answering service solution will provide a consistent patient experience, reliable connectivity, accurate message routing, and appropriate escalation while supporting work-life balance for your providers and eliminating variable costs.
Let’s discuss how your practice can benefit from the right answering service solution.
Sometimes, traditional medical answering services come with hidden costs that could be undercutting the success of your practice. Costs associated with human error—such as lost and delayed messages, negative patient interactions, inaccurate symptom descriptions, and more—carry significant risk for your patients and your practice.
Mistakes that were once par for the course with answering services have become largely avoidable in a modern healthcare environment. Since quality communication between patients and providers (before, during, and after business hours) is a fundamental pillar of patient care, it would be wise for any organization using a live medical answering service to ask yourself the following questions:
Are your patients being served a positive experience with your practice?
Any negative encounters with your practice (including over the phone) can begin to erode the trust and positive relationships you have built with your patients. Many patients perceive the answering service as an extension of your practice—not a separate, third-party service. That makes live call agents a contributing factor to your overall patient experience, a factor you have limited control over.
If a patient feels at any time as though their medical needs are not met with the level of urgency they feel is necessary, their trust in your practice quickly dissolves into frustration, fear, and motivation to seek care elsewhere. Whether or not a patient leaving costs you any recurring revenue, word of mouth can impact your organization’s reputation for care quality and, therefore, your ability to bring in new patients.
Is your staff empowered to use their time as efficiently as possible?
It’s tough to assign a dollar amount to the frustration of having to resolve a breakdown in patient care caused by miscommunication. It’s impossible to quantify the impact of anxiety your staff can develop when they feel unable to deliver the best patient care due to issues with the clinical communication process. But if your communication process isn’t optimized to help providers focus on delivering proper patient care, you may wind up calculating costs in terms of turnover and other negative effects of low provider satisfaction and burnout.
Are you legally or financially at risk?
Some unlucky practices have discovered a best-kept secret of certain deceptive answering services: subcontracting. In some cases, live “medical” answering services turn out to be subcontracting their work out to other answering services that don’t always have a medical focus or adhere to HIPAA compliance standards.
Few medical practice leaders would knowingly risk placing subpar answering services between their patients and their providers or practice. In fact, a practice in this situation is at risk for fines and penalties associated with breaches involving PHI and unsecure communications.
Another scenario in which a practice using a live answering service may be at risk includes one where the answering service is referencing an outdated provider shift schedule.
Consider this worst-case scenario — A patient, unknowingly suffering from a stroke, calls your practice after hours to report blurred vision and confusion. The medical answering service, operating off of an inaccurate on-call schedule, fails to deliver the patient’s message to the correct on-call provider for another hour. Due to the time-sensitivity of this ailment, your practice could be at risk for a malpractice suit.
An unforeseeable and adverse incident like the one above could become a substantial loss for your practice.
Are you safeguarding your reputation?
Imagine another unfortunate scenario — A critical care surgeon with his own practice routinely performed emergent consults for a local hospital. But then, the hospital stopped calling. They felt the surgeon’s medical answering service was unable to deliver messages in a timely, efficient manner. The hospital now works with other providers instead.
Don’t let the above scenario happen to you. Your credibility and reputation in the healthcare community can be negatively affected if outside consultants and hospitals cannot reach you quickly in times of emergency. The impact of an unreliable reputation can be detrimental to your providers and your practice. It may seem easier to stick to the status quo with a live answering service, but is it worth letting avoidable lapses in communication tarnish your reputation?
Have you uncovered all hidden fees?
Most medical answering services are upfront about their fees, but practice leaders and managers seldom realize how many fee-based events they’re actually being charged for on each single after-hours call or message. Varying types of hidden fee-incurring events include:
Taking the call or message.
Relaying that message to the right clinician.
Relaying the clinician’s instructions back to the patient.
Recording and logging the conversation as a whole.
Recording and logging each communication.
These events can incur minute fees that can account for an unexpectedly substantial amount of overtime.
What is the real cost of your answering service?
Take a skeptical look at your answering service’s monthly invoice to understand the hard costs. Think through how your current answering service effects patient safety and satisfaction, as well as your providers’ satisfaction. Is your answering service a compliance risk? Can it harm your professional reputation? At the end of the day, these are the costs that put your practice, providers, and patients at risk.
What is the best solution to eliminate the costs and risks of your answering service?
In the age of digital communication, automated tools are commonly used to eliminate human error, simplify communication processes, and streamline accurate connections. These advantages are perhaps most valuable in a clinical environment. An ideal medical answering service solution can sync with the most up-to-date shift schedules, protect providers’ caller IDs, escalate urgent messages, and save non-urgent messages for regular business hours.
Let’s discuss how your practice can benefit from the right answering service solution.
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.
Learn how a care team communication solution can enable your clinical integration strategy. Get a demo.
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.
The Important Role Nurses Play in Care Transition and Reducing Readmissions
In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.
Nurses are the linchpin in clinical communication and coordination of patient care and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries through clinical communication.
Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.
The most important factor in transition of care is communication during the handoff process.
What to communicate and when
The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.
It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.
It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.
For example, nurses should be prepared to provide handoff communication:
At shift change
During a break
When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)
It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.
At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:
Patient care instructions
Any recent or anticipated changes
More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:
Patient’s name and age
Reason for admission
Current isolation or precautions
Lab results—including any pending and/or abnormal findings
Relevant diagnostic studies
Fall risk assessment
Any assessment findings that are appropriate to the patient’s current health
Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.
Pay extra close attention to medication communications
While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.
Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.
However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.
There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.
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.
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 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.
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.
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.
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.
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.
Optimize rapid response team efforts with automated, real-time communication
Agnes Cappabianca worked as a stroke nurse manager at NYU Lutheran Medical Center, a Brooklyn-based teaching hospital. She was in the middle of a shift when the unthinkable happened—she suffered a stroke and found herself admitted to the hospital as a patient in her own ward.
The hospital’s rapid response team (RRT)—one that Agnes had helped train and prepare for these critical situations—sprang into action. Within 30 minutes, the team had final results of her CT scan and blood tests and began to administer tPA treatment.
Her role in advocating advances in stroke care within the hospital seems to have saved her life.
The primary goal of rapid response
The American Heart Association and the American Stoke Association® have warned since 2010 that “the benefits of tPA in patients with acute ischemic stroke are time-dependent.” The associations’ guidelines recommend a door-to-needle time of 60 minutes or less for the treatment to be effective.
In most hospital settings, the process for communicating the needs of a newly admitted stroke patient to care team members is manually intensive. These workflows usually have many steps, numerous decision points and multiple handoffs—creating many opportunities for communication breakdowns and delays in a situation in which every second counts.
One of the primary goals all RRTs strive for should be to reduce the number of steps in the communication process—including the number of decision points, communication handoffs and number of people involved in transmitting the information.
Some hospitals have achieved this goal by implementing a unified communication and collaboration solution that automates many of the steps in the RRT process, such as sending notifications to all team members—including team leadership—at the same time. With just one call, schedules are analyzed and the appropriate care team members are identified and contacted simultaneously—based on their preferred contact method.
This eliminates numerous steps and players from the communication processes and makes significant strides toward improving patient outcomes by speeding time to treatment.
Building an effective rapid response protocol
Pre-planning is required for a communication platform to optimize the capabilities of RRTs. Evidence based guidelines and individual hospital protocols determine the number and composition of responding teams. Some hospitals assign different care team members to different teams depending on urgency levels.
For example, Henry Ford Macomb Hospital in Clinton Township, Michigan, has two RRTs. One is dedicated to Level II traumas and does not include an anesthesiologist in the alert system because Level II trauma patients rarely require advanced airway management. However, the Level I trauma RRT—the team assigned to the most critical cases—does include an anesthesiologist.
Deciding whom to alert depending on the urgency of the situation is a key factor in RRT success.
Another important factor is identifying timelines for each care team member’s arrival at the patient’s bedside. For St. Rita’s Medical Center, a 419-bed hospital in Lima, Ohio, the pre-set arrival time for the rapid response nurse is three minutes; it’s five minutes for their 4A nurse. St. Rita’s also set guidelines for both the physician arrival and ordering of the CT scan at 10 minutes.
An effective communication platform feature that aids RRT outcomes is an automated callback and escalation process. This eliminates critical minutes being wasted on resending notifications and manually escalating the issue to another provider when team members do not arrive on time.
The proof is in the results
St. John Hospital and Medical Center (SJHMC) in Detroit aimed to comply with the guidelines set by The Joint Commission and the American Heart Association/American Stroke Association, all of which call for having CT scans interpreted within 45 minutes of the patient’s arrival and having treatment administered within 60 minutes.
SJHMC implemented PerfectServe and used the flexibility of the platform to develop its stroke team protocol. The protocol called for alerts to a multidisciplinary team of nurses, physicians and staff from neurology, the ED and neurosurgery, as well. Each team member’s preferred method of contact was configured in PerfectServe Synchrony so that when a stroke alert is sent from the ED, each member (or their on-call counterpart) is contacted via their preferred method.
The ability to contact team members directly on their personal mobile devices, as opposed to using overhead paging systems, eliminates the potential for missed pages.
After the system and process were implemented, SJHMC saw significant improvements in time to treatment for its stroke patients. The on-call neurologists’ response times dropped 90%, from 22 minutes to just 2 minutes.
Their door-to-CT scan completion time decreased 41%, from 78 minutes to 46 minutes.
Additionally, SJHMC was able to administer life-saving tPA to three times more stroke patients than they were before.
Making lasting, life-saving process improvements
Most hospitals in the Unites States have some version of an RRT in place for major medical events. Some hospitals have even included local EMS organizations in their rapid alert processes in order to improve speed-to-treatment times.
There’s no question that streamlined and automated communication aids RRTs in their work to lower mortality rates for stroke patients and other traumatic injuries.
Rapid response alerts have proven benefits for clinicians, too. Having a rapid response alert program in place eliminates stress and frustration for the ED staff, which usually has the primary responsibility of initiating treatment to stroke and trauma patients.
In addition to simultaneous instant alerts to appropriate response team members, PerfectServe’s rapid response alert system also sends activation notices to hospital leadership. These notices include the time the alert was activated and the time each care team member arrived (as input by the nurses involved). This additional insight into rapid response operations gives healthcare leaders the opportunity to identify problem areas and make lasting process improvements that ultimately save more lives.
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
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.