Nurses need innovative care team collaboration technology

Part 1 of a 3-part series in conjunction with our nurse leadership webinar series.

Six years ago, the National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), recommended that nurses lead inter-professional collaboration and healthcare delivery improvement and redesign. They noted that nurses are uniquely positioned to do this since, given the care setting, they are quite often the primary patient caregiver. As such, they serve as the virtual linchpin of care—connecting the various care providing professions while coordinating patient care across the entire care team. Toward that end, nurses are responsible for over 90% of physician communications while directing over 80% of their own communications to the broader care team.

While some inroads have been made in regard to this IOM recommendation, there are formidable challenges impeding significant progress. As the industry transitions to value-based-care, nurses are being held increasingly more accountable for patient outcomes and experience. Paradoxically, they are concurrently being asked to perform more indirect and non-patient-care tasks which reduce the amount of time at the patient bedside—one of the strongest predictors of positive patient outcomes and experience.

One such activity is care team communication.

Specifically, nurses have reported that difficulty communicating with the care team has decreased direct patient care time. One survey study found that 75% of nurse respondents reported wasting valuable care time just attempting to communicate with physicians and other care team members. In part, as 50% of the respondents acknowledged, this is because they are unaware of the right care team member to contact for the clinical situation at hand. The latter explains why the majority of physicians reported being frequently erroneously contacted when not the right physician for the situation.

These recalcitrant obstacles to care team communication and collaboration have served to delay patient care and prolong patient wait times. No one is more acutely aware of this than the nurse.

Nurses quite often find themselves waiting for physicians to return phone calls/pages while their patient needlessly suffers. As the nurse struggles to coordinate care, no one is more cognizant of the impact of missed care or delayed transitions on the patient and the patient’s family. Moreover, no one is more handicapped by the limits of fragmented communication technologies that have not successfully overcome these challenges because they only address a small component of the overall problem. And no one is in more need, than the nurse, for innovative technology that is able to immediately connect the right care team members to facilitate timely collaboration.

The good news is that this technology is now available. However, when evaluating the various care team collaboration platforms, it is important to avoid common pitfalls. Here are a few guiding principles to keep in mind:

  • While secure messaging is a salient feature of the platform, it is not wholly sufficient to address these communication obstacles since it is dependent upon two flawed assumptions.
    1. The recipient, such as the physician, must desire to be contacted at all times for all situations every day of the week.
    2. The sender, for example, the nurse, knows who to contact in every single situation.
  • All of the care team must be on the same platform. As the IOM noted, “True inter-professional collaboration can be accomplished only in concert with other health professionals, not within the nursing profession alone.” This holds true for any other profession.
  • Most importantly, the technology must be purposefully designed to overcome the known referenced obstacles. To do this, it must be able to automatically identify and provide immediate connection to the right care team member for that particular clinical situation. This type of complex logic requires that for every single communication by every care team member, the contextual variables of the particular message must be analyzed in real time to ensure the communication is routed to the correct individual.
  • The care team collaboration platform capabilities must transcend the walls of any one facility. Nurses, as well as physicians and other care team members, quite frequently need to contact team members who work in and across other facilities and locations. The platform must be able to support this communication and the intelligent routing capabilities must extend to provide immediate identification and connection to these care team members when needed.
  • Ultimately, the care team collaboration platform must have proven functionality to reduce communication cycle times. Reducing the time to connect and close the communication loop translates into care team efficiency and increased patient care time. As every nurse knows, this means speed to treatment, improved patient experience and improved patient outcomes.

Nurses are indeed perfectly positioned to lead inter-professional collaboration and healthcare delivery improvement. However, it is critical that they are provided with the technology that will allow them to overcome all the challenges this entails.

Let us not repeat the mistakes of the past—providing nurses with inadequate technology in response to which, they must find a work around—increasing their effort and workload in the endeavor. Quite sincerely, healthcare improvement and reform depends on it.


Interested in learning more? Read part 2 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.