Health System Implements Best Practices for Clinical Communication Governance

Challenges

In 2017, Carilion Clinic noticed their clinicians were texting through unsecured means, creating the need for a HIPAAcompliant communication solution.

At the same time, paper-based call schedules were maintained by each department and shared with a centralized switchboard. It worked but was hard to keep up to date when changes came through, and it didn’t offer great visibility for all clinicians.

Carilion decided to implement PerfectServe’s Clinical Collaboration solution to ensure HIPAA compliance with texts, calls, and pages. They also wanted to digitize schedules to provide a single up-to-date source for on-call schedules that could be easily accessed by smartphone.

Although the initial deployment was governed by system-wide policies, it became apparent over time that specific governance over Clinical Communication was needed. Carilion decided to develop a strategic and cohesive governance plan to standardize communication across all departments.

The first step they took was creating a multi-disciplinary committee to ensure representation from every user group. This committee was charged with navigating the commingling of communication and scheduling while reducing variability in processes like adding new clinicians, addressing user requests, eliminating (or limiting) user workarounds, and managing changes to workflows, call schedules, and guidelines.

Lessons and Recommendations

Carilion was ultimately successful in creating and implementing an effective governance strategy to standardize the use of PerfectServe for reliable clinical communication. And they learned lessons along the way that can help guide similar efforts for other organizations.

Establish Weekly Committee Meetings With Key Stakeholders

Carilion recommends giving a voice to all user groups, including informatics, clinical leaders, compliance & privacy, application analysts, call center operators, training, and PerfectServe partners.

This committee should continually review the prioritization list while focusing on culture and change management strategies. This includes considerations like folding governance into the EHR structure and standardizing communication etiquette to reduce “click fatigue” and “noise” for users.

Plan for Ongoing Maintenance, Training, and Education

Perform routine data reviews through operations and PerfectServe to monitor compliance and identify where support may be needed. Look for users performing workarounds and address the underlying issues.

Carilion also suggests distributing a general definitions guide to ensure standardized use of terminology. For example, define urgent care versus routine care.

Create Policies for Patient- or User-Specific Data Needs

Explicitly state how various tasks should be accomplished, like event investigations or requesting data. Be clear on what is or is not acceptable, including how patient data can be shared to ensure compliance with privacy guidelines (e.g., the CMS prohibition of texting orders).