TABLE OF CONTENTS

CMIO’s Guide to Selecting a Clinical Communication Platform

Introduction

Clinical communication solutions have evolved from basic HIPAA-compliant texting programs into system-wide collaboration solutions that influence key hospital metrics like patient outcomes and clinician satisfaction. The added complexity required to support these systems makes it all the more important to select the right vendor. In this guide, we’ll cover some of the most critical elements to take into consideration as part of your evaluation process, including:

Overcoming challenges associated with physician technology adoption
Effective implementation and governance teams
Advanced workflows supporting speed to care
Integration and security requirements
Vision of a unified solution supporting patients and clinicians throughout the care continuum

The Impact of Poor Communication

Efficient communication, productive care teams, and happier physicians all have a direct
impact on patient throughput and a health system’s bottom line. Consider the following:

$4.6 Billion

It’s estimated that burnout related physician turnover and reduced work hours cost the US healthcare system $4.6 billion per year—that’s about $7,600 per physician.¹

$24 Billion

Sepsis is the leading cause of death in US hospitals, costing nearly $24 billion per year.2 Suboptimal communication and coordination among care team members can easily be a contributing factor in these cases.³

49%

Communication failures were identified in 49% of medical malpractice claims in a sample of malpractice claims from 2001 to 2011, and of those claims, 47% involved provider-provider miscommunication.³

Poor communication impacts the entire health system in a series of downstream effects. Not only does it inhibit the delivery of quality patient care—which impacts hospital reimbursements, patient leakage, operating costs, and more—but it increases feelings of burnout and frustration while decreasing care team morale. An effective clinical communication system supports clinicians’ ability to positively impact these metrics by enabling more efficient patient care with better, more collaborative workflows.

Key Components of an Efficient Clinical Communication Platform

Building on PerfectServe’s 25+ years of experience implementing effective clinical communication solutions, this guide can help CMIOs and other hospital leaders analyze how a clinical communication platform boosts care team collaboration workflows to meet the ultimate goal of providing outstanding patient care.

Unify Care Teams and Patients

Connect providers, patients, nurses, staff, and caregivers.

Many clinical communication solutions focus on nurse-to-nurse or physician-to-physician communication. To improve both speed and continuity of care, it’s important to connect clinicians not just to each other, but also to patients, patients’ families and caregivers, and other non-clinical staff members like transport, security, or even environmental services.

It’s equally important to reduce provider frustration by ensuring they only receive relevant communications. Too often, providers receive non-urgent messages when they’re no longer on shift, and other times, messages about patients who aren’t under their care end up in their inbox. Choose a solution that manages this process for them—only critical messages regarding current patients get through, and alerts are managed by message type.

Make Location Limitations a Thing of the Past

Enable connections regardless of location, message type, or contact preference.

Care within the four walls of the hospital is only part of the patient journey. Patients need support before arriving at the hospital, during their stay, and after discharge. This means taking into consideration how providers and patients will communicate when either is at home (provider working from home or off site), en route (patient checking in from their mobile), or located at a specialty facility. Find a solution that’s cloudbased, location-agnostic, and supports secure communication via text, voice, and video.

Integrations, Software Development, and Security

Integrate or replace to reduce click fatigue.

Clinical communication doesn’t stop at text messages. To drive the best outcomes, your vendor should integrate with all systems that may need to be involved in communication workflows. Among others, this could mean the EHR, the operator console, and scheduling, imaging, and lab systems. Beyond the integrations themselves, select a vendor that can support various message types like waveforms, videos, pager messages, and lab results.

To reduce click fatigue for providers, consider a solution that offers an EHR embedded messaging experience and has the ability to send mass notifications when needed.

Whether you support an ambulatory site, hospital, or health system, it’s critical to identify solutions that can connect patient-related communication between clinicians and with patients across all care settings— including the patient at home.

By finding a platform that unites the care team around a patient in these three ways, a health system equips providers with the tools necessary to facilitate much more efficient care delivery.

Provides Physician-Centric Core Functionality

With the right features and workflows, a clinical communication and collaboration platform is a powerful antidote to physician burnout. It dramatically improves physician workflows by allowing physicians to be very specific about who can contact them, for what reason, and when. It also provides rapid access to the EHR without logging in and facilitates direct access to colleagues inside and outside the hospital setting. This is critical, because team-based care has actually been linked to improved clinician well-being.⁵

Fast, intuitive communication tools can help physicians catch infection earlier, provide consults sooner, coordinate safer patient handoffs, find the correct on-call colleagues instantly, and turn convoluted communication processes into one-step tasks. Here are just a few features of a clinical communication platform that can have a meaningful impact on physicians:

Secure Text, Voice, Paging, and Video

HIPAA-compliant, patient-centered communication is table stakes for ensuring protected health information (PHI) is kept safe. Beyond that, physicians are also interested in the workflow benefits that stem from streamlined communication:

Physicians should be able to instantly locate colleagues in their contact list or in the directory where they can text, call, page, or initiate a video chat at the touch of a button.
Asynchronous texting allows communication to take place without a phone call interrupting patient encounters. Urgent messages can be prioritized with a special alert tone and escalation workflows, while routine messages can have a different alert tone to let the provider know they can be addressed after their current patient engagement is complete.
“Message Types” provide a template for rapid, time-saving completion of patient communication. Senders choose options such as “Consult Request” or “New Admission” from a preprogrammed dropdown menu.
Using a clinical communication platform to replace pagers improves security and functionality while reducing costs. This gives physicians the ability to maintain their pager numbers and augmented pager functionality with two-way messaging and escalation functionality. See “OR Mode” for advanced functionality.

From the staff directory or patient record, one-click access allows users to securely text, page, call, or video chat with the intended party without cumbersome lookups. Two-way communication with time- and date-stamped read receipts provides assurance that messages are received.

Enterprise Directory

A single, integrated enterprise directory ensures that physicians can easily find and communicate with colleagues anywhere in the organization, inside and outside the four walls of the hospital. That’s no minor accomplishment—an integrated directory saves time and boosts satisfaction by:

Facilitating one-touch text messages, voice calls, and video chats
Giving quick access to pager numbers
Housing phone numbers for all departments and locations, including call center contact information
Accommodating physician communication preferences
Accounting for clinician availability status

Enterprise Provider Scheduling and Case Management

Optimizing schedules is critical to managing providers’ well-being. Ensure your clinical communication solution offers or integrates with advanced enterprise scheduling software that offers the ability to swap shifts, manage schedules, and accommodate personal preferences right from the clinical communication app. Include case management for effective workforce balancing and drive real value for your organization by ensuring all resources (staff, rooms, equipment, and more) are utilized as effectively as possible.

On-Call Scheduling

Paper or Excel-based schedules are cumbersome to manage and quickly become outdated. If your organization faxes, emails, or otherwise sends paper schedules, level up their processes with a clinical communication platform that digitizes schedules or integrates with an advanced scheduling solution to ensure:

All messages are routed to the correct clinician(s)
Clinicians can see an up-to-date schedule via mobile or desktop apps
Clinicians can submit time-off and shift-swap requests on the fly to accommodate real-time schedule changes
Schedulers can access, manage, and edit schedules via mobile or desktop apps as often as needed

An up-to-date, system-wide call schedule feeds one of the most valuable innovations for physician communication: rule- and role-based messaging. Clinicians no longer need to determine who’s on call in any given department—they can simply send a message to the “Hospitalist On Call” or “ED Charge Nurse.” The system then automatically routes messages to the person who’s on call or logged in for
each role.

Support Various Message Types

Find a platform that supports all message and alert types, such as live waveforms, photos, videos, voicemails, and lab/imaging results. Managing all communication in one platform reduces click fatigue, improves speed to care, and gives care team members just one inbox to check for the most critical information related to ongoing patient care.

Personal Contact Preferences

A key component to driving physician adoption is ensuring they can customize when and how others are able to communicate with them. Key configurations for physicians include the ability to:

Mask their personal phone number on outgoing calls. Patients receiving a call from their physician should see a public phone number, such as the physician’s office or main switchboard phone number.
Specify the ringtones associated with different alert types. Urgent requests may pull a physician from a patient’s bedside, whereas a routine message doesn’t need to be addressed immediately.
Configure routing rules such that communications are automatically sent to the covering provider when off shift and not on call.
Select whether incoming calls are received live on their cell phones/VoIP client, routed to an alternate number, or received as a telephone page.
Enable someone else to “monitor” their inbox and respond on their behalf when they’re busy, such as when a surgeon is in the OR.

Patient-Centered Communication

Physicians want to walk into the hospital and immediately know who their patients are, where they’re located, and where to find their demographic info. A patient-centered clinical communication platform pulls patient lists from the EHR, providing patients’ names, locations, birth dates, and chief complaints while listing all members of their care team. The ideal platform also provides the full message history, notes, and the ability to message care team members individually or as a group—for example, to coordinate a discharge. The platform should also allow physicians to easily “add” patients to their lists and facilitate safe patient handoffs in accordance with Joint Commission standards.

Rules, Routing, and Escalations

The ability to configure message routing based on time of day, message type, on-call schedule, sender, and recipient is critical to improving the experience for providers. Automating this process will ensure providers aren’t contacted in the middle of the night when they aren’t on call or sent messages about patients who aren’t under their care.

Escalations occur when the recipient doesn’t respond to a message in the predetermined time frame allotted for that message type. The escalation rule will automatically identify the next person in line who should receive the forwarded message to ensure that care is still provided in a timely manner.

Supports Advanced Workflows

Selecting a partner with advanced workflow expertise is the single biggest key to long-term adoption and use of any care team collaboration platform. The right communication partner should be able to optimize current processes, demonstrate tangible outcomes, and provide guidance on effective governance.

ADT Workflows

Streamlined communication around admissions, discharges, transfers, and bed availability improves speed to care, outcomes, and profitability. Choose a platform equipped with advanced functionality like:

Easy lookup of roles like “Admitting Hospitalist” and the ability to record a voice dictation describing the case.
Immediate triggers after admissions that generate alerts to assign patients.
Workflows started by discharge orders in the EHR that notify the bedside nurse and environmental services.
ADT notification messages automatically delivered to a patient’s PCP to meet CMS guidelines.

EHR Embedded Messaging

Another way to reduce click fatigue is by embedding the messaging platform directly within the EHR—such as Epic or Oracle Health (formerly Cerner)—to give physicians all of the communication platform’s advanced workflow functionality without requiring them to leave the EHR. EHRs are critical software, but they’re not expert communicators. Embedded messaging should be available to use with the EHR’s desktop and smartphone apps.

Critical Results

Receive near-instant notification of critical lab, pathology, or radiology results when the platform is integrated with the EHR, laboratory information system, and/or radiology information system. Notifications can be sent or forwarded to the covering provider or the entire care team.

Use Case #1

A radiologist discovers a significant finding for a patient. Per protocol, the radiologist must escalate this finding before completing the full report. The radiologist looks up the “Attending” physician role in the call schedule and sends an urgent message noting that intervention is required. The attending physician’s phone is not currently connected to a Wi-Fi or cellular data network. The communication platform detects this and places a telephone call to the attending to alert him about the critical finding. The attending cannot be reached by telephone, so the platform automatically escalates to the “Second Attending,” who immediately receives and reads the message. The radiologist can see this escalation occur, and she can see when the second attending has read the message. The second attending replies that he will go to the unit immediately to coordinate care for the patient.

Group Notifications and RRT Activation

Message groups streamline communication intended for multiple people. Choose a platform that can message to groups like “nurses ward C,” “D wing active threat,” or “code red,” or deliver notifications that are otherwise communicated via overhead paging. Non-clinical messages can also be managed through the system—for instance, sending messages to the security team to investigate suspicious behavior or to coordinate curbside pickup of a patient being discharged from a traffic-heavy urban facility.

Use Case #2

A patient is rapidly declining, and the unit clerk pages Rapid Response Team members simultaneously by dialing a specific fivedigit extension. All recipients of the page see when their team members have received and listened to the message. Team members reply with pre-programmed quick responses, such as “Be there in five minutes.” If a physician is unresponsive, a backup physician is messaged with the same protocol.

Consult Requests and Order Notifications

When a consult request or order is entered in the EHR, advanced workflows allow the covering provider to receive an immediate notification from the EHR that includes patient context. The ability to look up in-network specialists to communicate in real time can improve continuity of care.

OR Mode

Allow a surgeon—or any other specialist— to use a message mirroring feature like ‘OR Mode’ to route messages to a covering provider, nurse, or supporting admin to ensure urgent notifications can be managed in a timely manner while the physician is in surgery (or otherwise occupied).

Inbound Patient Inquiries Via Call Center

What is leakage?

When a patient calls in to a hospital for information, or when an external provider calls in to refer a patient, and they struggle to reach the correct individual or are put on hold for an extended period of time, they may hang up and seek care at another organization. This is called “leakage” and can lead to notable loss in revenue.

Call and transfer centers are significant sources of inbound referrals, transfer requests, and patient inquiries. If your clinical communication system doesn’t have an integrated operator console solution, ensure that it can at least manage these call and transfer center inquiries through third-party software to ensure all requests are addressed in a timely manner to improve the patient or referee’s experience and help reduce leakage.

Patient and Family Communication

To preserve all workflow benefits, improve speed to care, and reduce click fatigue for clinicians, your communication technology should also manage patient and family communication in the same solution clinicians use. Having a solution that enables video visits and expedites post-treatment communication (like automatically sending follow-up appointment reminders after discharge) boosts patient access, improves outcomes, and strengthens provider-patient relationships. Read our guide on Engaging Patients and Their Family Members for more information.

Supports Integrations That Drive Value

Despite the intense focus on interoperability in healthcare, there is much work still to be done.6 Aside from the clinician experience, many are focusing on the patient experience and the intersection of the two. By integrating with other important hospital systems, an advanced clinical communication and collaboration platform:

Reduces click fatigue and improves clinician satisfaction with workflow improvements.
Connects the acute and ambulatory settings and unites care team members on one communication platform.
Pulls critical patient data from the EHR to inform and provide context for patient care communications.
Provides access to the most up-to-date schedule and directory to reduce time spent finding the correct clinician.
Automatically delivers critical messages to the right clinicians who can initiate care.
Empowers the call/transfer center with the same workflow benefits as clinicians to streamline communication, improve the patient experience, and reduce referral leakage.

Many important clinical solutions can be used together to deliver higher-quality patient care. Here are a few key integrations that facilitate more efficient workflows and better patient outcomes:

Authentication Infrastructure

Integration with Active Directory or single sign-on (SSO) systems facilitates easy provisioning of users onto the communication platform. For daily use, it allows users to authenticate to the platform using their pre-established health system credentials.

Provider Schedules

Look for a platform that offers a native scheduling tool and integrates with thirdparty scheduling systems. Scheduling integration enables departments to continue using third party solutions that are already ingrained in hospital workflows. A builtin scheduler offers an easy upgrade for departments that are still using paper call schedules. The solution should also give physicians the ability to update their own schedules on the fly and swap shifts to accommodate last-minute coverage changes.

Corporate Directories

A communication system only works if everybody’s on it. A robust, system-wide directory must be integrated to provide instant access to colleagues. Active Directory can be leveraged to provide the most current and reliable names, roles, and contact information for all users throughout the organization.

Nurse Call

Think of how often bed calls require follow-up from nurses. The ability to answer, prioritize, and assign nurse call alarms easily (ideally, from a mobile device) reduces repeated trips to patient rooms, speeds up care delivery, and allows nurses to engage in more top-of-license work by keeping them focused on the most critical patient care matters. This integration makes it possible to distinguish urgent and non-urgent call alarms, escalate critical alarms when they’re not addressed in a timely manner, and forward alarms within the care team.

EHR

Order notifications, patient lists, care team members, and test results are all routed to the communication platform through the EHR. Integration with EHRs like Epic, Oracle Health (formerly Cerner), McKesson, and MEDITECH is what enables physicians to access patient chart details for context when communicating.

Lab, Pathology, and Radiology Systems

Faster notifications lead to faster patient treatment, which in turn leads to better
patient outcomes.

Few integrations deliver more measurable ROI than this one. Automated routing of critical lab, pathology, and imaging results saves hours of time each month for physicians waiting on results, as well as for lab technicians who are charged with delivering them.

Hospital Phone System

Phone system integration expands functionality beyond text messaging, allowing clinicians to place and receive voice calls. Synchronous communication is essential for escalating text interactions when discussion or clarification is needed. Integrate with existing PBX phone systems such as Avaya, Cisco, Mitel, and Nortel, and the cloud-based system can replace much of the on-prem PBX system. Ensure the platform also has the functionality to assign phone extensions from the existing hospital switch, which removes the need to purchase separate DIDs.

Pagers

Because a large health system will undoubtedly have departments and clinicians that still use pager technology, a communication platform must simultaneously be able to 1) message existing pagers by integrating with other pager technologies and 2) offer enhanced paging functionality that reduces pager dependence.

After-Hours Answering Services

Integration with hospital operators and physicians’ after-hours answering services grants patients access to their providers at all times. Solutions like PerfectServe’s automated medical answering service can guide patients through customized phone trees, which help to direct patient calls to the right provider at the right time. With features like automated routine requests that hold non-urgent calls till morning, one-touch callback numbers, and voice-to-text transcription, both patients and providers experience a more seamless call experience and improved care delivery.

Operator Console

Inbound calls and patient transfer requests are both crucial and common components for any hospital or health system. A cloud-based operator console that lives within your clinical communication ecosystem can facilitate better call-in experiences for patients and referring providers while making operators’ jobs that much easier. The location-independent nature of a cloud-based solution also means your operators can work from anywhere while providing coverage for any facility within your system.

Consolidate Your Vendors with PerfectServe Unite

For far too long, it’s been common practice for health systems to seek out disparate solutions for their basic operational needs: one vendor for scheduling, one for secure communication, one for the call center, and so on. This isn’t their fault—it’s the nature of the industry. With PerfectServe Unite, you can consolidate many of your organization’s most important clinical communication and provider scheduling functions on one advanced platform.

Download the PerfectServe Unite guide to learn how healthcare’s most advanced scheduling and communication platform can make true care team collaboration a reality for your organization.

Benefits of a Unified Clinical Communication Platform

By deploying PerfectServe Unite and its five integrated solutions—Clinical Collaboration, Lightning Bolt Scheduling, Practice Communication, Patient Engagement, and Operator Console—your organization can expect a number of benefits:

One close partner (with just one contract!) that can help your organization design, implement, and optimize critical communication and scheduling workflows that lead to tangible ROI
Top-notch customer education and support
SOC 2-compliant solutions from a vendor Censinet has named a “Cybersecurity Transparent” pioneer
A cloud-native approach to technology, meaning:
- Faster implementation with no on-site hardware required
- Less demand on the health system’s in-house IT teams
- No downtime during updates or power outages
- Automatic and secure over-the-air updates

Deployment Considerations

Although workflows and integrations will be the showpieces in a presentation to physicians, the behind the-scenes architecture is also a significant component in the overall success of the project. A technology vendor should be able to guide a healthcare organization through the following deployment and implementation considerations:

Communication Policies and Governance

Secure texting without a formal communication policy is a formula for physician burnout. Organizations need to establish clear guidelines for how and when physicians may be texted by nurses and clinical staff members. Workflow-enabled communication tools can assist in the process by automatically routing messages to providers based on established parameters such as time of day, physician preference, and preferred workflows, but thoughtful policy and governance are still critical for any platform’s success.

Security and Encryption

HIPAA compliance is a core functionality of a clinical communication platform. Look for a vendor with SOC 2 certification that can support security features such as two-factor identification, PIN protection, message lifespan, audit history, and user access rights. See a full list of security recommendations here. Find a vendor with:

The ability to authenticate users, preferably with two-factor authentication.
Safeguards against unauthorized access.
The ability to keep a discoverable archive of messages for seven years (or longer).
The administrative ability to lock users from the system when they leave the organization.
The administrative ability to wipe all texting data from a user’s device.
Third-party validation, including:
- SOC 2 Type II certification
- Censinet “Cybersecurity Transparent” pioneer designation
- Strong analyst reviews by Gartner, KLAS, and Black Book

Emergency Preparedness

Cloud-based solutions offer an extra leg of support during emergencies, such as active threats, power outages, extreme weather, or other unforeseen circumstances. The ability to stay connected during crises can make all the difference in the continued delivery of crucial patient care. From day-to-day communication to flexible workflows during emergencies, choose a solution that can support and adapt to the changing needs of the facility/care team in any circumstance.

BYOD and Device Management

Most physicians still prefer to use their personal devices for healthcare communication. For those physicians, the organization needs to select a vendor that can maintain security and HIPAA compliance with features like remote lock and wipe. Hospital-owned devices require additional consideration—plan for modular charging and an efficient system for disinfecting devices and conducting routine maintenance.

Wi-Fi

A communication partner must be able to assess and rectify any dead spots and connectivity issues within the hospital before rolling out a communication platform. Look for a partner that is Cisco DevNet Fast Lane certified to prioritize voice and texting.

Auditing and Reporting

At the administrative level, a clinical communication platform will provide insights into messaging patterns and communication workflows that can uncover inefficiencies to target for improvement. From the physician perspective, it can also confirm that communication policies put in place to safeguard physicians are being followed.

Conclusion

To improve patient outcomes and provider satisfaction, it’s important to select a clinical communication vendor that offers:

Advanced workflows that improve care delivery
Solutions that reduce click fatigue, promote provider well-being, and make it easier to communicate with patients
Close and continuing partnership to optimize your technology investment
A governance program that makes communication easier for providers
Interoperability standards that promote scalability and organizational growth

Sources

1. Estimating the attributable cost of physician burnout in the United States, Patient Safety Network: https://shorturl.at/lwEMV
2. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study, The Lancet, The Lancet – Vol. 395 – Issue 10219 – Pages 200-211, Rudd, K.E. et al., Jan. 18, 2020: https://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(19)32989-7/fulltext
3. Sepsis Resulting from Delays in Treatment and Miscommunication among Specialists, Patient Safety Network:https://psnet.ahrq.gov/webmm/ sepsis-resulting-delays-treatment-and-miscommunication among-specialists
4. Frequency and Nature of Communication and Handoff Failures in Medical Malpractice Claims, National Library of Medicine: https:// pubmed.ncbi.nlm.nih.gov/35188927/
5. Implementing Optimal Team-Based Care to Reduce Clinician Burnout, National Academy of Medicine, Smith, C.D. et al., Sep. 17, 2018: https://nam.edu/wp-content/uploads/2018/09/Implementing-Optimal Team-Based-Care-to-Reduce-Clinician-Burnout.pdf
6. NAM Special Publication Outlines Use of Procurement Requirements to Drive Interoperability in Health Care, Nation Academy of Medicine, Oct. 12, 2018: https://nam.edu/nam-special-publication-outlines-use of-procurement-requirements-to-drive-interoperability-in-health-care/