More Efficient Clinical Communication Necessary for ACO Success

Among the significant changes taking place across the U.S. healthcare industry is the transition to the accountable care organization model. In a survey of healthcare professionals commissioned by Imprivata earlier this year, 62 percent of respondents said their organization is an ACO today or is expected to become an ACO within the next 12 months.

In the ACO model, information technology can play a significant role in helping clinicians to provide quality patient care at affordable costs. However, integrating disparate systems efficiently while also ensuring that protected health information remains secure can be a major challenge.

Of particular concern is how to optimize communication and collaboration among healthcare providers across all participants in an ACO. In this model, the number of care providers accessing a patient's records increases, along with the range of methods, locations and endpoints from which information can be accessed. This commands the need for a robust communication and collaboration solution to improve the efficiency of the patient care continuum.

Although some progress has been made, clinical communication remains, for the most part, inefficient and costly, primarily because regulatory compliance and security requirements compel healthcare organizations to prohibit the use of smartphones and other more efficient communications solutions. According to the same Imprivata survey, the majority of respondents think HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, they cite reasons such as HIPAA regulations reducing the time available for patient care, making access to electronic patient information difficult and restricting the use of electronic communications.

As a result, the use of pagers and other outdated communication technologies continues as the status quo, which is especially concerning for ACOs, in which efficient communication is critical to meeting the organization's objectives. To quantify the impact, the survey sought to determine the productivity and economic losses associated with outmoded communication technologies.

According to the study, clinicians waste an average of 46 minutes each day waiting for patient information as a result of inefficient communication technologies. The main culprit is the inefficiency of pagers, but healthcare professionals also cited the inadequacy of email and the inability to use text messaging or personal mobile devices as reasons for the delays in the communication and collaboration process.

This wasted time has a substantial economic impact as well — the study estimates that the cost of this inefficiency approaches $1 million per hospital, per year. Based on the number of registered hospitals in the U.S., this translates to a loss of more than $5.1 billion annually across the industry.

The survey also looked at specific workflows within the care delivery process that are impeded by outdated communication technologies to determine where improvements could be made. For instance, the study found that, according to participants, the average amount of time it takes  to discharge a patient from the hospital is approximately 101 minutes, about 37 of which are spent waiting for a doctor, specialist or other provider to communicate the information necessary for the patient's release.

The majority of survey respondents believe secure text messaging to communicate with care teams during patient discharge can significantly improve this process. In fact, they believe the total discharge time could be reduced by approximately 50 minutes by using secure texting. In economic terms, reducing discharge time through IT improvements and other measures could add more than $550,000 in revenue per hospital annually. Based on the number of registered hospitals in the U.S., this translates to more than $3.1 billion in lost revenue across the industry every year.

All told, the study concludes that the use of pagers and other outdated communication technologies collectively costs U.S. hospitals more than $8.3 billion annually. For ACOs in particular, the extent of these inefficiencies and the associated financial impact is unacceptable for the model to be successful over the long term.

For ACOs to succeed in delivering affordable, high quality patient care, they must be coordinated across all organizational functions, including clinical communication and collaboration. IT and clinical leadership must work together to balance convenience and ease of use with meeting security and compliance requirements.  The productivity and economic impact of continuing to relay on pagers and other forms of outdated communications technologies is far too great for ACOs to ignore.

Fortunately, the study does indicate that healthcare professionals realize the necessity for change — within the next two years, 84 percent of respondents plan to adopt secure text messaging to replace pagers for some communication and collaboration applications. At the same time, the use of pagers and phones for communications between clinicians and other hospital personnel is expected to decline significantly.

While the right mix of communication and IT solutions can significantly improve efficiency, keep costs low and contribute to the delivery of high-quality patient care, outdated technologies can stifle the progress of ACOs. Many other industries have gone through a similar maturation process, and healthcare executive leadership would do well to heed the lessons learned in these other industries. Communications technology and IT solutions can catalyze change, for better or worse, depending on the quality and usefulness of the technology employed. As more and more organizations continue to transition to the ACO model, increasing the complexity of their healthcare ecosystems, time will tell if information technology has helped — or potentially impeded — their progress.

Dr. Sean Kelly is an emergency physician at Beth Israel Deaconess Medical Center in Boston and CMO at Imprivata, a leading global provider of healthcare IT security solutions. Dr. Kelly practices and teaches at Beth Israel Deaconess Medical Center, a level one trauma center and academic teaching hospital in Boston. For several years he served in hospital administration as director of graduate medical education, responsible for more than 600 doctors in training, comprising over $65 million in Medicare funding. He is also an assistant clinical professor of medicine at Harvard Medical School and has won several teaching awards, including the Harvard Affiliated Emergency Medical Residency Best Teaching Attending and Role Model awards.

More Articles on ACOs:
Aetna, PinnacleHealth Form Accountable Care Collaboration
University Hospitals, Cigna Ink Accountable Care Deal  
Creating an Employee ACO: Opportunities and Challenges for Hospitals 

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