It's time for hospitals to revamp clinical communication — 4 experts weigh in on moving beyond pagers & faxes

Healthcare remains one of the few industries to rely on communication technologies like pagers and fax machines, both of which garnered widespread use in the 1980s but have since fallen by the wayside in most sectors.

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"Everywhere else you have this clear and efficient form of communication that's getting easier by the day with smartphones, yet when you walk into the four walls of a health system, where responsiveness is actually more important and collaboration is more critical … you're taking the space capsule back 30 years," Brad Brooks, co-founder and CEO of TigerConnect, said during a workshop at the Becker's Hospital Review 9th Annual Meeting April 12 in Chicago.

For physicians, stilted communication isn't just inconvenient — it can harm patients. A 2016 study in JAMA Internal Medicine identified improved communication between care teams — for example, streamlining exchange of patient information between emergency departments and outpatient professionals — as a key to reducing avoidable 30-day readmissions among general medicine patients.

"Imagine this scenario," said Spencer G. Erman, MD, vice president and chief medical informatics officer at Hartford (Conn.) HealthCare. "An abnormal X-ray result comes in at 2 a.m. What's the current procedure? It goes into the EHR, a radiologist will call the on-call [physician], who might be able to get in touch with the [patient's] doctor, maybe not, and then [the radiologist] sits there for six hours until he comes in."

To address these types of issues, Hartford HealthCare implemented TigerConnect, a clinical communication platform for connecting a healthcare organization's disparate systems. With TigerConnect, a clinician is able to send a variety of HIPAA-compliant messages and data to members of a care team — including allied health professionals — across the enterprise to support care coordination and information sharing.

Dr. Erman noted TigerConnect helps to streamline clinical communication and improve patient safety. At Hartford Healthcare, when an abnormal X-ray result comes in at 2 a.m., a radiologist at Hartford HealthCare is able to use the clinical communication and collaboration solution to send a message to the appropriate attending in real-time, accelerating the delivery and discussion of the abnormal result.

A clinical communication and collaboration platform also holds great potential to increase patient satisfaction, according to Mary Asal, MD, a pediatric resident at Valhalla, N.Y.-based Westchester Medical Center.

"While I'm in a patient's room, with their mom there, I can text the surgical resident that's on call and say, 'Hey, what's going on with this case?' … and I can get an answer faster, instead of [the mom] having to hear, 'As soon as rounds are over, I'm going to try to call them, and see how long it takes them to call me back,'" Dr. Asal explained.

However, modern clinical communication solutions at hospitals are not yet mainstream. Almost half — 49 percent — of clinicians at hospitals indicated they most commonly receive patient care messages by pager, according to a 2017 study published in the Journal of Hospital Medicine. The continuous use of outdated technologies has a lot to do with inertia, the panelists hypothesized.

"Hospitals are inherently risk-averse places," Jonathan Berkowitz, MD, medical director of regional emergency services at Valhalla, N.Y.-based Westchester Medical Center Health Network said, commenting on barriers healthcare organizations face when attempting to integrate new technologies into clinical workflows. "The entrenched culture is a barrier."

This experience trickles down into almost every medical specialty — even those that require instant feedback. Dr. Berkowitz shared experiences from his role managing emergency services, during which he coordinates care decisions and transitions between emergency medical technicians, dispatchers and physicians at the facility.

"It's a total tapestry of different things going on. Each silo has its own culture, its own communication systems," he said. "There are doctors who you will have to pry their beeper out of their dead, cold fingers. There are pockets and silos at our hospital reliant on faxes."

To overcome technological inertia, panelists suggested engaging an often overlooked segment of the workforce to deploy a mobile communication solution — the younger generation.

"It's really popular among the residents," Dr. Asal said, adding TigerConnect streamlines her daily workflow by running on her own cell phone, avoiding the need to carry another pager or hospital-issued device. "We live in an age of instant gratification … We go from a very fast-paced expectation in life to slowing down really quickly [in healthcare]."

At WMCHealth, Dr. Berkowitz saw first-hand how residents like Dr. Asal pushed this project forward, rolling out the project among transport, pediatrics and now helping providers across the health system install it.

"There are attendings at my hospital who, when we first started [using TigerConnect], said 'No, no thank you,'" Dr. Berkowitz said. "Then, when all the residents were using it, they said, 'Hey, that's a great idea, I love it.' Now they're our biggest advocates."

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