Using tools to maximize EHR potential, close the clinical loop

While EHRs offer complex functionality, there is an increasing reliance on purpose-built solutions to enable systems to interoperate, such as those used for communications between care team members. Enabling healthcare providers to do more with mobile devices and specialized software could be the key to improving staff satisfaction and patient outcomes.

"EHRs are designed for documentation, not purpose-built for workflow integrations and communications, but those communications need to happen on a minute-to-minute and second-to-second basis for EHR management," Brian Edds, vice president of product strategy for Spok, said at the Becker's Hospital Review CIO/Health IT + Revenue Cycle Management Summit in Chicago on July 20. "The key element is getting hold of the right person, on their preferred device, and keeping track of every step in that process."

Springfield, Va.-based Spok is a leader in critical communications for healthcare, government and other industries. The company offers solutions for workflow improvement, secure texting, paging services and contact center optimization.

Mr. Edds outlined several use cases in which enabling add-on or integrated systems to an EHR can improve communication, functionality and patient outcomes. Firstly in an instance where a physician orders laboratory tests via a computerized physician order entry, a request is sent to the phlebotomist through the EHR. Once the blood is drawn and samples are delivered to the laboratory, they are entered into the laboratory information system and published in the EHR.

"The ordering physician likely spends time frequently checking the EHR for results," Mr. Edds said, "It becomes a game of phone tag between the laboratory and the ordering physician where the information is in the EHR but not efficiently communicated to the caregiver."

In a case like this, there are a whole series of workflows that can be set up to automatically send these notifications out, rather than having care team members rely on phone calls, he said. These workflows can be used to close the clinical loop by delivering information effortlessly and electronically and notifying users about who has and has not seen the results as they are being integrated into the EHR.

Mr. Edds also outlined examples on the administrative end of the spectrum. After hours, a patient may call with a question. The answering service will generally page the physician, who then calls the answering service to receive the details of the patient's concerns.

"Following this back and forth, the physician will call the patient and update the EHR," Mr. Edds said. "We see that sometimes the EHR isn't updated until the next day or following weekend after the physician is on call."

In this example, enabling nurses to use a secure messaging platform built into the EHR would allow them to reach out to the proper physician directly with a detailed request. The parties are automatically alerted back and forth as they receive responses. According to Mr. Edds, this results with both a happier staff and faster treatment.

"In these use cases we see that asynchronous communication occurs," Mr. Edds said. "There are many possible improvements for these workflows to make the interaction between people a lot better. Communication devices are extremely prevalent — 96 percent of physicians are carrying smartphones and using them for patient care, even without the consent of IT."

Another 61 percent of physicians have concerns about being able to communicate with colleagues, and 52 percent of nurses report having difficulty knowing which physicians to reach out to, Mr. Edds said. In one study at an academic medical center in Toronto, researchers found that 14 percent of pages were sent to off-duty providers, 32 percent of which were urgent and sent to the wrong providers.

"Empowering mobile providers can help streamline them but it's much easier said than done," Mr. Edds said. "We're talking not only about people getting a hold of each other, but machines. Connecting those people and machines with the right thing on the other end is becoming harder and harder."

Mobile EHR apps are being increasingly used at patients' bedsides and there is an opportunity to not only allow people to use those as primary source of EHR documentation and order entry but to use them as workflow communication points for the patient care team as a whole, Mr. Edds said.

"Starting to keep track of all this communication from a mobile standpoint is the future of using smart devices."

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