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Efficient clinical communication reduces provider workflow ‘toil’

Google recently published an eBook about how they manage their worldwide server operations.1

Chapter five describes a term their engineers use internally: "toil," which is also highly applicable to healthcare delivery. Defined as "manual, repetitive, automatable, tactical, devoid of enduring value that scales linearly as a service grows," Google has found that toil can quickly exhaust an engineer's time if left unchecked.

This notion of identifying and eliminating toil offers numerous lessons for healthcare, especially surrounding clinical communication and data access. For several reasons, primarily the introduction of electronic health records (EHRs), toil has increased significantly, interfering with care, increasing costs, and frustrating physicians and nurses.

However, there are effective methods to combat toil that do not include eliminating EHRs. With the rise of smartphones and an open API, cloud-based mobile communication platform, health systems can improve clinical communication and data management efficiency and restore meaningful patient care time for physicians and nurses. Simultaneously, patients will feel more satisfied and engaged in their care because their providers are paying more attention to them instead of toiling away at an EHR.

Toil takes its toll
Many common healthcare activities could be classified as toil. Among them are:
• Paging or using a call service to reach physicians
• Leaving repeated voicemail messages
• Searching hallways for providers
• Looking through directories and whiteboard schedules
• Repeated EHR log-ins
• Searching for data in the EHR because information is unavailable on-demand

A recent study found that for every hour spent with patients, physicians spend two hours on EHR and administrative tasks, with most of this data entry addressing coding and billing.2 On an even more granular level, a typical EHR session takes three to four minutes to search and retrieve relevant information, which, multiplied by 15 to 20 times per day, results in more than an hour in lost productivity.

Combined with the antiquated communications and workflows that hospitals continue to rely on, such as pagers, IP phones, handwritten scheduling methods, and third-party human answering services, it is no wonder patients and providers are frustrated. In fact, a recent observational study at a large North Carolina health system found that nurses spend as little as two-and-a-half hours of a 12-hour shift actually treating patients with the remainder spent hunting down supplies, and searching for physicians and interacting with pharmacists3; in other words: toil.

As a result, physicians and nurses become burned out by the constant repetition and delayed information access. This leaves them feeling rushed and overwhelmed by all the patient care that often has yet to be accomplished. Meanwhile, patients are also dissatisfied due to care delays, limited provider attention and lack of answers to their questions.

Skipping the repeated log-ins and manual searching to find information, however, is not an appropriate workaround. Uninformed clinical decisions create much greater patient safety risks, which no healthcare organization can afford.

Mobile clinical communication streamlines workflow
As Google points out in its eBook, not all toil can be eliminated. The technology corporation sets an internal objective to limit toil to 50 percent of an engineer's time to prevent burnout. They do this by identifying and calculating how much time each engineer spends toiling and offering support when anyone becomes overburdened.

Healthcare organizations have also tried to limit toil, with limited success, by using smartphones for clinical communication. Using SMS alone however, although common in hospitals, is insufficient and non-compliant with the HIPAA Security Rule. Through only SMS, providers are unable to identify and include the entire care team in care discussions. These group chats through smartphone-based apps likely lack integration with hospital systems, so the context of these discussions is limited. In addition, if a physician needs to be alerted about test results, additional manual steps by another member of the care team are required.

Supporting departments, such as translation services, can also add to toil if they are not available when needed. A $15-per-hour support service can delay care delivery and cause a $300-per-hour physician to wait, greatly increasing costs for the organization and distress for the patient. By reaching translators in real-time, physicians can see more patients per rounding session, improve productivity and reduce length of stay (LOS). Even just reducing LOS by an hour per discharge can save millions of dollars in costs for an average health system, in addition to the increased patient satisfaction.

A secure and integrated clinical communication platform overcomes SMS limitations and compliance risks. Critical lab results can now be routed automatically at the point of care from the EHR to a physician's smartphone rather than wasting four to five minutes logging in to view results. A highly intuitive interface that only takes seconds to learn would accelerate adoption of the new platform and workflow. While the ability to use their own smartphone, in a secure and HIPAA-compliant manner, would also encourage adoption.

An advanced clinical communication platform allows providers to direct message or place a phone call to the on-call specialist or technician from their mobile device, regardless of shift or facility, based only on their role. The physician can then securely view the group conversation or patient information, and respond and enter an order from their device. Fully-informed, safer care in less time reduces the toil of repetitive, unproductive tasks and transforms frustration into physician, nurse and patient confidence and satisfaction.

Returning the focus to the patient
Equipping nurses and physicians with a mobile clinical communication platform reduces toil and returns their focus to the patient. More effective communication and less toil also promotes greater productivity through shorter LOS, less waiting in the emergency department before admission or discharge, greater hospital capacity and reduction of wasted care, thanks to more fully informed decisions. All of these benefit the health system's bottom line as well as overall patient satisfaction.

Maybe one day we will thank Google for labeling an enemy we can all unite behind: toil. Defeating toil will drastically reduce costs, improve patient outcomes and restore time that physicians and nurses need to care for and create healthier, more engaged patients. Let the battle begin.

About the author:
Brad Brooks is the Chief Executive Officer of TigerText

1 https://landing.google.com/sre/book.html
2 http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties
3 https://www.beckershospitalreview.com/quality/bringing-nurses-back-to-the-bedside-how-novant-health-tripled-direct-patient-care-time.html

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