When a 90-year-old woman with no caretaker showed up in an emergency department in dire condition, it may have been customary to launch a heroic effort to save the patient, despite her wishes. But at one Bay Area health care network, doctors were able to instantly huddle with other members of her care team and determine that the patient preferred care that emphasized quality of life and comfort.
Communication is crucial to excelling in new models of health care. And yet, it can be an enormous hurdle for accountable care organizations such as the Meritage Medical Network based in Novato, Calif. The physician-led, Medicare Shared Savings ACO includes numerous physician practices and a hospital with disparate records systems, covering a 26,000 square-mile region.
In the absence of interoperability, Meritage has perfected the use of a smartphone-based tool that allows clinicians to huddle virtually and quickly check in on a patient’s care history. After a few short years, the app has shown promise, reducing the number of phone calls by 47 percent and length of stay by a half day, says Andrea Kmetz, R.N., director of care management and quality assurance.
“It was a giant game of phone tag, and now, with the virtual huddle, that has been eliminated,” she says. “Until there is a truly meaningful health information exchange — and we’re a long way from that — this bypasses that and puts people at the point of care in touch with the whole team across the continuum.”
Developed by technology company Zynx Health, the mobile app allows providers to see who is on a patient’s care team and message back and forth with them in a HIPAA-compliant fashion. Doctors also receive reminders and “ticklers” about certain markers along a patient’s care path, and alternatively can send out reminders to alert staffers of such things as the need to discharage a patient.
Up next, Meritage will look to incorporate the virtual huddle tool into its outpatient physician practices, as well as an additional rural hospital in Sonoma. Plus, they’re adding the ability to upload and share documents between providers, Kmetz says. Two key lessons learned so far are the importance of understanding each patient’s living situation, and reconciling prescriptions before discharge.
Meritage member Marin General Hospital in Greenbrae, Calif., also has seen an uptick in the satisfaction of physicians who have been frustrated with finicky electronic health record systems. One survey at the hospital found that 7 percent of clinicians at the hospital said it was “easy” to update changes in a patient’s discharge plan, which shot up to 72 percent after implementing virtual huddles.
Terry Winter, R.N., director of care transitions at Marin, says hospitals won’t eliminate the need for an EHR, but this is one way to alleviate some of its communication shortcomings.
“The electronic medical record is a valuable tool, but it doesn’t do much to improve communication between disciplines and even within the same discipline at different shifts,” Winter says.