A symbolic rite of passage among physicians is taking the Hippocratic Oath, frequently paraphrased as primum non nocere, or “first do no harm.” Indeed, there is much good to be done. Over the last few decades alone, medicine has advanced so dramatically that sometimes treatments seem like miracles.
With this explosion of complex medical capability has come a dramatic expansion of the health care team to include a variety of personnel, all of whom communicate for many reasons and, by necessity, in many ways. With each communication, there is potential for error, such as timeliness of a message, or appropriateness of a recipient or message medium.
Adding to this complexity, health care is transitioning away from standby communication tools. The paper charts, faxes and paging systems of yesteryear are being replaced by electronic technology such as texting, as well as with messaging tools embedded in electronic medical records. Such communication methods are particularly useful when providers are off-site, are involved in other activities, need information during transitions of care, or are occupied during emergencies. A physician might take half an hour to call back a nurse after a page, but can respond to a text message almost instantaneously. However, there are risks to using everyday electronic communication in the health care setting. For example, sharing certain types of information over a non-secure electronic system, such as basic texting, violates HIPAA.
However, secure communications systems that can be integrated into desktop modules, mobile phones and other mobile technology, such as Imprivata Cortext®, from the health care IT security company, Imprivata, can help prevent HIPAA violations while improving communication efficiency. Secure communication systems assist providers and support staff in conveying information to the right recipients in a timely fashion, streamlining workflows and possibly even improving the patient experience. For instance, Imprivata Cortext enables health care professionals to send secure and encrypted information only after requiring user authentication to access the application. Imprivata Cortext allows for HIPAA-compliant communication of patient health information by removing patient health information (PHI) from lock screen messages; segregating PHI-related message chains from other, less secure forms of communication; and enabling organizations to lock down devices in the event of a loss or compromise.
Streamlining secure communication is also a matter of money. The Imprivata report on the economic impact of inefficient communications in health care found wasted time due to inefficient communication costs an average U.S. hospital about $1.75 million each year, nearly half of which could be recouped with secure mobile messaging.
Who connects and why?
Reconfiguring communication in health care, the foundations of which can be built on rarely-updated practices and outdated technology, can seem like an impossible task. In Imprivata’s experience with clients, a critical step to this process is going back to the basics and examining how health care providers already connect, surveying how providers and care teams currently send information, and why. Recognizing the place each piece of technology has in a variety of clinical and supporting workflows is vital to supporting communication efficiency. Instead of imposing a new system on clinicians, administration must work to foster team engagement to ensure success. Those in the position to make technological decisions should gather direct information about who will use a new system and how, to invest scarce health information technology dollars in a way that creates maximal benefits for patients and providers. Working with behaviors that are already in place, a method popularized by economists as “nudge theory” in the late 2000s, may further enable a communication overhaul to succeed.
“Working with the users from the very beginning will make a big difference. We had a lot of people that were against it like you wouldn’t believe. They’ve come full circle now. They’re the ones promoting it,” said Tom Calo, technical solutions engineer at Waterbury, Conn.-based Saint Mary’s Hospital, of that organization’s rollout of secure texting through Imprivata Cortext.
What should be communicated?
When a new communications system is deployed, providers are given the ability — and responsibility — to share information more efficiently. This can be a difficult thing to enable providers to do given their busy schedules and pressing concerns. A secure communications platform does not run itself. Creating protocols about when and how it is appropriate to share certain types of information is key. Protocols, and education about protocols, can save lives and prevent lawsuits. For instance, a protocol may deem it appropriate to notify a physician about patient discharge via secure text but inappropriate to notify supporting providers of patient orders using the same platform, where they might be missed. Such protocols, as well as the use of the platform itself, should be reconsidered periodically to assist clinicians, staff and patients in best leveraging a tool for the jobs at hand.
One Imprivata client, a system with more than 800 beds, deployed Imprivata Cortext to improve care efficiency and coordination, and discovered it was necessary to modify the initial parameters of the Imprivata Cortext rollout. Based on user feedback, the system updated protocols for Imprivata Cortext from one-way, physician-only messaging to include two-way messaging where all members of the care team can participate, helping them to achieve their secure communications goals.
How can you collaborate?
With an updated communications system in place, there is significant potential for collaboration. Interactions that before were complex and unclear, such as a physician communicating instructions to a social worker via a series of support staff, can become simple: a secure message from physician to social worker. However, it is important to recognize communication pitfalls and patient safety dangers exist even when using updated technology.
According to Imprivata, proactive education about new systems, policies and protocols can better alert users to potential issues before they arise. Designing alterations to communication systems that consider the current behavior of care teams can make transitions safer and easier. Recognizing the fears and objections of staff reticent to use a system is safer than ignoring them and assuming they will follow the rules. Based on its experiences working with numerous clients on communication overhauls, Imprivata suggests moving quickly and using strong messaging — the shorter the transition period, the less opportunities there are for HIPAA violations and other issues.
Improving health care communication isn’t easy, but it doesn’t have to be impossible. Rather than sitting back and expecting a pledge of non-maleficence to do its work, communication managers should work with trends, secure provider engagement, and insist upon protocols recognizing clinical communication for the collaborative masterpiece it is.
The Secure Messaging Solution from Imprivata has earned the exclusive endorsement of the American Hospital Association.