Clinical communications is a broad concept that covers a multitude of interactions throughout a complex healthcare system. Clinical communications includes face-to-face, handwritten, telephone, video and email exchanges between and among caregivers, including nurse-to-doctor, nurse-to-patient, doctor-to-patient, nurse or doctor-to-insurer, doctor-to-doctor, doctor and nurse to patient’s family, and on, and on. This web of communications exchanges is immense, and the possibility for error or simply “mis”-communication is also immense. In fact, communications errors are a leading cause of medical errors. Those errors in turn can lead to re-admissions, exacerbation of chronic conditions, morbidity or even mortality. Coupled with these unwanted patient outcomes comes excess costs.
JCAHO has addressed this issue in several studies and has emphasized one-to-one communications as the ideal, suggesting that this method overcomes barriers such as hierarchy, age, gender, specialty and culture. However, mainstream clinical communications have become increasingly broad and complex, especially with the emergence of IDNs, and community and regional health information exchanges. One-to-one verbal exchanges, while effective in smaller environments, become practically impossible in multi-facility, multi-community settings. Unless of course they are carried out “virtually”.
Information Technology and a Paradigm Shift
The healthcare market has been decisively moving away from a transaction-based care delivery model based on activity, and toward a value-based care delivery model focused on outcomes. This is due in large part to the role that information technology (IT) is finally playing as it becomes more integrated with a wide variety of clinical processes. And again thanks to IT, this transformation increasingly focuses on quality as being one of the key criteria of healthcare, representing a fundamental shift in values. The transition has been occurring over decades, but has gained momentum in the past few years as advances in technology enable the standard exchange of clinical data.
The resulting patient care in this paradigm shift will inevitably become more patient centric and will increasingly require successful coordination among the many players in the healthcare process: primary care doctors and specialists, nurses, patients, interns, administrative assistants, therapists, pharmacists and so on. In addition to players in the process, the multitude of care settings continually increases in number and geographic dispersion as healthcare evolves. Communication is paramount to facilitating team-based care to successfully coordinate a patient’s treatment plan in this model. However, due to a variety of reasons, communications technologies up to this point have been ineffective and even crude. Ironically, technology accelerated the flaws in the clinical communication process by increasing the speed and volume with which communications flows without controls in place to ensure that the amount of communication was necessary and effective. Attempts to address this problem have recently resulted in such initiatives as The Direct Project and Integrating the Healthcare Enterprise (IHE). These initiatives have taken on the task of promoting the coordination of standards designed to ensure interoperability between and among clinical enterprise systems, accelerating the adoption of electronic health records (EHR), and improving the exchange of health information among healthcare systems. However, the capability to exchange clinical data does not necessarily parallel the clinicians’ ability to effectively communicate with each other.
Communications Technologies Evolve
Early clinical communications technologies, such as pagers, mobile phones and even email, have been rejected by most clinicians as being too primitive and inflexible as well as, in the case of email, unsecure. Paging remains the most common form of electronic communication in healthcare even though it has been all but abandoned in most other industries. Mobile phone signals are considered hazardous in the hospital and ambulatory clinical environment with studies indicating that their signals disrupt the operations of certain medical devices and equipment. Consequently, cell phones have been discouraged if not banned outright in most hospitals and clinics in the U.S. That leaves the telephone and email as the last generally available communication tool option. In a hectic clinical environment, telephone communication is haphazard and disruptive. The email alternative has long been considered unsecure and therefore untrustworthy –and unacceptable–for sharing patient information.
So what makes secure communications secure? Unlike email, secure communications is part of a self-contained system where each participant is known and authorized. Users are typically one of the following participant types: patient, physician, clinician, clinical team member, triage staff or administrator. These participants are all part of the patient-centered healthcare spectrum and play key roles in the healthcare process. Secure communications is not email. Unlike email, secure communications can only be sent to other specified messaging participants. The messages are irrefutable because the author is authenticated. And because messages are typically made a part of a patient’s medical record, it requires that the care collaborators fulfill HIPAA requirements.
Ultimately, the long road of clinical communications begins with conversations in the hall but leads to some form of ever-evolving comprehensive information technology and health information exchange. This exchange enables multiple organizations in multiple settings, whether they are integrated delivery systems or states, to leverage existing data to communicate, share and exchange so that patient care can be enhanced by real-time information at the point of care at the moment of need.
