real-time clinical communication and care coordination

clinicalMessage transform care through realtime communication

Abstract clinicalMessage® is a robust Provider-centric communication platform that

facilitates realtime care collaboration across the entire interprofessional frontline

clinical team. clinicalMessage® is not a solution to substitute for pagers or to

replace the essential Electronic Health Record(EHR). However, clinicalMessage® is

a pragmatic solution that fundamentally transforms how clinicians communicate in

the patient care setting and enables a streamlined processes through the use of best

practices, and secure Smartphone information technology.

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Document No. 08201405

Published by iCareQuality Incorporated® in 2013, 2014

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Table of Contents

Abstract ................................................................................................................ 1

Problem Background with Rising Cost and Complexity ................................... 4

Transform How Clinicians Communicate ......................................................... 5

clinicalMessage® Built-in Capabilities ............................................................... 7

Mobile Communication and BYOD .................................................................. 7

Patient Handoff and Care Transitions .............................................................. 8

Closed-Loop Messaging Communication ......................................................... 8

Enhanced Patient Experience ............................................................................. 9

Industrialize Evidence Based Practices .............................................................. 9

Performance Measurement and Business Analytics ....................................... 10

Access to Expert Community for Learning ...................................................... 10

clinicalMessage® Architecture .......................................................................... 11

Deployment Options ......................................................................................... 13

Summary and Call to Action ............................................................................. 13

References .......................................................................................................... 14

About iCareQuality Organization .................................................................... 15

About Our Team ................................................................................................ 15


Problem Background with Rising Cost and Complexity

In considering the home care, primary care office, patient

centered medical homes, hospital or long term care setting,

the need to communication and collaboration can occur in

the management of urgent medical issues when a clinician is

needed in a real-time. They can also occur in non-emergency

situations when multiple members of the interprofessional

care team contribute to resolving a patient’s issue such as,

diagnosis, care plan, discharge planning etc. Depending on

the complexity of the patient’s condition, care must be

coordinated across multiple disciplines and specialties. This

includes the nurse, the pharmacist, and other allied health

staff, along with the various specialists involved such as

cardiology or critical care and often family members. Most of

this communication is facilitated through the use of numeric

pagers and so it is inefficient and interruptive. Transfer of

care from one shift to another occurs multiple times a day for

a patient and so is another source of errors when

communication breaks down.

The literature has also suggested that eliminating these

communication inefficiencies and failures will significantly

improve patient safety and quality of care. [1-4] Poor

communication in hospitals also contributes to a significant

burden of rising healthcare costs. A 2009 report estimated

that communication inefficiencies among care providers in


U.S. hospitals cost the country $12 billion per year.[5] In

Canada over the last decade, the government’s federal health

care expenditure has more than doubled from $97.6B in 2001

to a forecasted $200.5B in 2011. Per capita spending during this

same period has increased from $3174 to $5811 per person

(84%).[6] In comparison, the GDP for Canada across all

industries between 2001 and 2010 increased at a rate of 19%

($1041B to $1234B). [7] Research indicates that the greatest

sources of waste in healthcare – time and money (54%) – are

largely due to increases in patients’ length of stay that stem

from poor care coordination and slow discharges.

In the midst of these economic challenges, the public still

expects to receive high quality health care, with greater

quality of life, increased safety and shorter waits. Therefore, a

new approach is much needed, and research highlights that

investing in healthcare information and communication

technology (ICT) solutions that dramatically help streamline

communication among caregivers as well as patients and

families; and can improve the quality of care while shifting

the cost curve downward at the same time.

Transform How Clinicians Communicate

clinicalMessage is a robust provider-centric communications

platform that facilitates care collaboration across the entire

interprofessional frontline team. clinicalMessage is not a

solution to replace pagers. However, clinicalMessage


fundamentally transforms how clinicians communicate with

one another by enabling streamlined processes through the

use of information technology. The real-time system was

designed by experts from the University Health Network

(UHN) in Toronto, Canada that have been developing and

evaluating communication solutions for the past eight years.

Key principles that have guided the development include:

Patient Centred: The solution is designed with the patient at

the centre of all interactions and functions, rather than the

clinician.

Focussing on the Process: Most of the issues relate to the

complexities inherent with interprofessional collaboration

and technology is simply an enabler.

Intuitive and Easy to Use: The application must be simple and

intuitive enough that a clinician who has received no training

can immediately use the primary functions of the system. This

is critical in an academic teaching environment where the

clinicians are very transient.

Extensible: The solution can be easily and quickly modified to

support innovation and the development of new care

processes.

Engaged Stakeholders: improvement is not limited to selected

few, all affected stakeholders including care givers, patients,

family members and vendors must have the ability to suggest

improvement. These opportunities must be processed

through active Learning Organization.


Real-Time Evidence of Success: To improve adoption, the

system must show evidence of success through real-time

dashboard that is based on data collected through natural

workflows.

clinicalMessage® Built-in Capabilities

The specific capabilities that clinicalMessage has been designed

to enable include:

1. Mobile Communication

2. Patient Handoff

3. Closed-Loop Messaging

4. Enhanced Patient Experience

5. Industrialize Evidence Based Processes

6. Performance Measurement and Business Analytics

7. Expert Community for Continuous Learning

Mobile Communication and BYOD

Mobile devices, particularly Smartphone’s, are becoming an

integral part of healthcare and clinicians have adopted their

use to improve productivity. Clinical Message supports the

mobile clinician and provides the primary functionality on

any device. Advancements in mobile device technology

requires the solution to be device agnostic (ie. not associated


to any single platform), ensuring it can be adopted by a large

academic teaching hospital or a small community based

hospital.

Patient Handoff and Care Transitions

The patient handoff module supports the transitions in care

that occur between clinicians at shift change. This solution

supports the physician sign-out process, nursing handover,

huddles, rounds and facilitates key interprofessional

communication activities that were traditionally facilitated

through the nursing Kardex. clinicalMessage facilitates the

communication of key summary information data to ensure

everyone in the patient’s circle of care can make timely

decisions when an issue arises. It also ensures everyone is

aligned regarding the patient’s overall care plan, improving

efficiencies and expediting the discharge process.

Closed-Loop Messaging Communication

The messaging module facilitates communication between

healthcare providers for coordinating patient care. However,

it is not simply a feature that allows text messaging. It utilizes

rules and logic to separate urgent and non-urgent

communication to ensure critical issues are addressed

immediately while at the same time allowing less critical

issues to be addressed with less priority. The closed loop

feature allows notifications to be sent when less critical issues

remain unaddressed, ensuring nothing “falls through the


cracks.” This reduces the amount of interruptions experienced

by clinicians, improving their overall efficiency and

productivity.

Enhanced Patient Experience

The Patient Experience module would introduce patients to

their clinical team so they know who is caring for them. It

would provide patients and their family and friends a high

level overview of the care plan so they can remain informed

and be active participants in the care being provided. There is

the ability for the patient to provide real-time feedback to the

clinical team on the quality of care being provided, allowing

changes to occur while the patient is still in hospital. The

module would also provide an interface for the patient to

remain connected with family and friends when they are not

in hospital for added support.

Industrialize Evidence Based Practices

Evidence-based practices are available to promote the

standardization of care, improving the quality and safety of

care provided. clinicalMessage® employs the use of checklists

to facilitate alignment of patient care activities with best

practices and scorecards to measure performance and

adherence to these best practices. Rules and logic are used to

provide reminders when a best practise is not being followed,

allowing clinicians to adjust their care on a real-time basis.

For example, if an intravenous line has been in place for more


than 72 hours, the nurse will be reminded that the site of an

intravenous line needs to be changed every 72 hours to avoid

phlebitis (inflammation of the vein).

Performance Measurement and Business Analytics

Key performance metrics and data required for regulatory

reporting is captured, monitored and tracked in real-time,

allowing issues to be identified and interventions employed

before issues arise. Operational inefficiencies can be more

readily identified, allowing process improvement activities to

be focussed on areas of primary concern for the organization.

Functional dashboards and business analytics tools provide

many views and approaches for organizations to improve

their operational effectiveness. For example, various metrics

around the emergency department disposition process can be

monitored and if a bottleneck is identified, such as an

inpatient service delaying consultation, escalations to the

service’s clinical director to remove this bottleneck can occur.

Access to Expert Community for Learning

clinicalMessage® is not just a communications solution, it is

also a community of experts that collaborate to improve the

quality and efficiency of patient care. While every

organization may face similar communication challenges, the

priority associated with each challenge may be different. One

organization may focus on improving one process, while

another organization focuses on improving another. By


creating a central knowledge base that allows healthcare

organizations to learn from one another, everyone benefits

and can improve their processes in a shorter period of time.

clinicalMessage® Architecture

clinicalMessage® allows patients, families and clinicians to

collaborate both in synchronous and asynchronous manner

using their own mobile or desktop devices (see Figure 1).

Collaboration initiator decides on when the response is

required. If an urgent response is required, the system alerts

the parties via SMS (no PHI information is transported via

SMS), otherwise message is posted in responder’s inbox and

alerts are sent as requested by the responder.

Integration with Hospital EHR: clinicalMessage integrates

with multiple EHR solutions and pulls the data using HL7

standards.

Third Part Mobile Apps: QRS provides a secure and reliable

integration mechanism for third party apps such as blood

pressure, diabetes, patient location applications etc.

SMS Gateway: Built in SMS gateway enables secure

transmission of all messages at significantly reduced cost than

cellular carrier.

clinicalMessage® does not require real-time integration with

core hospital systems. This reduces the complexity and cost

yet provides most critical information to all stakeholders in

real-time.


Figure 1: clinicalMessage Integration Architecture


Deployment Options

Public Cloud: leverage the QRS managed cloud in your

jurisdiction and interact with clinicalMessage™ using your

own mobile device

Private Cloud: let us build and maintain your own private

cloud

In-House: Deploy clinicalMessage in your own datacenter

Summary and Call to Action

In summary, clinicalMessage® is not a replacement of the

Electronic Record System (EHR) or the traditional pager

system, but an adjunct to both systems. Having a complete

patient record is critical for appropriate care delivery. The

accuracy of a patient record is important and the entire

patient experience should include BOTH the EHR and the

clinical communication record. Thus with a complete record,

it is important to manage costs and to make the patient

electronic health record available to essential and care team

Providers in realtime.

Thus, access to real-time essential information helps improve

quality of care, patient satisfaction, staff satisfaction and

brings real transparency and accountability of care delivery.

With clinicalMessage® deployment, healthcare leaders can

accomplish this without investing millions of dollars in a risky

EHR enterprise rollout.


References

1) Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Consensus

Report: National Academy of Press, Washington, DC.

2) The Advisory Board Company (2012). Strengthening Interdisciplinary Collaboration, Best

Practices for Enhancing Partnership and Communication. Nursing Executive Center,

Washington, DC.

3) M Smits, M Zegers, P P Groenewegen, D R M Timmermans, L Zwaan, G van der Wal, C

Wagner1,, Exploring the causes of adverse events in hospitals and potential prevention

strategies, BMJ, Qual Saf Health Care, 2010

4) Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to

medical mishaps. Acad Med 2004 February;79(2):186-94.

5) Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J et al. The Canadian Adverse

Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ

2004 May 25;170(11):1678-86.

6) Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication

inefficiencies in U.S. hospitals. J Healthc Manag 2010 Jul;55(4):265-81.

7) Canadian Institute for Health Information. National Health Expenditure, 1975 to 2011. Nov

3, 2011. Available:

http://secure.cihi.ca/cihiweb/products/nhex_trends_report_2011_en.pdf

8) Statistics Canada. Gross Domestic Product by Industry, 2001 to 2010. Available:

http://www5.statcan.gc.ca/ bsolc/olc-cel/olc-cel?catno=15-001-X&lang=eng&chropg=1


About iCareQuality Organization

iCareQuality, Inc. is a benefit corporation registered in state

of Delaware United States with head office in Springfield

Pennsylvania. We believe systematic engagement of care

providers is key to building a sustainable healthcare system

globally. To support our mission we build provider

engagement tools, enable care providers develop new

knowledge and freely disseminate this knowledge to care

providers globally. As a benefit corporation, we pledge 40%

of our profits to our providers, 50% for reinvestment and 10%

for our investors.

About Our Team

Chief Architect

Jason Uppal, P.Eng.

[email protected]

Clinical Support

Kate ONeill, MSN, RN

[email protected]

Sales and Business Development

Bryan Weston

[email protected]



real-time clinical communication and care coordination

Healthcare

home care

critical care

care plan

clinicalmessagetransform

care transitions

quality of care

care providers

transfer of care