Hospitals, physicians practices, and other healthcare facilities have rapidly expanded their use of technology in an effort to move from a paper-based environment to one that supports the use of electronic health record (EHR) or electronic medical record (EMR) solutions. However, sharing information among healthcare IT systems has traditionally been a challenge. Most facilities use a mix of disconnected technology including EHR/EMR solutions, lab systems, IP phone systems, nurse call, patient monitoring, bed tracking, and other solutions.
This creates an environment in which data is inconsistent across systems because of the reliance on manual communication and documentation, along with duplicate (or even triplicate) data entry in order to keep these solutions synchronized.
There has been a steady movement toward more integrated and interoperable core clinical systems, along with ancillary systems, to facilitate the exchange of data between, for example, two different EMR systems at different hospitals. In order to truly improve electronic communication, providers require semantic interoperability among solutions so that they can exchange and use this electronic data.
This would involve linking disparate systems such that a change in an EMR or laboratory system could automatically generate updates to other systems, send alerts via phone, paging, nurse call solutions, or even medical devices.
That level of real-time, synchronized communication is critical. According to the Joint Commission Sentinel Event Data report, poor communication is a major cause of sentinel (serious adverse) events in hospitals.
These events can range from medication errors to wrong-site surgery, falls, and post-operative complications. According to the report, poor communication was ranked as one of the top two or three causes of such events in each of the past three years, resulting in hundreds of otherwise avoidable medical errors.
An emerging class of messaging middleware could potentially eliminate these communication delays and errors while reducing reliance on manual data entry and paper-based processes.
Hospitals, physicians practices, and other healthcare facilities have rapidly expanded their use of technology in an effort to move from a paper-based environment to one that supports the use of electronic health record (EHR) or electronic medical record (EMR) solutions. However, sharing information among healthcare IT systems has traditionally been a challenge. Most facilities use a mix of disconnected technology including EHR/EMR solutions, lab systems, IP phone systems, nurse call, patient monitoring, bed tracking, and other solutions.
This creates an environment in which data is inconsistent across systems because of the reliance on manual communication and documentation, along with duplicate (or even triplicate) data entry in order to keep these solutions synchronized.
There has been a steady movement toward more integrated and interoperable core clinical systems, along with ancillary systems, to facilitate the exchange of data between, for example, two different EMR systems at different hospitals. In order to truly improve electronic communication, providers require semantic interoperability among solutions so that they can exchange and use this electronic data.
This would involve linking disparate systems such that a change in an EMR or laboratory system could automatically generate updates to other systems, send alerts via phone, paging, nurse call solutions, or even medical devices.
That level of real-time, synchronized communication is critical. According to the Joint Commission Sentinel Event Data report, poor communication is a major cause of sentinel (serious adverse) events in hospitals.
These events can range from medication errors to wrong-site surgery, falls, and post-operative complications. According to the report, poor communication was ranked as one of the top two or three causes of such events in each of the past three years, resulting in hundreds of otherwise avoidable medical errors.
An emerging class of messaging middleware could potentially eliminate these communication delays and errors while reducing reliance on manual data entry and paper-based processes.
Middleware Bridges Communication Gaps
In most provider facilities, generating alerts and notifications is done in a very disjointed manner. Patients trying to reach a nurse can use the nurse call system, but actually reaching a particular nurse may require overhead paging, texting, or the use of an IP phone solution. Lab results may be automatically routed to a patient’s electronic chart, but any alerts or notifications associated with the completion of those tests are handled through other disconnected systems.
Healthcare providers need a way for the range of technology solutions they use to communicate and interact so that they can exploit the full potential of these solutions. Doing so can improve patient outcomes, reduce costs, and boost efficiency. Making these cross-system interactions happen has traditionally required the development of custom interfaces (a time-consuming and expensive undertaking) or manual entry of the same data into multiple systems.
A communications middleware solution could integrate personnel directories and on-call schedules with clinical software, nurse call and alert solutions, third-party devices (such as IP phones and pagers), and other applications to automate the handling and dispatching of messages and alerts. Such a solution would appear as one integrated system to the average end user, but behind the scenes would handle the messy work of merging multiple systems into a single touchpoint.
These systems, leveraging standardized communication protocols like HL7, could eliminate the chaos of moving information between these systems. This could ensure that the right message gets to the right staff member, and that all of these notifications, alerts, and other data transfers are auditable and documented in the electronic medical record.
How would such a solution work? Middleware acts as the “glue” that holds these many IT systems together, and translates a variety of different inputs (voice calls, pages, record updates, alerts, etc.) in such a way that other solutions can interpret the data and react accordingly.
For example, bed tracking solutions are typically not directly integrated with the messaging systems that are used to alert staff when a room is available. Using middleware, once a bed is cleaned the bed management system (based on customized alerting protocols) can automatically send a message to the correct personnel to let them know that a room is available via the middleware solution. An e-mail or text message can be sent to designated staff based on rules established by the facility on any platform.
In the case of a nurse call system, when a patient calls for a nurse, the notification would not only go to the nurse’s station, but could also be forwarded to a specific nurse who may be in another patient room, or elsewhere in the building. That way, those patient requests don’t depend on the nurse being physically present at the station to receive them. The nurse call solution still handles the escalations, but messaging middleware can ensure that those notifications are received by the correct staff members in a timely manner via whatever delivery mechanism is the fastest.
Efficient, Secure Communications
With the right middleware acting as a bridge between software solutions and communication devices, hospitals can automate alerts and notifications, which can improve caregiver response times. A middleware product that interfaces with the on-call schedule to reach the correct staff members can ensure that the right person receives the right message in a timely fashion.
With integration to IP phones, pagers, and mobile devices, these solutions can reduce overhead paging, providing a quieter environment for patients while more accurately directing patient requests and physician notifications.
More accurate and timely notifications can, in turn, reduce nurse travel time by eliminating unnecessary trips back to the nursing station. By providing a platform for real-time notifications and improving efficiency, staff will have more time to spend with each patient.
Lab and test result notifications can be sent directly to physicians. This can eliminate the “phone tag” that staff often have to engage in when trying to reach a busy doctor, while providing automatic updates to electronic patient charts and records. With a secure connection among solutions, this type of middleware product can meet the secure messaging requirements of the Health Insurance Portability and Accountability Act (HIPAA) while also providing the type of fully auditable documentation required for accreditation programs such as those offered by the Joint Commission. Each message can be both date and time-stamped, and the system can provide confirmation that the message has been delivered, viewed, and accepted.
Hospitals Integrate Communications with MergeComm
Once such middleware solution that has already been successfully deployed by a number of hospitals is MergeComm from AMTELCO’s 1Call Division. MergeComm is an event notification software system that can merge and expedite enterprise-wide communications in healthcare environments.
Inputs from disparate healthcare solutions can be used to generate notifications that are sent to individuals, groups, or other personnel based on on-call scheduling data. Admit/ discharge/transfer (ADT) messages, nurse call messages, alerts, alarms, orders and e-mails can be instantly sent to designated recipients via 1Call’s miSecureMessages encrypted messaging application, Vocera badges, IP phones, SMS, e-mail, and pager systems using the solution.
The solution can also create an audit trail of these notifications, generating messaging statistics that can help improve communication processes and document response times.
The solution is also capable of twoway HL7 messaging. If the system sends an alert about lab results, for instance, a physician can send back an acknowledgment of the results, which becomes part of the medical record. The doctor could make notes or comments on the results and document those in the record using MergeComm as well.
AnMed Health, a hospital system that serves communities in South Carolina and Georgia uses MergeComm and Red Alert solutions to notify environmental services workers about patient discharges. This enables faster response times for cleaning rooms so that beds are ready for the next patient. Bed turnaround times are an important factor in patient throughput, satisfaction, facilitating better decision making, and better overall outcomes.
Winchester Medical Center/Valley Health, a 445-bed non-profit hospital in Winchester, Va., uses MergeComm and AMTELCO’s Web On-Call Scheduling feature to interface with the GetwellNetwork interactive patient care software. Nurses can receive notifications on their pagers about patient pain levels using this combined solution.
A question appears on the patient’s TV about their level of pain, and when they answer, the page is sent to nursing. If the patient doesn’t answer, the nurse receives a page stating that there was no reply.
Winchester also uses MergeComm and Red Alert to send reminders to staff to do stroke education with patients and their family members. They also have a reminder scheduled on a daily basis 15 minutes prior to meal trays arriving to allow staff in other locations to prepare patients for their meals. The hospital also uses the solution to send notifications to Winchester’s Stemi team and Special Procedures Team. At Warren Memorial Hospital, another Valley Health location in Winchester, the system is used to notify the OR team and anesthesiologist when they are needed after hours.
Conclusion
As more healthcare providers rely on electronic health records and mobile communication technologies, there is increased impetus to link these systems in meaningful ways to improve patient outcomes and operational performance. Providing real-time messages and alerts from the full suite of health- care solutions not only improves visibility for doctors, nurses and other staff, it can also streamline activities from bed management to medication administration, improve accuracy, and speed response times.
Advanced middleware that provides this type of notification management can help hospitals reduce the occurrence of adverse events, reduce costs, improve care, and improve efficiency.
About 1Call
The 1Call Division of AMTELCO specializes in offering enterprise-wide communication solutions for healthcare organizations. AMTELCO, 1Call’s parent company, has been a leading provider of innovative communication applications since 1976. AMTELCO has its roots in the early 1950s when its founder, William J. Curtin, invented and patented solutions for his call center. With AMTELCO systems currently in operation in all 50 of the United States, and in more than 20 foreign countries, AMTELCO customers process millions of calls each month. AMTELCO is well-known in various industries for continually developing innovative solutions designed to streamline communications, all backed by AMTELCO’s superior 5-star service and support.
For more information on MergeComm, call (800)225-6035, send an e-mail to info@1call.com, or visit 1call.com.
