Being patient-centered and providing care in teams is supposed to address all the fragmentation in healthcare, but it’s hard to implement such plans when processes and technology are as fragmented as the care itself, a Brigham & Women’s Hospital physician explained Monday at the American Medical Informatics Association annual symposium.
“Care team communication in acute care settings is fragmented, inefficient, and difficult,” according to a paper presented by Dr. Anuj Dalal, a hospitalist at the Harvard-affiliated Boston institution. Clinicians have had to communicate over multiple platforms, including e-mail, text messaging — neither of which is secure by HIPAA standards — and even that 1980s technology known as alphanumeric paging.
“We spend far too much time tracking down key inpatient providers,” Dalal said at AMIA, now underway at a San Francisco hotel.
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Seeking to streamline communications and make team care more compatible with clinician workflow, Dalal and colleagues at the Brigham designed a “microblog” platform to support care continuity in acute care at the hospital. “Why microblogs?” Dalal asked. “They have a lot of appeal for getting everyone on the same page.”
The Brigham piloted the microblog platform in six critical care, oncology and general medicine areas. “We integrated this tightly into workflow,” Dalal said. “It was always only one click away.”
Specifically, the hospital partnered with messaging vendor Care Thread and integrated the technology into the patient portal and the electronic health record while BWH was transitioning to an Epic Systems EHR from a home-grown system. There were separate discussion threads for patients and providers, Dalal explained.
Over a two-month study period, recipients viewed 74 percent of the 11,277 message notifications sent. While they left more than a quarter of messages unread, Dalal was pleased.
The places where it was used the most was where there was an engaged champion,” he explained, suggesting that other wards need champions. Dalal also reported that patients thought the microblog format was “ideal” because all the relevant information was in one place and the system solved the problem of keeping new shifts up to date on each patient’s condition.
“Overall, core functionality was favorably received and actual clinical use matched intended use-cases. Concerns regarding alert fatigue were present but reflected variable understanding of functionality that was incorporated to minimize excessive notification,” the paper said.
Dalal was optimistic because the technology faced many barriers the way it was implemented, including competing messaging systems and difficulty translating assignments for each member of the care team from hospital scheduling systems. “I don’t think these barriers are insurmountable,” he said.
Photo: Flickr user elyce feliz
