Anyone who has stayed at a hospital can relate to this common experience. It’s 7 a.m. on the fourth day of your hospital admission, and you hear the word you’ve been waiting for: “discharge.” The intern comes and relays that you are ready to go home. However, later in the day, you’re seen by a different doctor who wants to run one more test. But mysteriously, that test never happens, so you get discharged and go home.
It turns out that there was a miscommunication between the team and you should have had that test because it would have caught the GI bleed that ultimately lands you back in a hospital bed.
How do these things happen?
Sometimes the accidents are minor — two people giving you different answers to the same question. But sometimes they are major, like the example I gave. We’ve made incredible strides forward with technology in our industry. Manual processes that existed two decades ago have nearly been eliminated. From many perspectives, incentives that encouraged the implementation of electronic health records across the country worked. But there are still gaps.
If you watch a medical team doing rounds, even in the most sophisticated of setups with the latest “workstation on wheels” and an expensive EHR, the team still carries around little scraps of paper. Every hospital administrator and IT professional in the country wants to eliminate the use of paper, but they haven’t.
Is this just clinicians being obstreperous and not following protocol? No, it isn’t. It turns out that we — those in healthcare — are missing a tool that is fundamental to all other industries. It’s called a project management tool, and it is something that Gartner has highlighted as an opportunity to create a “real-time health system” with a better grip on situational awareness.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Currently, there is no space in any EHR for real-time thoughts or future plans about a patient as they evolve minute to minute. So this information is typically written down or texted to someone before it is acted upon. And all thoughts like this are either scribbled on paper or shared informally with colleagues. When this happens, these thoughts are siloed and static. The entire team can’t see them, comment on them, correct them when they are wrong or add to them when they are incomplete.
Even as I write this, I can hear the howls of indignation. Of course there’s a place to write this information — it’s called a progress note. This is updated every 24 hours. The scribbles on paper, emails, sticky notes, texts and other informal communications are fluid. The progress note is not interactive and is owned by one person. It’s locked as part of the legal record. Point being, it doesn’t help care coordination and it certainly isn’t a project management tool.
Communication failures contribute to more than 70% of all clinical errors, according to the Joint Commission. When we had manual systems, we had manual handoffs, printed lists and other tools to make sure everything was communicated.
Now we live in a digital world and rounding lists — the gold standard of all EHRs — will not help us solve our communication problems. To overcome these issues, we’ve resorted to a patchwork of workarounds in the form of digital communication tools, such as text, email and alerts. These have become so prevalent that pretty much everyone is now suffering from alert fatigue. Imagine trying to have a conversation with your doctor about a new diagnosis while her phone is constantly dinging from urgent messages and calls.
I’ve spent the last 15 years living, breathing, dreaming and thinking about how to fix this problem. That includes iterating through multiple efforts to find a solution, many of which ended up on the scrap heap. When I started, the goal was to eliminate paper from our hospital system. But as often happens when you pull at a thread, you find there’s a lot more attached than just one single fiber.
What’s become clear to me is that we are missing a system to collaborate. We have conversations, we take notes, we send texts, but we don’t do it in one holistic system. There is nowhere for me to see what my peers are thinking, and much of our collaboration today requires synchronous communication. It is essential that when I’m ready to think about a patient and you are not, I can still “see” your thoughts.
As Dr. Vivian Lee lays out in her book ‘The Long Fix,” this is not something that will change overnight. That is why we must get started now. Every incremental step is an investment in that future “fix.”
It’s going to take partners from various disciplines to shift mindsets and enact the necessary changes across the healthcare ecosystem. But it’s a cause worth fighting for to reduce preventable mistakes and improve patient care.
Photo credit: ipopba, Getty Images
