Vertical Industry Communications: Inpatient Health CareVertical Industry Communications: Inpatient Health Care

In this, the sixth in our series on vertical industry communications, we review communications technology requirements and applications in inpatient health care. As has been the case throughout the series, this post uses the term “unified communications,” or UC, to describe the evolution of communications technologies, though we see the term morphing into “business communications,” or BC.

For earlier articles in the series, see:

Inpatient Health Care Highlights

Inpatient health care is an important industry sector in all societies, since the services are critical to those who need them and since the costs of health care are significant -- for patients, the insurers, and governments. Inpatient health care, exclusive of the physicians who refer the patients and participate or oversee the treatment plan, employs five million in the U.S., representing about 3.5% of total non-farm employment, according to 2018 U.S. Bureau of Labor Statistics data. If all physicians were included, the total would rise to 7.5 million, representing 5% of non-farm employment in the U.S.

All health care, and especially inpatient health care, is a disciplined industry. The industry must follow specific guidelines for everything related to patient care, due to the importance of the outcomes for the patients as well as for various regulatory and reimbursement requirements. In most cases, these guidelines are only changed when improvements have been tested through research and clinical trials. Thus, changes in communications technologies for inpatient care also require rigorous planning and testing.

Please note that the communications perspective of this post is a view into the future, rather than the past. In other words, this is an aspirational view. Some hospitals are already well along the transformation suggested in this post; others are hindered by issues such as culture, risk aversion, labor union rules, or other barriers. However, the benefits of UC integration into the workflows are real. Some healthcare organizations will embrace them now; others may not move quickly but will find that UC functionality makes its way into their operations as part of the inpatient care software applications from companies such as Cerner, Epic, and others.

Inpatient Healthcare Value Chain Processes and Roles

Inpatient processes fall into three broad groups or cycles, each of which is communications-intensive in distinct ways.

Admit, Discharge, Transfer (ADT) and Reimbursement Cycle

The key attribute of this process group is the number of approvals required for completion. While ADT is not directly involved in care delivery, delays in these processes can impact how quickly a patient receives care; result in extended patient stays and risks; stymie patient throughput, which is the cycling of patients through a hospital's physical resource base; and increase costs. In the past, much of this type of communications was conducted via telephone calls, paper documents, and face‐to‐face interactions. Processes in this cycle include:

With UC, often in combination with electronic ADT or electronic heath records (EHR) systems, these communications can be automated and facilitated with application software. Instead of on paper and in person, almost all communications can be conducted by posting to the patient-related records in the ADT or EHR systems. In addition, automated text-based processes (bots) are or can be integrated into the ADT or EHR systems.

These processes are represented by the Information Processing or Production Usage Profiles.

UC benefits in these processes are primarily the reduction of delays in patient throughput. This in turn can shorten patient stay, lowering costs, and may allow for increased occupancy rates, thereby increasing facility revenues or reimbursements. Benefits may also include improved admissions flow, especially from the emergency department. This helps reduce backlogs.

Treatment Management Cycle

The key attributes of this process group are the giving of orders that define the treatment management plan, delivering the care elements, monitoring and charting patient progress with consultation as needed, adjusting the treatment plan when indicated, implementing a transfer or discharge decision, and tracking quality assurance. The services provided by ancillary departments such as laboratory, radiology, pharmacy, transportation, and housekeeping are considered part of the treatment plan. Orders are placed through the EHR, often integrated to specialized subsystems in the ancillary departments, and results, including images such as X-rays, MRIs, and ECGs, get posted through the subsystems and the EHR.

Patient monitoring has progressed significantly in recent years, thanks to advanced instrumentation, wireless communications, and video monitoring. While nurse call systems are still in use, the trend is to a specialized, central monitoring location for each floor or ward. Care providers can be dispatched from this monitoring location via wireless devices.

Clearly, this is communications-intensive, but much of the communication is now occurring through electronic monitoring and via recording and charting in the EHR. Thus, many health care organizations already have eliminated legacy communications delays or difficulties. For example, attending physicians receive up-to-date results via the EHR rather than needing to make telephone calls for information. Processes in this cycle include:

However, many communications are still required, especially at shift transfers of responsibility (or handoffs) and when treatment plans need adjustment. UC is already assisting many hospitals in this area.

We see the use of mobile devices -- especially computers on wheels and nursing station computers to locate the exact resource for the needed communication based on the physician on‐call and in-service assignments, other nursing assignments, and ancillary staff availability. Once the software finds the right resource, the communications can proceed using the best method.

Increasingly, care providers are using asynchronous text (instant messaging or cellular SMS texting) rather than phone calls. Efficient and accurate asynchronous communications can be a major improvement to the care process, allowing providers to avoid the interruptions of synchronous or real‐time communications while also providing an activity log for cross‐team or cross‐shift reference. When two or more team members need to speak by phone, the software can find those professionals at the most convenient location or number, thus saving significant professional time and accelerating the care process.

Note that a real-time call is the exception, not the primary tool. Consultations are best conducted with ad hoc or scheduled online meetings than with phone calls. Also, note that these communications are best when initiated from within the EHR software, rather than from an IP-PBX soft client.

Again, these processes are represented by the Production Usage Profile. Some UC vendors claim that the treatment plan processes are collaborative, and there certainly is some collaborative work done in a consultation between care providers. However, the necessary safety-oriented, disciplined, and procedural nature of patient care is much more of a production process and uses production-like methodologies.

UC benefits in these processes are primarily a reduction in the effort required to deliver the treatment plans; care providers spend less time in repetitive or redundant communications tasks and can often accelerate tasks such as shift handoffs. The results can be more time for patient attention and, in some cases, a reduction in the levels of shift overtime. Also, since communication events can be logged automatically, regulatory compliance is enhanced.

Exception Management Cycle

Beyond the structured events of ADT and treatment management, unplanned events or exceptions drive much communications in inpatient care. Examples include out‐of‐tolerance patient indicators, code calls for stat response teams, other types of alerts, and patient requests. To date, health care organizations have addressed these effectively using audible alarms, overhead paging, hallway lights, and electronic paging. However, these methods have several challenges. First, the exception notification doesn’t always reach the best, correct, or most proximate staff. And secondly, many of these tools aren’t two‐way solutions, so a timely response may not be assured and repetitive calling or alerting may be needed.

UC is significantly improving these processes with the application of software, presence indications, and mobile devices. With UC, care givers can find the best resource immediately and send a secondary notification to that resource. And mobile devices allow for two‐way communication to confirm timely responses or to start an escalation if the requested care team member cannot respond or declines the request.

When a care provider needs additional assistance or consultation, the UC tools already mentioned for ADT and treatment management are available to find and communicate with those team members. Note that the current primary notification tools -- audible and visual alerts -- can remain in place for regulatory compliance, but UC will enhance the ability of the care providers to respond most appropriately.

These processes are represented by the Production Usage Profile, reflecting the necessary procedural nature of the processes, for quality, safety, and regulatory compliance.

UC benefits in these areas are primarily an improvement in patient care both through reduced response times to alerts and exceptions and through faster access to supportive or consultative resources. Some reduction in errors is also a likely outcome from these UC improvements. Also, since communication events can be logged automatically, regulatory compliance is enhanced.

Summary

In summary, inpatient care is being significantly improved with UC tools. These improvements are available immediately and are even more effective for those hospitals that are advanced on the EHR adoption scale, since UC solutions can take advantage of EHR information. For example, current care provider assignments for each patient are available in the EHR to support all three of the process groups defined above.

Important to note is that communications for inpatient health care must be seen and understood as being unified with the processes and with the application software (ADT, EHR, and ancillary systems) rather than being a unification of all types of communications tools. Exceptional communications for inpatient health care will be provided through communications platform as a service, or CPaaS, rather than through UCaaS.

BCStrategies is an industry resource for enterprises, vendors, system integrators, and anyone interested in the growing business communications arena. A supplier of objective information on business communications, BCStrategies is supported by an alliance of leading communication industry advisors, analysts, and consultants who have worked in the various segments of the dynamic business communications market.