Patient-centered care teams have been compared with auto racing pit crews, who collaborate in real time amid controlled chaos. In surgical settings, the pit crew analogy makes complete sense, as an expert team of clinicians physically surrounds the patient. But the patient-centered, interdisciplinary teams that work across time and the continuum of care are dispersed across different floors, inpatient and outpatient facilities, and locations. With the imperative that these dispersed teams must work together seamlessly to optimize the quality, safety, speed, outcome and cost of care, a more fitting analogy is a military special operations force, whose members are also dispersed across multiple sites or even countries.
Like special ops forces, clinical teams – physicians, nurses, pharmacists, care coordinators and others – work in an intense, fast-paced environment, ready to respond to changing conditions and sudden crises. They must scan and gather information, apply their unique expertise and keep one another fully informed at all times. To do that, they must continually converse with each other in real time – regardless of each member’s physical location.
So if patient-centered care teams need to perform like special ops teams, then what are the tools they need to continually converse with each other in real time to complete their mission? Are electronic health records the tool of choice? EHRs were designed to capture, organize and stockpile information, not support dispersed virtual care teams. While EHRs have certainly increased clinicians’ ability to document and share histories, results, assessments and orders, they underperform when it comes to finding and connecting clinicians with other team members, insights, and coordinating complex care processes, especially when team members cross organizational boundaries.
Sharing electronic records among clinicians should not be confused with real-time clinician-to-clinician conversations that clarify concerns and expectations. As an IDC study notes, the sheer volume of data captured in electronic records makes it increasingly time consuming for clinicians to sift through those records to find the nuggets that really matter. Clem McDonald, MD, world leader in EHR research, recently remarked that the records and reports within EHRs now have so much information in them, they’ve become "endless and mindless."
An unintended consequence of EHRs is that the additional time they’re taking away from clinicians is coming at the expense of time with patients and care team conversations. A 2013 analysis of the use of EHRs, published in the American Journal of Emergency Medicine, found that the physicians studied spent an average of 43 percent of their time on data entry, but only 28 percent of their time in direct contact with patients. “Doctors now spend so much time on their EHRs, they assume that takes care of communicating,” says Andrew Barbash, MD, chief medical officer, Specialists on Call. “Patients know that the doctors aren’t taking the time to truly collaborate and communicate.”
Nurses are also worried about care teams under-communicating, and they’re not seeing EHRs as the solution. According to a recent report by Black Book Market Research, 94 percent of 13,650 nurses surveyed do not believe that communication between the nurse and the rest of the care team has improved with the implementation of their organization’s inpatient EHR system. In fact, a nurse colleague in charge of a local 300-bed hospital EHR implementation even told me that they’re trying to perfect everything in their EHR so they rarely, if ever, need to talk to each other.
While EHRs may be leaving less time for clinician-to-clinician conversations, doing away with them isn’t the solution. And, despite the benefits of forcing EHR interoperability, the bigger problem that needs solving isn’t that EHRs don't talk to each other as much as it is care teams are under-equipped to talk to each other. According to an IDC report, the financial services, retail and manufacturing industries, which, compared to healthcare, require far less team collaboration, invest almost four times what health care organizations invest in unified communications and collaboration software. The solution to help clinicians truly communicate in real time to reduce delays, missed handoffs and errors lies in equipping them with the same technology that’s broadly used today in those other industries: unified communications.
Unified communications brings together contacts, voice, voicemail, email, instant messaging, presence awareness (the ability to see which colleagues are available), and conferencing in one place. In addition, it can be easily integrated with EHR systems for communication-enabled complex care processes. Care teams can determine the best way to converse within seconds and see who is in a meeting and who’s available to talk, allowing for constant, secured contact with teammates through phones, tablets or laptops as they move from a clinic to a hospital, or even at home.
Unified communications available from any device could help a nurse more quickly call or instant message a physician for approval to discharge a patient, adjust the dose of a medication, or hold a private conversation with a patient from anywhere in the hospital or clinic. Care team members could participate virtually in care team meetings from any location — and quite possibly, most care team meetings would start on time. A pharmacist could answer questions about medications or dosages over instant messaging and dictate a message back using speech to text. Most important, clinicians could choose the communication channel that’s most appropriate in the moment, and confirm that their colleague or patient hears and understands what they need to know and do.
All of these capabilities stand to substantially improve the quality, safety, speed and cost of care by allowing more precise conversations, reducing delays, and leaving patients with the reassurance that their care team is on the same page. Health systems that are able to integrate unified communications with their EHR before their competitors do will be better positioned to transform what are now teams of autonomous experts into expert teams fully equipped to complete their common patient-centered mission.