Boston Children’s Hospital was facing several problems that it had hoped it could solve with some new clinical tools.
The top problem was that its communications channels were not integrated into the larger healthcare ecosystem. Finding who was responsible for a given patient or a given role was in one system while finding out the phone number for that person or a role was in another system (or on cheat-sheets tacked up in workrooms or other places not available to everyone).
The inability to efficiently find the right person at the right moment led 411-bed Boston Children’s to look for a better and more integrated solution.
On another front, from a nursing perspective, the integrated health record at Boston Children’s allows for a comprehensive view of patient care. However, this view was limited to desktop workstations and portable workstations on wheels.
“If there was an issue with the mobile workstation, it presented a potential risk for accessing the patient EHR and utilizing our built-in, point-of-care safeguards, such as bar code medication administration,” said Lynnetta Akins, RN-BC, director of clinical education and informatics. “Boston Children’s wanted a mobile solution to incorporate a comprehensive view to deliver patient care while leveraging point-of-care functionality.”
The same issue applied to nursing and communication. Knowing who to contact and what number was a challenge, she added.
"Now, instead of knowing who the charge nurse is or what that role’s phone number is, I can look into the directory, search for the role, know who claimed the role at that moment, and securely text or call that person."
Lynnetta Akins, Boston Children’s Hospital
“Nursing would have to look in several places to communicate to the whole care team, decreasing the time nurses were spending at the bedside,” she said.
Boston Children’s Hospital worked together with its EHR vendor Cerner to facilitate and coordinate care team communications. The hospital implemented CareAware Connect (CAC) and Connect Nursing, using Cerner’s newest cloud-deployment model.
“The proposal from CAC and Connect Nursing was to effectively integrate and mobilize our care team to allow for more efficient and integrated secure communications,” said Dr. Jonathan Bickel, senior director of BCH clinical health record, business intelligence, health information management and the Boston Children’s Medical Library and Archives at Boston Children’s Hospital.
“The CAC platform provided the interoperability solution to quickly communicate across our continuity of care,” he said.
The nursing application allowed for greater mobility and streamlined workflow efficiencies for the clinical workforce while continuing to support safe care for patients, he added.
There are many vendors with electronic health records systems on the health IT market today, including Allscripts, athenahealth, Cerner, DrChrono, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.
MEETING THE CHALLENGE
CAC solves the challenges by allowing team members to claim roles that allow for efficient communication with the right person, Akins explained.
“Now, instead of knowing who the charge nurse is or what that role’s phone number is, I can look into the directory, search for the role, know who claimed the role at that moment, and securely text or call that person,” she said. “Putting the CAC devices in nurses’ hands allows for greater mobility while quickly communicating among the care team.”
"Enabling Bluetooth for people who use personal protective equipment has been an ideal side benefit, because you can use the device without having to touch anything."
Dr. Jonathan Bickel, Boston Children’s Hospital
With Connect Nursing, staff was able to empower nurses with increased accessibility for clinical workflow, she added.
“The mobility and flexibility to deliver patient care with tools in the palm of their hands,” she noted. “Our nurses were able to dedicate more time spent at the patient bedside to providing safe and high-quality care. Connect Nursing brought greater mobility and flexibility to the bar code medication administration process, inclusive of positive patient identification.”
For the pediatric population, staff had the flexibility for scanning to change the event sequence to support pediatrics medication preparation.
“The Connect Nursing platform supports point-of-care alerts functionality,” she said. “Nurses have stated that having a mobile workflow that doesn’t require the use of a workstation on wheels to support safe and highly reliable medication administration has been a real win for safety, workflow and satisfaction.”
“The results speak for themselves,” Bickel said. “With our prior secure texting platform, we had hundreds of users sending a few thousand texts a month. With our integrated CAC platform, we have about 300,000 messages sent a month across 3,580 providers. We are seeing 200,000 calls a month. This far exceeded our expectations, and highlights how much communication is needed to care for our complex pediatric population.”
Additionally, Connect Nursing brought greater mobility and flexibility to the bar code medication administration process, Akins said.
“Two of the largest patient care areas – emergency department and post-surgical unit – are using it for most of their medication administration events,” she reported. “Nurses in those patient care areas say a mobile workflow that doesn’t require the use of a workstation on wheels supports safe and highly reliable medication administration.”
In the fight against COVID-19, there are more capabilities for Boston Children’s staff to potentially use.
“With Bluetooth, we can start to think about performing contact tracing using devices to record interactions with other personnel and their devices on a given floor,” Bickel observed. “Enabling Bluetooth for people who use personal protective equipment has been an ideal side benefit, because you can use the device without having to touch anything. This implemented platform has been serendipitous and quite useful.”
ADVICE FOR OTHERS
“When considering a vendor, one needs to consider how tightly integrated the vendor’s collaboration is with your care team,” Bickel advised. “Do you have a single source of truth of who, at any moment, is part of a given care team? Can that platform take the care team information and utilize this to facilitate communication? Does the texting platform support all the functionality needed?”