SMS: The digital health tool of the century
Halifax Health CIO Tom Stafford doesn’t want nurses or doctors even looking at computers when a patient is in the room.
“Patients want to see them providing comfort and giving them control back,” Stafford said. “If a nurse is across the room typing into a computer, that’s not where they should be.”
That catalyzed a journey to find tools Halifax clinicians can use at the point of care to more effectively and efficiently communicate with other caregivers that ultimately led to deploying SMS.
Secure messaging seems like such a simple, almost everyday technology that it might be easy to overlook its potential.
“The digital health tool of the century is SMS,” said Shahid Shah, a health IT consultant. “We know that digital health tools, at their best, create situational awareness, context-driven messaging and just in time education to work wonders for all kinds of behavior change.”
Indeed, that is proving true for hospitals of all sizes. Halifax Health, which is in Daytona Beach, Florida, is one example and Ringgold County Hospital in Mount Ayr, Iowa, is another.
Doctors pick smartphones over HIPAA
As was the case with Stafford at Halifax Health — and pretty much every hospital in existence — Ringgold’s director of health information systems Carrie Main explained that it needed a way to ensure that employees were sending secure messages.
Ringgold employees, in fact, were tossing around texts that may or may not violate HIPAA and just making that determination was difficult because many of the messages were vague in nature. Those sometimes included pictures, such as wounds or skin rashes, and more.
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“Our fear was that they were using personal devices to take those pictures, maybe backed-up to the cloud,” Main said.
Ringgold also needed a way to confirm whether individuals received text messages or were merely ignoring them.
What emerged from the SMS deployment was a foundation for Ringgold to also incorporate several other modern types of communication.
Stafford eschews the standard nomenclature interoperability and, rather, espouses intraoperability as a way to create systems that improve healthcare.
The need to tie existing data sources together began about 15 years ago as radiology images transitioned from film to digital and hospitals needed a place to store, transmit and view those at the same time that healthcare was bringing in other information systems, such as lab modules and pharmacy.
Add multiple EHRs, HR software, oncology systems, technologies particular to labor and delivery as well as other departments to today’s data infrastructures lineups.
“The problem is there are a lot of different areas,” Stafford said. “We focus on taking data from silos. Every system has golden nuggets so we work with our clinical base to deliver what they need most.”
Whereas Ringgold uses DrFirst’s messaging service in conjunction with Corepoint’s interface engine, Halifax Health opted for Vocera’s texting app for smartphones as well as Corepoint’s engine. Stafford also worked with Wolters Kluwer on alerting for sepsis as well as a startup, CarePulse, for prescriptive alerting about tasks such as cleaning ED beds quickly so that waiting patients can check-in.
“We needed a way to alert clinicians if a patient was possibly septic or not,” Stafford said. “We use Wolters Kluwer engine to take 300 data points out of the EHR, send them to a cloud-based decision tree to predict if someone might get sepsis, then send alerts to Vocera badges.”
Legal and compliance considerations
Hospitals deploying these technologies have to strike a balance between worker productivity, not to mention their human will to use whatever device is both easy and at the ready, when it comes to deploying SMS technologies — and that’s never as simple as leaving it up to the vendor.
“We changed our policy to state that ‘if you are communicating via text at work it has to be through the system,’” Ringgold’s Main said.
Roy Wyman, a partner at the law firm Nelson Mullins Riley & Scarborough advised hospital executives to use both education, as in explaining the security and compliance considerations, and incentives such as money, fear or saving from embarrassment.
Doctors, after all, are still tempted to post curious things, such as an odd foreign object in a patient’s stomach, to Facebook, Twitter or other social networks in ways that could violate HIPAA, Wyman added.
“There’s a lot of push back because it’s easier to use their own devices, it’s the quickest way to get the job done, and education alone doesn’t work,” Wyman said. “If you don’t give them incentive or a lot of fear they’re just going to do it anyway.”
Main also said that Ringgold has phased out almost everything that holds security and compliance concerns. The hospital also conducts annual risk assessments and security analyses to make sure what’s left is up to the task.
Another concern, of course, is alert fatigue. Both Ringgold and Halifax are working on alerting steering committees to make sure they only send what doctors and nurses need, rather than drowning them in too many messages.
Beyond analytics: alerting
By harnessing Vocera APIs Halifax can connect multiple data sources and send patient-specific alerts to clinician badges.
Clinicians can also flip those badges over to receive both voice and text messages and Stafford said that physicians, armed with only the patient’s room number, can pull up a contact list within the app and either speak with or text that patient’s nurse or certified nursing assistant.
“That reduced the workflow of physicians wanting to talk to a nurse about a patient or vice versa,” Stafford added. “It used to be a lengthy, multi-step process.”
Stafford said the whole initiative has to be more than just analytics because even if predictive or prescriptive analytics software uncovers an important health event likely to occur but nobody knows about it, that is essentially worthless.
“We’re focusing on alerting,” Stafford said. “We have to alert as soon as we can because clinicians will not be in front of their computer all day. Their profession is to be next to the patients.”
SMS only a beginning
Having the messaging platform in place, the security posture and policies in place enables hospitals such as Halifax and Ringgold to innovate in ways they otherwise could not.
Ringgold, for its part, is testing apps that send messages to people not always in the office, such as a respiratory therapist, to keep them apprised when orders need to be carried out.
And it has been using functionality that enables sending videos as attachments. When an ambulance goes out to a scene they can relay that video back to the hospital, in fact, so nurses and doctors can prepare for the incoming patient.
“Once you get SMS working a lot of things can happen,” Shah said. He pointed to medication or task reminders, as well as basic two-way communication to confirm an action request or more complex conversational interfaces, appointment scheduling UIs, patient notifications and reminders and obtaining e-consent without documents as examples.
The beauty of SMS, after all, is its simplistic elegance.
“SMS and messaging in general forces solutions designers to simplify products so that they focus on the essentials and focus on behavior change and education content,” Shah said. “When you only have text and images in small bursts, you need to make sure every word counts.”