Abstract
An ability to rapidly convert data from multiple different sources into actionable information is embodied in a concept called Real-time Health Systems (RTHS). The foundational component of RTHS is a modern Clinical Communication and Collaboration (CC&C) Platform, which translates organizational knowledge into action. Effective communication is the key. A CC&C Platform that can receive data from multiple hospital systems, analyze the data, arbitrate any resulting actions and determine the relative priorities to distribute work to the right person or teams–can lead to improved operational efficiencies and better patient outcomes.
Introduction
The stress of the pandemic and the accompanying patient surges have demonstrated that the ability to rapidly respond to areas of operational and clinical friction characterizes those hospitals that successfully navigate crises. An ability to rapidly convert data from multiple different sources into actionable information is a key determinant of success, which is embodied in a concept called Real-time Health Systems (RTHS), organizations that leverage their digital infrastructure to dynamically improve efficiency and outcomes.
The foundational component of RTHS, without which quick responses are not possible, is a modern Clinical Communication and Collaboration (CC&C) Platform. A CC&C Platform translates organizational knowledge into action. Effective communication is the key (See Figure 1).
Discussion
The majority of problems that arise during patient care are event-driven and time-dependent; an event has taken place of sufficient operational or clinical consequence that it requires notification of one or more people. Time to recognition and subsequently to intervention has a major impact not just on patient outcomes, but on hospital operations as well. This concept is true for sepsis, stroke, heart attacks, and many other critical diagnoses.
Without a modern CC&C Platform, connections become subject to human frailties, introducing the potential for communication delays and failure. And when knowledge sharing is delayed, the consequences can be profound for both the patient and the organization. For example, the length of time taken to rescue patients with unexpected clinical deterioration has been correlated with poorer outcomes, including excess days in the ICU, increased mortality rates, and additional costs. In the midst of a pandemic, these inefficiencies are magnified; an overconsumption of beds and resources limits a hospital’s ability to optimize throughput. Shortening the time to treatment significantly improves outcomes and operations.
Effective communication is essential
Why the importance of a communications platform? It’s actually rather simple: knowledge can’t be put into action if there is no awareness that it exists. Communication links knowledge to action. Real-time Health Systems leverage their digital infrastructure, sharing knowledge using modern communication systems to shorten the time it takes them to act.
From a very practical vantage point, most communication systems implemented in hospitals today have an ability to message someone–to send alarms about the status of the patient or the monitoring system itself.
Unfortunately, these systems are often siloed with a resultant lack of coordinated messaging or the absence of contextual patient information. Incessant notifications from multiple systems can create problems for the nurse, whose day depends upon an ability to successfully triage work. The sheer volume of interruptions can easily create cognitive overload. While these messages are sent to the nurse with the best of intentions of getting information to those empowered to act as swiftly as possible, they are nevertheless disruptive and distracting from direct patient care duties.
Nurses have a finite bandwidth and there is simply too much information constantly being churned through hospital systems to expect staff to successfully cope with the flood of data. The situation can become very chaotic very quickly, an unintended adverse consequence of digital technology.
The solution is a CC&C Platform that can receive data from multiple hospital systems, analyze the data, and arbitrate any resulting actions–determine the relative priorities and distribute work to the right person or teams. An analogy to air traffic controllers is one that is commonly used: RTHS require a solution that can make sense out of chaos and ensure that data is converted into information and distributed quickly and easily into the hands of the people responsible for acting.
Interoperability breaks down silos
How does effective communication minimize the chaos? At the most basic level, a CC&C Platform is made up of three elements: inputs, a processing layer, and outputs.
On the left of the image, you can see various hospital systems as well as staff members providing inputs. To give you some perspective, the Vocera Platform integrates with more than 150 clinical and operational systems used in hospitals. It has adapters for these clinical and operational systems, which serve as input to the main platform’s processing layer where the important actions take place. Clinical Communication and Collaboration (CC&C) Platform.
The processing layer aggregates data streaming in from the various systems. Silos are broken down so data from independent sources can be merged and processed together, and by using a system of rules, converted into information which may or may not require action.
If a rule determines that information needs to be transmitted (as examples: a critical lab. result, a room cleaning delay, or a sepsis alert) the system acts by routing it to the right person or team based upon role, responsibility, and availability. The same platform constructs an audit trail and provides the analytics and reporting services.
Given data feeds from care team assignment systems as well as integrations with the Electronic Health Record (EHR) and scheduling systems, Vocera is able to create and display a real-time care team, tracking who’s currently working, what roles they’ve got, which patients they’re caring for, and their presence status: are they currently available or not? Maintenance of this real-time care team is crucial to our ability to deliver the right information to the right people and to reducing interruption fatigue.
Finally, on the right side are outputs. Modern communication platforms should be able to message one or more people, one or more ways, with manual and automated escalations built in. If a nurse is unable or unwilling to respond, messages should be automatically rerouted until delivery takes place if efficiency is to be maximized.
Platforms must support device of choice
Importantly, a CC&C Platform should be agnostic as to the mix of communication devices staff use to accomplish their jobs. Each role in a hospital has uniquely associated workflows, so each role will have a device which best enables communication to take place. Neither the EHR nor the communication platform should constrain a hospital’s ability to provide their staff with the best tools to accomplish their jobs.
When you limit access to optimal communication devices, you limit how ‘smart’ your hospital can get. In some circumstances staff members may be best served by smartphones, in others by hands-free communication devices, while others may rely on a desktop console. There is no single device which serves all staff members equally well, a reality we’re keenly aware of. Vocera supplies solutions for all of the above, providing hands-free communication badges, a smartphone app which runs equally well on both iOS and Android devices, as well as a desk-top solution.
The Vina smartphone application provides users with complete access to all of the functionality of the Vocera Platform: secure chat, voice calls, video conferencing, a uniquely prioritized inbox, access to on-call schedules and more, all enhanced by a voice-driven user interface. This solution was developed in partnership with our physician and nursing community–truly an experience that was designed by clinicians for clinicians. The Vocera Badge and Smartbadge.
In addition to enhancing smartphone usability in healthcare, we have been making hands-free voice-driven communication equipment for more than 20 years (See Figure 2). Staff members do not need to know phone numbers or remember who is on call when they use Vocera solutions. Instead, they can reach colleagues with simple voice commands. They can reach the right person or team by name, by role, or by group as examples.
The hands-free, voice controlled Vocera Badge is used by nurses, physicians, and many other care team members to communicate and collaborate. It is small, lightweight, and worn either on a lanyard or clipped to a shirt or jacket.
The newer Vocera Smartbadge was named to TIME’s list of the 100 Best Inventions of 2020. The wearable Smartbadge has a larger touchscreen making it a better fit for text-messaging users. It has all of the functionality of the Vocera Badge as well as the ability to be awakened using a smart phrase such as ‘OK Vocera’, after which it will respond to voice commands. Both devices are designed to ease the work for clinicians, especially when they need their hands-free to provide direct patient care.
Importantly because these can be worn and used underneath personal protective equipment, they’ve become critical technology for patient care in isolation environments and while caring for COVID patients.
And finally, both badge types offer a built-in duress feature or a dedicated panic-button that can be custom mapped to safety or security personnel appropriate for their location. Once triggered, the recipients of the panic call can hear everything going on around the person who triggered the call and can locate the badge-wearer based upon the wireless access points they are connected to.
Conclusion
Real-time health systems can improve safety
In conclusion, a Real-time Health System shortens the time to act by efficiently recognizing and sharing new clinical and operational information and leveraging digital technologies and a modern communication platform. By shortening the time to respond and delivering contextual information at the point of care, hospital operations are streamlined, cognitive load among clinicians is minimized, and patient care and safety is improved.
An optimal CC&C Platform is capable of integrating with multiple different hospital systems, processing data and intelligently distributing information to those who are responsible for taking action independent of the communication devices in use.
This process is what makes the promise of interoperability a reality. This process is what makes hospitals more efficient and improves patient outcomes while simultaneously reducing the communication burden on physicians and nurses.
About the author
Benjamin Kanter, MD, FCCP, is the Chief Medical Information Officer at Vocera, where he works closely with clinicians and engineers to co-design the next generation of real-time communication and collaboration solutions for hospitals and health systems. Prior to joining Vocera, Dr. Kanter worked as an industry consultant and thought leader with several innovative healthcare IT companies. Dr. Kanter earned his medical degree and completed internal medicine training at Northwestern University. He completed post-doctoral studies in both pulmonary disease and critical care medicine at the U.C.S.D. Medical Center in California. Dr. Kanter is board certified in internal medicine, pulmonary disease and medical informatics.
About Vocera
The mission of Vocera Communications Inc. is to simplify and improve the lives of healthcare professionals, patients, and families. Founded in 2000, Vocera provides solutions that help protect and connect team members, simplify workflows, increase efficiency, enhance the quality of care and safety, and humanize the healthcare experience. More than 2,300 facilities worldwide, including nearly 1,900 hospitals and healthcare facilities, have selected Vocera solutions to enable their workforce to communicate and collaborate with co-workers and engage with patients and families. Mobile workers can choose the right device for their role or task, including smartphones or one of the company's wearable communication devices, and use voice commands to easily reach people by name, role, or group. The hands-free Vocera Smartbadge was named to TIME’s list of the 100 Best Inventions of 2020. The Vocera Platform can integrate with more than 150 clinical and operational systems, including electronic health records, nurse call systems, ventilators, physiological monitors, and others. In addition to healthcare, Vocera solutions are found in aged care facilities, schools, luxury hotels, retail stores, power facilities, libraries, and more. Visit www.vocera.com to learn more and follow @VoceraComm on Twitter.