Piedmont Healthcare, a Georgia health system with 11 hospitals, nearly 100 physician practices and 2 million patients, had a caregiver communication problem.
Piedmont’s original clinical communication goal was to consolidate after-hours answering services across its rapidly expanding employed physician base to reduce the overall cost of those services.
Each time the health system adds a new practice to its network, it assumes responsibility for another set of purchased services agreements – including after-hours answering services.
Piedmont analyzed after-hours data and discovered significant differences in base service rates – per minute cost, flat-fee per month, etc. – and significant variable costs that fluctuated with call volume.
The goal for 2018 was to consolidate and standardize after-hours answering services across nearly all 100 physician practice locations and 555 physicians by implementing a standardized care team communication platform from PerfectServe, a vendor of clinical communication and collaboration technology.
It would roll out the platform in phases across the practices to optimize workflows and ensure the project’s success. It would unite all physicians on a single platform while improving clinical response time, ensuring HIPAA-compliant communications, and achieving substantial cost savings by converting a variable expense to a lower, fixed cost, Piedmont said.
While the original impetus for the project was simply cost-cutting through purchased services consolidation, Piedmont quickly realized that larger issues needed to be addressed, including:
- Eliminating manual steps in identifying on-call providers, which were extremely confusing, inconsistent and often led to erroneous contact.
- Improving physician satisfaction and response time by expediting the delivery of messages and making it easy for providers to act upon the information.
- Addressing patient frustration with the after-hours call management process and service.
- Ensuring consistent, secure management of PHI in all communications.
- Scaling after-hours service to grow and expand with the organization’s growth.
“We took a step back to analyze three important concepts,” said Ryan Bowcut, executive director of operations at Piedmont Healthcare.
“One, the complexities of our current communication processes – after-hours services, call schedule management, sophisticated rules,” he said. “Two, the fragmented technologies in place today – pagers, VoIP devices, smartphones, secure texting, alerts and notifications; and three, our needs for the future – our growth plans, the need to communicate across settings of care, patient and family engagement.”
As the health system progressed through the process, it began to understand how it could tie all of these needs together into a broader clinical communication and collaboration roadmap, improving the technology infrastructure to enhance the service.
There are many clinical communication and collaboration technology vendors on the market today, such as Avaya, CareTeam, Doc Halo, Imprivata, Lua, Mobile Heartbeat, Spok and TigerConnect.
MEETING THE CHALLENGE
At Piedmont, the PerfectServe technology is used by anyone that needs to initiate a communication event with another caregiver. There are several ways to reach the appropriate caregiver.
First, they simply call the office number and follow voice prompts to speak the name of the provider who they are trying to reach and the urgency of the request. The smartphone application uses what it dubs Dynamic Intelligent Routing to identify the appropriate on-call provider that can act on the information at that moment, and automatically routes the information based upon the receiving provider’s personal preferences (such as text or voice call, or routing to a cell phone or office). Urgent messages are delivered immediately; routine messages are held until the morning.
If the provider returns the call from within the smartphone application, their cell number is kept private by displaying the office number. Patients can also use this method to relay messages to providers after hours.
Second, the initiator also can open the PerfectServe web browser or smartphone application, select the patient and/or enter the name of the provider or service they need to reach, and if appropriate, the urgency of the request. The application uses the dynamic routing to identify the appropriate on-call provider that can act on the information at that moment, and automatically routes the information based upon the receiving provider’s personal preferences.
The system considers the current location of the patient, time of day, day of week, urgency of the request, the role of the initiator, and others to expedite the delivery of information to the right provider.
Third, physicians also can communicate with one another by selecting colleagues from a provider directory and initiating a secure voice or text exchange.
The provider answers the voice call (or retrieves a voice message), or opens the secure text message to view the patient details and the request/question. The provider either responds to the message via secure text, or calls the initiator directly from the message. The dynamic routing automatically connects the provider to the initiator’s mobile device, or if the communication was initiated from a desktop PC, to the unit from which the message originated; the text message includes the name of the clinician that initiated the request.
“Physicians appreciate the ability to manually change their call coverage schedule or status – for example, in surgery – from within the application,” Bowcut said. “These dynamic schedule changes are incorporated in real time, ensuring that calls and messages are routed and escalated to a clinician that can address the situation immediately.”
Piedmont Pulmonary and Sleep Medicine, for example, has about 45 physicians live on the communication and collaboration platform. The physicians previously had been receiving calls on their cell phones throughout the day, with a mix of urgent and non-urgent matters.
“Our providers were very frustrated with non-urgent interruptions, particularly when they came amidst a patient visit, a procedure or at night; providers had no ability to identify the urgency of the request before answering the call,” Bowcut explained.
The implementation process was an important key to success, according to Bowcut. The team merged best practices with the clinic’s workflows and schedules while incorporating knowledge of how the hospital staff interacted with providers.
As a result, Piedmont Pulmonary and Sleep Medicine staff and Piedmont nurses have experienced a significant improvement in their daily workflow, he said. Nurses automatically are connected with the right person; they no longer spend energy trying to identify the proper on-call provider, nor worry about calling the wrong provider in the middle of the night, he explained.
The system automatically includes important information in the message, which reduces the burden on the nurse and optimizes communication safety, he added. For example, call-back information is determined based on the patient location (when a LAN line or desktop is used) or the mobile device.
Messages are encrypted and include the patient name, medical record number, room number, nurse’s name and any clinical detail desired; unlimited character texts ensure that the provider has the appropriate information upon which to make a clinical decision, he explained.
ADVICE FOR OTHERS
“We have only begun to tap the potential of this technology, and we’re in the initial planning phase of our next step,” Bowcut said. “There are a multitude of communication-related opportunities, and we’ve only begun to improve the efficiencies of our communication processes – after-hours services, call schedule management, sophisticated rules.”