In 2014, Gartner Research defined the concept of the Real-Time Health System (RTHS) as a healthcare organization that uses information and communication to accelerate change in business processes, eliminate waste and latency, and better balance resources and demand. In Gartner’s view, a RTHS derives its operational intelligence from situational awareness and real-time knowledge of patient context to determine the need for intervention.
Over the past two decades, hospitals have spent billions of dollars digitizing their operations. Yet, digital is not synonymous with “smart.” For a hospital to be smart it must be able to transform its data into real-time information, and by acting on it, gain knowledge while improving operational and clinical care. The most important component of a RTHS is a Clinical Communications and Collaboration (CC&C) platform. A CC&C solution integrates data from multiple systems, processes it, and provides actionable information to care team members that allow them to connect, communicate and collaborate on their device of choice inside and outside a healthcare facility. A true CC&C solution is more than just traditional transactional middleware with the ability to send messages. A modern CC&C platform integrates data flowing through disparate hospital systems and is an active participant in turning that data into contextually-relevant information. By doing so, information is made available to staff members at the time data is being generated.
Coordination in real-time
Care teams across a hospital or health system require a CC&C platform that is able to continuously integrate data from multiple systems, transform it using rules and logic, and communicate actionable information. The traditional approach of post facto data-analysis is insufficient for supporting the dynamic nature of hospital operations; acting on analytics based upon historical data is by definition not acting in real-time. As an example, while knowing that patients have historically been harmed by preventable falls is indeed important, but only by exploiting information in real-time can future falls be prevented. In this example, a CC&C platform – knowing which patient is in which bed via an admission, discharge, and transfer (ADT) system feed from the electronic health record (EHR) – is able to pair a patient’s out-of-bed alarm with their fall risk score as documented in the EHR. Using an appropriate rule, the CC&C platform transforms a generic out-of-bed alarm into something that has much more clinical meaning and effectiveness. If the patient has at low fall risk score, the system can generate a low priority alarm that goes directly to the patient’s nurse, making her aware of the situation. If, however the patient is believed to be at high fall risk, the same out-of-bed alarm can now trigger a disruptive high-priority alarm which can be routed to an entire team of nurses – offering maximum protection for the at-risk patient.
Decrease alarm fatigue
Real-time situational awareness can decrease interruption or alarm fatigue. Interruptions from systems, mobile devices and people take a toll on clinician well-being and resilience and may interfere with the delivery of safe patient care. In contrast to traditional middleware, an intelligent CC&C platform is designed to factor in the clinical context of an alert or message along with the operational context of potential recipients: which member of the care team is best positioned to respond to the information and act on the patient’s behalf? What is their role on the care team? What is their licensure? Where are they located? What is their call status? Are they available to act on the information or are they engaged in a high-priority task from which they shouldn’t be disturbed? Using rules and logic, a CC&C platform can intelligently direct alerts and avoid messaging people when they are not available or are involved in interruption-sensitive tasks. For example, if a nurse is responding to a code blue alarm, it would be best to exclude her from alerts and alarms until the code has been completed. Triage and escalation rules must be able to accommodate provider-centric factors as well as operational context to make this type of determination.
Furthermore, situational awareness is vital in speeding responses to emergent conditions. Some hospitals have integrated clinical data with analytics systems and their communication platform to predict and detect early signs of patient deterioration and then quickly alert members on the care team. When the ‘early warning’ system enters an alarm condition such as sepsis, a high-priority message containing situational information can be sent directly to the patient’s care team members via their mobile device of choice. This clinical workflow and proactive communication can result in faster discovery of the unstable patient, ensuring the patient’s clinical resource needs are being met and either canceling a possible ICU transfer or shortening the duration of ICU care.
While real-time situational awareness plays a critical role in patient care, it is as important to the operational staff of a healthcare system as it is to clinicians. A robust CC&C platform can let operating room recovery teams know, for example, when a surgical case is about to wrap up to maximize throughput efficiency. Hospital discharge processes can be sped up, too, making patients ready to go home happier. And when a ward bed is freed up sooner, it can positively impact ED wait times; empowered by real-time situational awareness, housekeepers and transporters can improve patient flow from admission to discharge.
In summary, real-time situational awareness is a critical component of a modern CC&C platform, and is essential for a hospital aspiring to be smart, to be a real-time health system. Embodied in the CC&C platform real-time situational awareness has the potential to improve patient outcomes, reduce interruption fatigue, decrease the likelihood of patient harm, and make clinicians’ work easier and more efficient. In the age of ubiquitous mobile communication, it is time to make technology that enables intelligent and contextual communication a standard of care.
Benjamin Kanter, MD, is CMIO of Vocera
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