U.S. healthcare providers are experiencing unprecedented pressures from a confluence of social, economic and political circumstances: State and Federal budget cuts, Medicare/Medicaid reimbursement reductions, rising “Boomer” healthcare costs and, most recently, demands for cost-effective, outcome-based patient care practices and payment protocols as detailed in the newly-enacted Affordable Care Act.
The mandate is clear: Find ways to deliver quality patient care at a lower cost or suffer the consequences of reduced funding and other penalties. Rooting out sources of waste and error in the highly complex, multi-layered healthcare system is no easy task. However, studies are increasingly pointing to obsolete, redundant, and ineffective communications as a clear culprit.
This paper examines why healthcare organizations are uniquely vulnerable to communication breakdown, why current tools are failing to fix the problem, and how a single platform messaging solution may be the answer to cost-effective collaborative care delivery while meeting patient safety and privacy standards.
In a journal report titled “Communication Failures in Patient Sign-out and Suggestions for Improvement: a critical incident analysis,” Dr. Vineet Arora, University of Chicago, references several studies that implicate breakdown in communication between healthcare personnel as a major threat to patient safety. Says Arora, “These failures also account for over 60% of root causes of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations.”1
At the same time, miscommunication of test results poses a serious, and growing, problem for hospitals. According to a study in the November 2011 Journal of the American College of Radiology, Claims payouts due to communication breakdowns after tests rose by $70 million from 1991 to 2010 across all specialties. The problem in most cases was not a matter of incorrect data, but rather failure to communicate those results to the patient. 2
While the impact on patients and families is clear, the significant financial fallout resulting from communication-related medical error and inefficiency is an undeniable source of concern for facilities already struggling under tight budgetary constraints. On top of legal liability, healthcare organizations are now facing additional loss of revenue and penalties for failing to meet value-based performance criteria as outlined in the Affordable Care Act and other recent Healthcare Reform initiatives.
Ironically, the number of communication systems operating at most hospitals today far exceeds that of other industries. There are applications for patient registration, patient monitoring, patient transport, nurse call, staff fulfillment, code alerts, building security, lab results, systems monitoring, electronic medical records and group notification, to name just a few. And, with the availability of mobile Wi-Fi and cellular technology, clinicians are increasingly carrying multiple devices, including pagers, smartphones, and tablets, just to keep up with messaging demands. Add to that the multitude of spontaneous face-to-face exchanges that take place as patient care team members cross paths throughout their rounds and you have the makings for an extraordinarily complex network of digital and verbal interactions.
Perhaps it is not for lack of communication that hospital errors are made but, rather, too much uncontrolled and undifferentiated communication that is at fault.
In a well-referenced psychology study, Improving Clinical Communications, 3 authors Julie Parker and Enrico Coiera explore the limitations of the human “working memory” in such interruptive-prone environments.
“Working memory” is described as the brain system that provides temporary storage of new information required to make decisions - like a mental “to do” list. The authors note that the working memory is quite limited in the number of items it can keep in play, leading to displaced, delayed or forgotten tasks when overload occurs. 4 Those who work in an interruption-driven environment such as the ER or ICU are most vulnerable to suffer failures of working memory. In fact, in a 1999 report, the Institute of Medicine (IOM) recorded 98,000 deaths per year resulting from hospital errors while characterizing critical care environments, such as emergency departments, ICU, and surgical suites, as “complex, tightly coupled systems intrinsically prone to accidents.” 4
Parker and Coiera suggest that closing the communication loop in such a disruptive environment is necessary for workers to move tasks out of working memory in order to make room for new information.
However, “It is probable that when the consequences of errors can be so serious, it is difficult for a doctor or nurse to feel that he or she has truly ‘handed over’ responsibility for a task without an explicit acknowledgement from the recipient.”
Just as messaging overload is part of the problem, control and consolidation of messaging must be part of the solution.
The Promise and Failure of Communication Technology
While most industries have been quick to embrace cellular and Wi-Fi communication technologies to improve information flow, the healthcare system has been stubbornly loyal to pagers, primarily because premise-based paging is perceived to be more secure. There is reason behind their caution – an accidental HIPAA patient privacy breach could result in fines to the organization anywhere from $125,000 to $1.5 million per incident.5
Penalty structure as established by the American Recovery and Reinvestment Act of 2009
However, pager systems are costly and inefficient. According to a recent Ponemon Institute study, the average U.S. hospital is absorbing approximately $900,000 per year in lost productivity and increased patient discharge times due to their reliance on antiquated communication systems. 6
These costs are compounded by pagers’ other clear shortcomings when compared to current
Wi-Fi and cellular communication technology: equipment overhead costs and maintenance, limited bandwidth, system failures, one-way only communication, lack of differentiation between urgent and non-urgent pages, missed pages, unreliable coverage, no means to track or audit messaging activity, and the list goes on.
As for the assurance of failsafe HIPAA compliance with pagers, even that is no longer a valid claim. According to a study at the Medical College of Virginia Hospital, nearly 5% of alphanumeric pages sent to hospital residents over a three month period contained identifying patient information that could be considered HIPAA violations. 7 What’s more, anecdotal reports reveal that physicians are forwarding their pages to their personal smartphones in an effort to reduce the number of telecommunications devices they carry. “Unless each personal mobile device has been modified by the hospital telecommunications team to ensure a secure transfer of information, it is possible that sending alphanumeric pages with patient information can violate HIPAA regulations.”
The fact is, according to a recent Wolters Kluwer survey, 8 out to 10 physicians are already bringing their smartphones to work8 and are quietly turning to the superior speed, reliability, and data transfer capabilities of those devices to communicate with colleagues through text and email.
Recognizing the opportunity to capitalize on this trend, numerous competing telecommunications software companies have launched mobile applications that support encrypted text messaging for healthcare users. However, while offering the benefit of HIPAA-compliant communication between mobile devices, such stand-alone apps are also adding another layer of technology for users to juggle and for IT technicians to support.
Additionally, group alerts, emergency/patient surge notification and post-discharge patient follow-up are just a few of the critical communication systems demanding the equal attention of clinicians and the support of IT staff. New regulations defined by the CMS, Joint Commission and the Affordable Care Act respectively are adding clear urgency to the need to upgrade these systems as facilities rush to conform or face stiff penalties.
Take, for example
1) The Discharge Dilemma: While scrambling to implement better clinician-to-clinician communication processes, hospital administrators are also facing the challenges of the newly-enacted CMS regulations affecting Medicare reimbursements for patients readmitted within 30 days of discharge due to complications. Approximately 2,200 facilities will be hit with penalties averaging $125,000 in 2013.9 At the same time, as noted in a recent Forbes article, “Both doctors and patients agreed that hospitals are under tremendous financial pressure to discharge patients quickly—a step that often puts more burden on discharged seniors to care for themselves.”10
Finding a better way to educate and provide ongoing patient care communication with discharged Medicare patients is not just a priority for patient well-being; it is now a financial necessity for the care provider.
2) New Joint Commission Standards: Events such as Hurricane Katrina and the Boston Marathon Bombing have prompted newly-revised Joint Commission recommendations for patient flow and surge response. Hospitals must have a clear plan in place for emergency response in the event a natural or man-made disaster cripples their facilities, including a failsafe, auditable crisis communication system backed by regular drills.11
3) Meaningful Use: As part of the new set of standards issued through CMS, healthcare providers are being offered incentives to meet federal standards for Electronic Medical Records (EMR) establishment and use.12 EMR systems are a costly but essential technology for the future of collaborative healthcare operations and, as central repositories of patient information, present both a challenge and opportunity for integrated IT applications.
In a report on the growing cost of hospital IT technology, American Hospital Association director Charles Worzala reveals that capital expenditure per bed grew by 62 percent between 2010 and 2011, whereas total capital expenditure per bed grew by only 2.6 percent in that same period.13 With hospital IT expenditures expected to top $6.8 billion by 201414, it’s no surprise that telephony systems providers are vying for a chance to extend their existing unified communications capabilities with applications specific to the healthcare environment. Avaya Healthcare Solutions, Cisco Care-At-A-Distance, and Philips InitelliSpace Event Management solutions are among a growing number of offerings promising to streamline communication between clinicians, staff and administration while adhering to patient confidentiality mandates. In addition, a growing number of third party vendors are throwing their hats into the ring with stand-alone solutions such as pager-replacement mobile clients, patient follow-up surveys, appointment reminder IVRs, and multi-channel group notification applications. “The problem,” says Mutare Health President Mike Sorensen, “is that too many disparate solutions simply add unnecessary cost and complexity to the healthcare communications environment. What healthcare providers really need is seamless integration of those available technologies in order to achieve a single, well-orchestrated communications ecosystem that naturally supports their normal workflow.”
As former CTO for the University of Chicago Medical Center, Sorensen experienced first-hand the expense and inefficiency of traditional stand-alone healthcare communication technology, particularly paging systems.
Combining his software engineering capabilities with insider knowledge of healthcare operations, Sorensen oversaw the development of an advanced mobile and workflow application for closed-loop communications that lets patient care team members securely share critical information from their mobile devices, resulting in enhanced collaboration, reduced error and swifter discharge. He brought his technology to Mutare in 2012 and, over the past year, has worked with the company’s engineers to add Mutare’s unified messaging, mass/emergency notification and customized IVR capabilities to the solution. In May of this year, Mutare’s Healthcare division launched Vital Link™ 2.0, a unique, single-platform solution that combines the functionality of secure, 2-way messaging, mass/group notification, and patient outreach/ engagement tools into one simple and cost-effective application controlled from any smartphone or browser.
Vital Link solves many of the financial, technological, and regulatory compliance problems faced by over-taxed hospital administrators and IT managers, while giving clinicians, staff and administrators a single-source solution for all of their messaging needs. 15 From patient admissions through treatment, discharge and follow-up, Vital Link maintains an active line of communication between clinicians and with their patients while providing a detailed audit trail of activity.
As a cloud or premise-based middleware solution leveraging Wi-Fi and cellular capabilities, Vital Link easily works in tandem with existing internal communications systems. However, its value is most fully realized when used to replace less capable pager, emergency notification, and IVR systems. Vital Link integrates seamlessly with most hospitals’ active directories and EMR systems, and includes robust reporting capabilities that are invaluable for HIPAA, Joint Commission, CMS and Meaningful Use compliance.
The Vital Link platform gives highly mobile health caregivers total control of their messaging from their smartphones. It provides administrators with a simple yet powerful group and mass notification tool for situations ranging from code alerts to patient surge, and includes fully customizable patient outreach capabilities, from automated appointment reminders to integrated patient discharge and two-way follow-up communications.
What’s more, the cost to purchase Vital Link is less than the savings realized by paper replacement alone for most hospitals. “Our goal,” says Sorensen, “is to help CIOs implement solutions that have significant business value and a compelling ROI.”
While communication technology has a clear role in helping healthcare organizations meet the financial and operational pressures of Affordable Care and other government mandates, adding solutions to an already complex web of hospital communication systems could end up exacerbating, rather than relieving, the serious problem of medical miscommunication. Hospital IT managers would be wise to consider a stable, secure, platform-based solution like Mutare’s Vital Link that easily integrates with, consolidates, and adds extended functionality to existing systems.
Mutare is an independent software developer driven by a passion to make information access easier. Mutare develops unified messaging, smart notification and speech technology solutions. Mutare's applications work with existing systems helping to increase revenues and lower costs. Mutare is what unified communications should be – guaranteed.
1. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis
V. Arora, J. Johnson, D. Lovinger, H. .J Humphrey, D. O. Meltzer, Qual Saf Health
Care/U.S. National Library of Medicine National Institutes of Health, 12/14/05
2. Failure to notify reportable test results: significance in medical malpractice
Journal of the American College of Radiology, November 2011
3. Improving Clinical Communications
Journal of the American Medical Information Association, Julie Parker, MSc and
Enrico Coiera, MB BS, PhD Sept-Oct 2000
4. Interdisciplinary communication: An uncharted source of medical error?
Journal of Critical Care, 2006: George Alvarez MD, FRCPC, FJFICM, Enrico Coiera
Center of Health Informatics, University of New South Wales, Sydney, NSW 2034,
5. HIPAA Violations and Enforcement
American Medical Association:
6. The Economic & Productivity Impact of IT Security on Healthcare
Ponemon Institute, 5/08/2013
7. Alphanumeric Paging: A Potential Source of Problems in Patient Care and Communication
Sasa Espino, MD, Diane Cox, MD, and Brian Kaplan, MD
Division of Surgical Oncology, Department of Surgery, Medical College of Virginia
8. Wolters Kluwer Health 2013 Physician Outlook Survey
9. Hospitals to be fined for readmitted patients
USA Today: 9/30/2012
10. Failure to Communicate: Why Seniors Are Readmitted To The Hospital So Often
by Howard Gleckman, Forbes 2/18/2013
Copyright © 2013 Mutare, Inc. Page 9
11. Surge Hospitals: Providing Safe Care in Emergencies
12. Centers for Medicare & Medicaid Services
EHR Incentive Programs
13. Hospital IT Spending Jumps High
Paul Ceratto, Healthcare IT News, August 22, 2013
14. Hospital I.T. Spending Surge Predicted
Health Data Management, June 4, 2009
Sentinel Event Statistics
Joint Commission on Accreditation of Healthcare Organizations, June 10, 2013
To Err is Human: Building a Safer Health System
Institute of Medicine, November, 1999
Communication Failures: an Insidious Contributor to Medical Mishaps.
Sutcliffe KM, Lewton E, Rosenthal MM.
Academic Medicine, 2004;79:186-194.
Communication Behaviours in a Hospital Setting: An Observational Study
Coiera E, Tombs V. British Medical Journal, 1998