There has been a recent surge in adoption of secure text messaging solutions within healthcare. Pagers and non-secured SMS messaging solutions are being replaced by HIPAA compliant texting messaging apps, which give providers greater utility and convenience—not to mention the added assurance that PHI is protected.
Quick communication between providers can accelerate the delivery of patient care. For example, one of our health system partners in Arizona conducted a quantitative study and found that with a secure healthcare texting messaging app, nurses were able to find and reach physician providers faster (4 min. to 1 min.), while physician response rates increased as well (you can read more about it here).
Although secure texting can accelerate care delivery, it can also impede it, while putting the patient at risk. One reason for this is that clinical users, such as nurses and unit clerks, expect a secure text messaging solution to be as reliable as a pager. Only after adopting a secure text messaging app do most healthcare organizations realize that they fall short of pagers with respect to reliability and user privacy.
Another crucial element missing from secure text messaging apps is the ability to integrate with the Electronic Medical Record to track communications data. We frequently get asked about EMR integration from our health system partners, and it's clear that most CIOs and CMIOs see the importance of integration and the added benefits to clinical workflow and information exchange.
There are three main reasons why a secure texting messaging platform needs to integrate with your EMR:
- Documentation of Patient Care:
HIPAA Compliant texting apps are two-way in nature. A doctor, for example, may naturally tend towards responding to a message from a nurse with a directive for care, or possibly even an order. This was never a problem with pagers, as pagers were one-way in nature and almost always resulted in a call-back. Whereas orders were delivered via a telephone conversation between a nurse and doctor.
Any care directive or order needs to be documented into the EMR for patient safety and continuity of care. However, much of the ad hoc communication between a nurse and doctor or between physicians is still of high value. While most of the communication may not need to be documented in the EMR, a system that can determine what parts of the communication need to be part of the patient record and allowing administrators to control how communications data flows into the EMR is key to a robust, auditable and highly contextual patient record.
- Coordination of Patient Care:
When we work with acute care delivery environments we often see a recurring challenge. Nurses and unit clerks are often tasked with determining who a message about a patient needs to be sent to. With contact and on-call schedule information being distributed through email, fax transmissions, and photocopies, for a nurse to piece it all together is extremely difficult and time-consuming.
Integrating your secure text messaging app with a hospital’s patient census from the EMR as well as providers’ call schedules centralizes all this data while providing a quick and accurate method for contacting a provider. Being able to see and contact the on-call provider assigned to a specific patient without having to search for that information from various sources streamlines nurse-to-physician communication significantly.
- Push-based (Not Pull-based) Patient Updates:
Integration with an EMR platform, and other clinical systems used within a hospital, gives a provider the ability to get real-time updates about a change in a patient's status, or critical test results. Many healthcare systems today, put the onus on the nurse or doctor to check back with the clinical system for results, unless they fall within a critical results protocol. Push-based updates result in faster and more responsive patient care, regardless of the criticality of such an update.
To date, HL7 has been one mechanism by which EMR integration can be accomplished. More often than not, however, we have had to engage our clients with customizations in order to get successful 2-way EMR integration.
Although we have yet to see widespread adoption and support from major vendors such as Cerner and Epic for future standards such as FHIR, we understand that integration with systems such as secure messaging applications it is supported on some level today. Interoperability and HIE are also major topics of discussion within healthcare, and we see communications data as being a major component to a better system for health data exchange between healthcare systems and vendor technology. Accelerating an open and secure standard for EMR integration will require the support and participation of executives from hospitals and healthcare systems across the country.