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Solving Notification Overload in Healthcare

Thanks to initiatives like Meaningful Use and the rise of digital solutions catering to clinicians, healthcare providers now have access to unprecedented levels of data and information during their day-to-day activities. But as many are now finding out, the tools that enable providers also come with a cost: notification overload.

Life in the notification era comes with a dark side: the more practitioners are exposed to repeated notifications, the more likely they are to ignore them. Tweet This

Healthcare professionals are inundated with a near-constant stream of notifications. From pages, bedside alarms, nurse call systems, overhead pages, EHRs, desktop and mobile software, [insert a few more examples here], clinicians face a barrage of notifications from the moment they wake up until the moment they clock out. Recent research found that physicians receive, on average, 77 notifications a day from EHRs alone— costing them an hour of work as they triage and respond appropriately.

Life in the notification era comes with a dark side: the more practitioners are exposed to repeated notifications, the more likely they are to ignore them. In extreme cases, this can lead to adverse events or even patient death. Physicians who acknowledge hundreds of notifications and alarms each day don’t fare much better; interruptions and disruptions to care workflow can result in numerous errors (some of which we’ve covered here). A study from Florida State University found that even receiving a notification on your phone, whether you acknowledge or even look at it, can increase cognitive load and distract from the task at hand.

For vendors, the question becomes ‘how do we walk the fine line between delivering the messages that matter without burying physicians and nurses in notifications?’ Tweet This

While notifications may be an evil, they are, unfortunately, a necessary one in healthcare—with so much crucial information being transmitted, there needs to be an intuitive, attention-grabbing way to alert hospital staff to critical communications. For healthcare technology vendors, the question becomes ‘how do we walk the fine line between delivering the messages that matter without burying physicians and nurses in notifications?’

Intelligent Routing

In 2008, researchers at Toronto General Hospital found 14% of pages were being sent to the wrong physician, with about half of those classified as “emergency” or “urgent” pages. That could mean 4,300 misfires a year, with about 2,000 being high priority.

4,300 misdirected messages annually are problematic enough on their own; however, when you consider the chain of notifications, interruptions, and course corrections these would set off, the problem is multiplied exponentially.

For example, Telmediq employs intelligent routing rules and pre-configured escalation paths to ensure the correct message is delivered to to the right individual or care team—no misfires. Thanks to a Patient Centric Messaging feature, any communications pertaining to a specific patient are delivered to the appropriate on-shift staff; if critical messages aren’t acknowledged or responded to after attempts by text and voice, messages are then pushed to the next recipient specified according to the hospital’s escalation path. It’s a workflow improvement that ensures that the only messages clinicians receive are the ones that are meant for them, reducing the amount of unnecessary notifications clogging up your day.

Consolidation

Pagers, smartphones, EHRs, overhead paging systems, nurse call, and medical monitoring devices are routinely competing for attention in healthcare environments—with disastrous results. Alarms go missed, notifications get ignored, and patient safety is compromised.

If these systems are integrated into the communications platform and layered on top of the logic that dictates how messages are filtered and routed, they’re no longer competing for mindshare—they’re joining forces to provide additional context and contribute to the complete patient story rather than one-off interruptions that may, at times, even conflict with the greater picture.

It’s a point we find ourselves returning to again and again. A ‘secure messaging’ app is just another point solution that adds to the noise rather than cutting through it. To truly enact change and provide a service that can reduce patient risk and propensity for error, a communications solution needs to envision ways to consolidate and contextualize data from the numerous systems into an event-driven communications platform.

To Disturb Or Not Disturb

All-hours notifications and interruptions rose to become enough of a problem that in 2012 both iPhone and Android released their versions of a ‘do not disturb’ feature, effectively silencing the device from displaying incoming app notifications.

This is incredibly useful when you’re attempting to avoid being woken up by an errant 4 am reply to a tweet—but when your phone is being used to receive critical values and communications around a patient, DnD becomes less of a boon and more of a liability.

If a platform is unifying all critical communications and routing them to the correct parties, it stands to reason that it should also have a means of communicating importance at the individual user level. In this regard, unique ringtones and alerts help (you know, the same ones you use to notify you when your significant other or parents are calling). Associating a unique tone with a critical messaging app ensures that the messages stand out from email or Facebook notifications on the individual device. Studies have shown it is difficult for humans to differentiate among more than 6 different alarm sounds—unifying critical systems within one messaging app frees up some mental bandwidth for the other five.

Further, the ability to have a critical messaging app override a local user’s DnD settings in certain situations is needed—if a critical event or message is missed due to DnD, it can have an enormous impact on patient wellbeing. If, after disengaging DnD, a physician or nurse is still unable to be reached, appropriate escalation paths can take over and route the message to the next appropriate party.

These are but three ways today’s mobile messaging solutions are doing their part to solve the growing burden of notification debt in healthcare environments. Have ideas for additional measures? Share them in the comments below!

blog, Clinical Workflow, Mobile