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Structured Messaging: Secure, Customizable Medical Team Workflow

Structured messaging protocols have come a long way since I first encountered them as a graduate student in a human-computer interaction course. Back then we studied the COSMOS structured messaging prototype developed in the UK. While it was just a limited prototype, it still showed the promise of intelligent, task-driven, structured communication, collaboration, and coordination. Today, the clinical communication workflow automation provided by secure text messaging vendors, widely available in other industries, and beginning to take off in healthcare, are starships in comparison to those early academic prototypes.

Telmediq is a secure texting solution that addresses classic communication pain points evident in most healthcare organizations with customizable workflows and structured messaging. Physician to physician communications and nurse to physician communications are rife with communication breakdowns, dropped calls, and unacknowledged messages. While secure texting in itself does not solve any of these issues on its own, it’s the beauty and magic of closed-loop, customizable, medical team workflows that solutions like Telmediq provide that help to largely mitigate these issues. Case in point, most clinicians are familiar with the term “page and pray,” which colloquially refers to the challenges a clinician has in getting in touch with the right, on-call physician for a specific event. Pagers, reliable and dedicated as they are, could never escalate a message to someone else when an intended recipient was not on-call. It’s only with current generation secure texting solutions and the appreciation that physician work schedules constantly change has a device truly started to address and try to simplify the complexity that is healthcare communications.

A well-known idea in science, engineering, and psychology is that the most important key to problem-solving is figuring out how to represent the problem in the first place. The first killer app on personal computers was Lotus 123, a spreadsheet program. There was a natural fit between the functions that Lotus provided and what users needed to do to solve (or at least identify) their financial problems. Similarly, Telmediq uses a shared calendar, incorporating user-customizable routing and escalation rules. This calendar, and associated filters, triggers, and routes, is Telmediq’s “workflow engine”, albeit integrated with a representation as apt for structured messaging as the spreadsheet was for balance sheets and income statements. On this group calendaring and scheduling communications workflow platform, Telmediq layers specifically valuable features:

  • Intelligently routes phone calls and messaging
  • Converts voice messages into text messages through automatic transcription
  • Eliminates need for switchboard operators or staff fulfilling that function
  • Unacknowledged messages automatically escalated to individual or call team role
  • Integrates with EHR ADT (Admissions, Discharge, Transfer) feeds, linking back to EHR records
  • Connects both internal and external healthcare teams (an example of task interoperability)
  • Handles multimedia such as text, structured UI data, voice, and image
  • Automatically secures the data above using HIPAA-compliant encryption whether on a personal or provided device

In the first post to this three-part series I outlined the history and ideas behind structured messaging and its relation to computer-supported cooperative work, groupware, and workflow technology. In this post I used a leading secure structured messaging vendor to provide specific examples of where structured message has arrived today in healthcare. In my third and last post I will speculate about how structured messaging could become the dominant workflow platform, gluing together the workflows of collaborating clinical teams within and across healthcare organization boundaries. A true structured messaging solution will encompass all possible message data and delivery types to facilitate greater conveyance of care, giving healthcare providers the data they need, when they need it.

Charles Webster, MD, is a Google Glass Explorer with degrees in accountancy, industrial engineering, artificial intelligence and medicine. He designed the first undergraduate program in medical informatics, was CMIO for an EHR vendor and wrote three successful applications for the HIMSS Davies Award for EHR Ambulatory Excellence. Chuck opines about healthcare workflow and other topics from @wareFLO.

Learn more about how secure text messaging solutions are underpinning healthcare workflow and contributing to the delivery care in this on-demand webinar. Watch now.

blog, Clinical Workflow, HIPAA, Pager, secure text messaging