On this blog we have thoroughly established the existence of communications breakdowns within and among care teams. We’ve also pointed out the cost of these deficits in terms of patient well-being, dollars, and legal activity. All of that begs the question of how these problems arise in the first place. Glad you asked.

The medical community spends a lot of time discussing the need for interoperability. EHR systems have long been the target of complaints from professionals ranging from nursing staff to hospital administrators. Countless startup companies are building software to integrate various aspects of digital medical records. The idea is to streamline the collection and transmission of patient information so that accurate and actionable insights can be drawn.

Our industry has a long way to go, though. With EHRs, information is for the most part input manually. This increases the burden on medical practitioners from a paperwork standpoint and reduces the time they have available for patients. Valuable features of EHRs are therefore offset by the disruptions they cause. (For an excellent discussion of this debate, please check out this article from FierceHealthcare.) So, what can you do to help move healthcare in the right direction while pushing your practice towards greater integration of health IT tools?

Medicine is stressful. Every aspect of interpersonal relationships, communications, business, finance, operations, and customer service that one would see in any other field are present in medicine. However, layered on top of all that is the simple fact that medicine’s product is healthy human life, and everything gets even more intense. Leaving med school to start a residency, and then finishing residency to take on an attending position, are stressful and intimidating transitions for any young MD. We can’t speak to the challenges of providing actual care, but we did want to give those new physicians reading here our thoughts on communication-related ways to smooth out the process.

Think we missed something? Let us know in the comments.

Change is coming to Washington, D.C. We don’t pretend to know what that change will look like, and we aren’t going to discuss the politics of everything happening these days. However we, like all of our colleagues in the healthcare space, are watching closely to see how the transition and incoming administration affects healthcare policy. With so much attention directed towards the Affordable Care Act and where it’s headed, we thought this would be a good opportunity to review the evergreen issue of healthcare communications in the context of medical malpractice. As always, this is a brief and casual discussion, nothing in this post constitutes legal/regulatory advice.

We take for granted the volume of data collected and stored during routine exams and medical procedures. What is equally remarkable is this data is collected by means ranging from physical palpation by a provider, to highly calibrated machines and software. Technology to disseminate health data has developed alongside the tools to acquire it, although perhaps not at the same rapid clip.

A few weeks ago we published a post saying that HIPAA compliance in a medical communications platform isn’t enough for that platform to be useful, or even interesting. In that post, we talked about the need to ensure that the secure information being transmitted reaches the correct end-user. Otherwise, what’s the point?

What we didn’t really talk about is one of the roadblocks to getting information to the right person: on-call schedules. Scheduling your group seems like just a management or housekeeping problem. However, it’s far more. It’s a significant communications problem, because a broken schedule adds friction to the process of getting medical information to that end-user, the on-call physician.

Think about it like this: No one ever asks who is on-call for fun. If they ask, it’s because they need to communicate with that provider.

There’s not a lot of ambiguity in the title of this post. Your nurses do, in fact, hate your answering service. We know because they’ve told us.

The simplest reason why is because of the significant discrepancy between what nurses want to be doing each workday and what they actually do. They spend too much time on the phone or filling out paperwork when they want to and should be working with patients. Trying to get in touch with a third party - whether it’s a specialist, send-out lab, imaging facility or even a patient - is an obvious challenge. However, trying to work through an answering service to connect with the on-call physician, a person who in theory should be right there when a need arises, adds an additional layer of unnecessary pain.

­­Last week, one of us here at BeckonCall grabbed the phone to get in touch with a physician’s office to clarify a question about insurance coverage for a recent minor procedure. Instead of the usual recorded message directing him to “press 1 for appointments, press 2 for billing,” etc., the machine clicked on after one ring and announced that the practice was closed for the day. And then, the office manager’s voice said, “if you are an existing patient and are calling with an urgent medical question, please call Dr. Smith’s pager at 555-123-4567, pager number 89.”

Make no mistake, we at BeckonCall are well aware of the prevalence of pagers in medical practices. Finding better ways to get in touch with physicians is literally our reason for existence. And indeed, we spend a lot of time talking about the use of legacy technology - like fax machines and pagers - in medical practices. Even so, it was a jolt for our colleague to hear, in the context of being a patient, that he was supposed to set off an irritating alarm screamed from a box on “Dr. Smith’s” hip. This is 2016, after all.

Pager use may be on the decline, but they’re not gone yet. Why? A Slate article published earlier this year by Dr. Allison Bond reviews some of the reasons. It’s a good read, so be sure to check it out. Briefly, though, Bond points to the simplicity of pagers (battery life, for example) and their reliability when receiving messages. She also notes that there is some pride when physicians and other providers are first given a pager, although she’s quick to point out that the novelty wears off in a hurry.

There are a number of other concerns medical providers and practices express when talking about switching away from pagers. Below are a few, as well as responses that might help break the inertia of technological stagnation.

Remember when it seemed exciting to find a communications tool that touted HIPAA compliance at the top of its feature list? “Is it secure?” was one of the first questions asked when evaluating medical communication technology. Now, 20 years after the Kennedy-Kassebaum Act was first passed, compliance is generally assumed. Of course, HIPAA compliance is critically important. It’s the law. But it now sits in the background, almost as part of the scenery, instead of prominently featuring in discussions about how a system works. It’s like airbags in your car; they’re legally mandated and you spend no more than a few seconds thinking about them when shopping for a new ride.

“Oh, I thought you said…” is a common refrain heard by parents, teachers, and TV police captains when their idealistic subordinates pretend to have misunderstood a command. Unfortunately, it is also a paraphrase of conversations heard far too often in clinical settings among healthcare providers, and it has severe consequences.

Miscommunication in healthcare causes quantifiable breakdowns in, and added cost to, delivery of care. Earlier this year, CRICO published a study that looked at medical malpractice lawsuits from the previous five years. The researchers found that more than 1,700 deaths in that timespan could be attributed to communication problems. In addition to the loss of life, the suits cost approximately $1.7 billion. That’s bad enough, but the CRICO stats only reflect part of the problem, as those numbers were pulled only from malpractice cases - i.e. where legal action occurred. Additional data has suggested almost two-thirds of sentinel events are caused by miscommunication within and between careteams, and that this problem costs over $100 billion a year in lost revenue and avoidable operating expenses.

Clearly, hiccups and outright failures in care team collaboration are enormously detrimental to all aspects of the healthcare system. Breakdowns in communication can and do occur between any two participants in delivery of care: nurse-nurse, nurse-physician, patient-staff, patient-nurse, etc. Some of these failures arise from in-person interactions, such as when a verbal message is not relayed from patient to staff to physician within the clinic. In many other cases, physical distance creates a literal game of telephone where humorous phrases are replaced by negative patient outcomes.