How Networked Communication Enables Better Quality Care (PT1)

When you talk to CIOs across the world, they feel like when they implemented all these EHRs, they were so focused on data and data management that they lost sight of some of the key things that need to be done. One of these is team cognition. But just because the data may be in an EHR, a specific data repository, or a dashboard, it doesn't necessarily mean the information will be accessible. If it's not presented in the right way, it can be almost useless to us. 

The environment of acute care is often much different from chronic care. Unlike chronic care management, acute care patients are unstable, they're often in transition, and they're undifferentiated. They just know that something is wrong—something's hurting, something's off. More importantly, they're not scheduled. Many of the providers who care for them are mobile. Those are the providers we're trying to unite and gather a team around.

When looking at the process, we sometimes fall prey to the notion that if we just get the information to the emergency department, we're done. Well, what about all the providers that are going to be taking care of the patient? They're in chaotic environments. They're mobile. And often, you don't know which providers are needed. How do you tag that right person so that they know they need to respond?

The teams that we're trying to mobilize are often very rigid in function and struggle with situational awareness around a specific event. Many times there are middlemen trying to facilitate, but they're playing the telephone game. Similar to the data problem, a lot of the technologies they use to communicate are not interoperable. If you look at how we unite organizations today in healthcare, it's still fax, phone, and radio for the real-time communication exchanges in which we say, "Hey, I've got something that needs to move." The data often is in silos. And even when that information is available, it may be missing context. Not to mention, a lot of the data and technologies are based on proprietary systems.

The Platform Solution

The companies listed below are platform-based businesses that connect people with similar needs and interests across great distances.

One of the central components of all of these companies is communication. Yet how many of these platforms leverage fax, phone, and radio to accomplish their customer-facing interactions and processes?

The answer, of course, is none. But when you look at the healthcare system and examine a traditional patient journey, all of these red lines (pictured below) are basically communication fragments. They are communication channels that open and close, open and close. We are literally playing the old-school telephone game.

So, a medic may send some information by ePCR, another ECG transmission. Then they pick up the phone and call report to someone who never takes care of the patient to let them know what's coming in. Even if the information is transmitted digitally, it's often not pushed directly to the right care team members—especially if there are downstream care team members that need to be there.

There are some successful methods for connecting intrafacility systems, marked by the star in the diagram. These are fantastic systems that help create a shared consciousness. But some of them struggle around team communication, and all of them are relegated to within one silo and one organization. None of them connect all providers together. The platforms previously pictured connect buyers and sellers from around the world, logistics organizations, and financial institutions, all with a couple of taps. They never leverage communication in logistics like we do here.

A similar problem occurs when you look at devices out in the field that generate data. You might have some monitors that have their own dashboards, and then ePCRs that have their own dashboards. And so already at that point, where do the providers at the hospital go if they want to see real-time streaming data, especially in the context of a patient that hasn't even arrived yet?

How can you aggregate all the data into one location for a very specific context, for a specific job?

The Cost of Miscommunication

Miscommunication in healthcare is an issue around the world. While the following data is from the United States, every country has its own data. It's difficult to find these stats, because these are things that people don't like to talk about.

Research suggests that medical errors and miscommunication are the third leading cause of death in the United States. A quarter of a million to 400,000 people per year die from miscommunication, with 10 serious complications every single day. These errors affect one in every five Americans.

The fascinating thing about this is that 80% of errors and miscommunications occur during transitions of care. 

We need to pause, examine this fact, and reflect on what we can do better to serve our patients in these scenarios and events.

And there are many other costs of ineffective communication:

• 63% of time is wasted in patient transfers playing the telephone game.
• 43% of time is wasted on emergency response coordination.
• 70% of lost time is on treatment delays secondary to communication inefficiencies.

If most solutions for communicating patient data only cover part of the process, is there a way to connect all care teams on one single patient channel? (Hint: The answer is yes, and that’s what Pulsara is all about. Stay tuned for Part 2 for more discussion, or check out the full presentation here.)

Over the last few years, a group of leading clinicians in Victoria, Australia have transformed their team communication with cutting-edge technology, successfully reducing treatment times, building relationships between their care teams, and improving patient care. This is their story.