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Don’t Squeeze the Doctor Between Urgency and Cognitive Error | Part 2

· Kim Tucker,

I. Deliver the Context

A clinician, upon recognizing an issue with a patient, may seek the engagement of another clinician. Modern telecommunication tools facilitate this messaging between clinicians. The message sender already has a mental model, the context, when composing and sending their message. The message recipient, however, brought to the message by an alert that most commonly interrupts the recipient in their work must change context to accept, read, and consider the content of the message.

II. Recomposing Context

Initially, the recipient will naturally call upon memory coupled to the message content to create context. Memories and the messages alone are rarely enough information for decision-making as the relevant information about the patient’s immediate issue contained in a comprehensive electronic health record (EHR) is likely expansive. Given the separation of the messaging, the communication among clinicians, and the EHR content, the message recipient’s likely next action is to pursue the review of additional information so as to create the context for decision-making and consequent action—usually the initiation of diagnostic and treatment orders in response to the patient’s new issue.

This “review of additional information” sounds like a benign enough activity for a clinician, even if undertaken in response to a message sent consequent to a patient’s changing condition and consequent urgency for intervention. The physician’s subsequent hunting and gathering of information, formulation of a context for decision-making, and issuance of medical orders together introduce a delay—a delay which the physician commonly recognizes as in tension with the decision the physician is undertaking and the likelihood of cognitive error.

III. Critical Care Physician and Colleague Create MIAA

Benjamin Kanter, MD, a San Diego-based pulmonary and critical care physician, had the opportunity to learn a lot beginning in 2007 through a communication project sponsored by Qualcomm that aimed to reduce the frustration a physician confronted when receiving a telephone call about a patient, and then needing to hunt for and gather necessary information before making a decision.
This experience prepared him for participation in the planning and building of a new Palomar Hospital—a hospital without nurse stations and built with mobility in mind—through his partnership with Palomar’s Orlando Portale, Chief Innovation Officer. Together they created “MIAA—Medical Information Anywhere, Anytime” with a proof of concept realization of contextual communication. Their explicit goal was to breakdown silos of information—not merely shrink the EHR’s monitor to the size of the smartphone—but redo the entire workflow coupled to embedded, integrated communication. When completed Kanter and Portale achieved the tri-partite aim of integrating communication, clinical context, and the action (medical orders) that together enable a full response from a physician on the receiving end of an urgent message or telephone call about a patient.

How are your EHR, telecommunication, and integration vendors helping you bring contextual communication to your clinicians?

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