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Making Sense of EMR and Communication Technology Convergence

· Tim Needham, Chief Commercial Officer

Top 10 Use Cases to Drive an Effective Epic Mobile Deployment

Doctor on cell phone

We repeatedly hear from our clients, “With Healthcare IT vendors, it is often very difficult achieve clarity on where one technology ends and the next one begins.” There are many reasons for this, including the often-confusing boundaries in terms of which product is used for which workflow, and the line between what’s actually available, what’s in development, and what’s conceptual. Regardless of the reason, the negative impacts are clear:

  • Delayed project approval and launch due to confusion and perceived risk
  • Disjointed end user experience due to poorly executed workflow integration across vendors
  • Disconnects between expected and actual project value

The Clinical Communication and Collaboration (CC&C) segment within Healthcare IT is currently experiencing this kind of confusion. On one hand, the past five years of vendor maturity, implementation lessons, and guidance from clients has led to consistent deployment architectures across communication apps (voice/text), clinical alerting, nurse call, and patient monitoring. Epic’s entry into the category with its maturing Secure Chat functionality has brought new levels of opportunity for delivering a successful, sustainable mobile communication experience for the full care team.

PatientSafe’s Epic clients have partnered with us to embrace Epic’s evolving capabilities and avoid functional conflict. Through our collaborative approach, we achieve the following:

  • Removal of confusion for clinical end users — everyone across the health system has absolute clarity on how to reach members of the care team
  • Creation of a comprehensive set of clinical documentation AND communication tools that successfully move health systems to a “mobile first” model of care delivery
  • Strong adoption of Epic’s mobile apps Rover and Haiku

Implementation strategy for our Epic health system partners is driven by three key components:

  1. Joint validation with the Clinical Informatics team to understand which communication-related functionality within Epic’s toolkit they plan to deploy:  Secure Chat, on-call scheduling, Treatment Team assignment, and EMR-initiated alerts/alarms
  2. Leveraging a well-developed set of communication and alerting use cases (see table below) to assess where workflows will be initiated and what integration points are needed to streamline the user experience
  3. Deploying the PatientTouch Communication platform with a modular approach, fully complementing and catalyzing adoption of Epic’s mobile tools by turning off any PatientTouch functionality that risks confusion or conflicts with Epic’s capabilities

Through this strong collaboration with our Epic clients, we have developed 10 Core Clinical Use Cases for Epic Health Systems to guide deployments. These use cases fall into four categories that play a major role in overall system design and project execution:

  1. Role-Based Communication
  2. Physician Adoption
  3. Patient Safety
  4. Assignment Process

The table below provides a brief overview of the key workflows and functional aspects of each use case.  Working alongside our customers, the PatientSafe implementation teams break each use case down into its component parts, developing multiple example workflows, integration requirements, and closed-loop end states. Additionally, we document target end-state outcomes of each use case related to efficiency, patient safety, and financial impact.

Top 10 Core Clinical Communication Use Cases for Epic Health Systems

#Use CaseKey Workflow Impact
1Role-Based Communication: Voice
  • Ability of any user to launch a voice call with one touch from either Epic or PatientTouch
  • Ability to easily identify and connect a voice call to the primary treatment team, extended care team, or anyone in the health system contact directory
End User Benefit:
  • Reduced search time
  • Visual indicator of “Available/Busy”
  • Fewer calls routed through unit coordinators
Integration Considerations:
  • AppLinking between Epic and PatientTouch
  • Active Directory Synch
2Role-Based Communication: Messaging
  • Peer-to-peer texting with care team awareness and full use of Epic Secure Chat
End User Benefit:
  • Efficient, accurate asynchronous communication
Integration Considerations:
  • Typically de-activated in PatientTouch to drive Epic mobile tool adoption (does not impact PatientTouch delivery of alerts)
3Physician Adoption: Streamlined On-Call Schedules
  • Easily managed and viewed by all care team members
  • Integrated into communication functionality to support one-touch text, call, or SMS page
End User Benefit:
  • Reduces unnecessary disruptions to physician community
  • Expedites resolution for inpatient care team
Integration Considerations:
  • Deliver a consistent end user experience for visibility to variety of scheduling tools in use vs. immediate enterprise wide standardization
  • Allow for purposeful on-call vendor consolidation over time and execution roadmap
4Physician Adoption: Protecting Physician Privacy and Preferences
  • Caller ID customization to hide personal cell phone numbers
  • Cloaking of personal cell phone numbers to prevent distribution to/by inpatient care teams
  • Individual physician ability to designate their preferred contact method
End User Benefit:
  • Encourages physician adoption of enterprise communication tools
  • Opens the door for cell phone outreach by inpatient team if needed
Integration Considerations:
  • N/A. Expect CC&C partner vendor native offering to fully support and augment Epic’s secure communication functionalities
5Physician Adoption: Outreach to Community Providers not in Epic
  • Identifies a plan to support inpatient care team communication needs for providers who do not use the health system’s Epic instance
End User Benefit:
  • Streamlines outreach compared to current state
Integration Considerations:
  • N/A. Expect CC&C partner vendor native offering to fully support and augment Epic’s secure communication functionalities
6Patient Safety: Role-Based Nurse Call Alerts
  • Notification delivery to mobile devices based on role and request type
  • Effective management of escalation path and backstop for newly arrived transfers and admits
End User Benefit:
  • Reduction of alert fatigue
  • Requests go directly to the correct care team member
Integration Considerations:
  • Significant effort to validate preferred alert delivery type, escalation paths, and reporting ownership
  • Clear design guidance and criteria in terms of necessity of separation between alerting-specific roles required (back-stops, secondary, escalations) vs. generic roles where standard assignment information can flow on a broadcast/bulk assign basis
7Patient Safety: Secondary Alarm Notifications for Patient Monitoring Events
  • Notification delivery to mobile devices based on role and request type
  • Effective management of escalation path, backstops, and alarm context
End User Benefit:
  • Reduction of alert and alarm fatigue
  • Supports accurate prioritization of time and attention
Integration Considerations:
  • Significant effort to review alarm types, suspend timing, distribution roles, and escalation timing
  • Testing demand is high to build clinical team trust in performance of the integration
8Patient Safety: Audible Triage of Alert Severity
  • Supports care team triage based on variable sounds or haptic/vibration responses
End User Benefit:
  • Reduction of alert and alarm fatigue
  • Effectively manage escalation without full disruption of in-progress tasks
Integration Considerations:
  • N/A. Expect CC&C partner vendor native offering to fully support and augment Epic’s secure communication functionalities
9Patient Safety: Team-Based Distribution of Emergent Events, such as Codes
  • Emergent event notifications sent to the correct subscribed or assigned care team members
  • Notifications arrive with distinguishable priority (typically audible)
End User Benefit:
  • Significant reduction in ambient noise resulting from overhead paging
  • Reduction in distractions impacting non-assigned care team members
Integration Considerations:
  • Tight alignment of technology and processes related to alarm initiation, team assignments, and response/ escalation needs
10Assignment Process
  • Clearly delineates opportunities for logical integration across systems to minimize assignment burden on frontline clinical staff
  • Identifies and manages alerting system-specific needs related to escalations, exclusivity, patient transfers, and staff break workflows
End User Benefit:
  • Reduction in time, effort, and confusion specific to the assignment process
Integration Considerations:
  • Assessment and validation of functional mapping between Epic Treatment Team, enterprise assignment processes, and alerting system needs/capabilities

By leveraging these use cases to develop vendor requirements and mitigate risk related to system overlap, health systems with Epic EHR will be prepared to successfully deploy the Epic mobile application ecosystem. Without consideration of this full set of use cases, our industry research validates likely project conflicts or adoption gaps including:

  • Extended project planning and delayed launch as the needs outlined above are discovered piecemeal and the resulting project scope creep increases project cost and timeframe
  • Post-Go Live discovery of significant communication functional gaps, which leads to a delayed “re-start” of the Epic mobile app program to achieve desired adoption rates
  • Failed 3rd party general-purpose communication apps — specifically voice-only standalone apps originally designed for enterprise business users — that can manage voice call delivery, but are unstable or incomplete related to alerting, assignment, clinical, and physician needs

If your health system is pursuing an Epic-first mobile strategy, our strong recommendation is to build your mobile program with this full set of use cases in mind.  Plan to scale with Epic’s Secure Chat functionality deeply embedded, and well complemented, by nimble CC&C solutions. PatientSafe and our Epic clients have repeatedly validated this path to success. If you would like to learn more about how PatientTouch serves as a perfect companion to the Epic mobile app ecosystem, read about it here or contact us.

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