One of the foundational elements of the clinical communication and collaboration (CC&C) market is management of alerts and alarms. Various companies established the early foundations of alarm management about 15 years ago. Those early alarm management systems, many of which are still in use today, are what I refer to as first-generation systems. As an example, consider a typical care unit where naturally some patients are at a higher risk of falling than others. Using a first-generation alarm management system that can provide notifications for bed-exit or chair alarms, the result is that somewhere in the unit, a member of the nursing staff is receiving a warning message with no context. Sometimes the entire staff receives these alarms on their mobile devices.
There are so many alarms. There is so much noise. A dark cloud of interruption fatigue descends on the nursing staff. Somehow, they think … there has to be a better way.
There is a better way: A next-generation alarm management system.
Next generation alarm management platforms approach alarm fatigue from an enterprise perspective by integrating contextual alarms and alerts, text messaging, and voice communications into a single platform. Consider that there are up to a dozen apps, clinical systems, and medical devices generating deliverable information at any one time. For example, there are nurse call and EHR alerts, smart IV pump alarms, patient monitor and medical device alarms, bed exit alarms, critical lab alerts, STAT order alerts, and text messages.
In an uncoordinated approach to clinical communications, each notification generated is not aware of the others and does not display to the recipient with a level of priority or patient context that would assist in the decision-making process. Interruption fatigue is a natural consequence of an uncoordinated approach to clinical communications.
IT can configure a next-gen system to combine nurse call-data and data from the EMR, such as bed alarms, fall risk scores, and patient demographics, and to send a message to a caregiver that is based on these multiple variables. This way, a caregiver receives a message only when it is appropriate, and with context, based on the patient. This creates situational awareness for the caregiver.
A Guide to Help You Get There
Maybe you’re a CIO at a hospital with a first-generation alarm system and you’re considering a next-generation alert and alarm platform. Or maybe you’re evaluating secure messaging platforms, or clinical communication solutions in general. If so, Gartner’s 2016 Market Guide for Clinical Communication and Collaboration, authored by analyst Barry Runyon, is essential reading.
The guide discusses in detail the features you should expect, and explains why CC&C will become critical to healthcare providers as they transform into real-time health systems (RTHS). It makes three recommendations for healthcare CIOs focused on care delivery IT strategy:
- Give preference to CC&C vendors who have proven system integration and interoperability capabilities and whose product architectures and service delivery models are adaptable to changing business requirements and circumstances.
- Address the challenges that surround CC&C selection, implementation, application support, and service-level expectations, as well as the cultural and workflow challenges that often accompany the introduction of CC&C.
- Reconcile areas of concern such as usability, mobile device support, and wireless coverage early in your vendor selection process.
Further Perspective on the Recommendations
I’d like to add further perspective to some of the key concepts these recommendations represent.
Some of the themes coming out of this guide are that this is an early market for CC&C, no one vendor can provide all of the required capabilities, and market consolidation will occur and is in fact already happening. In October, Vocera announced the acquisition of Extension – one of the exemplary CC&C vendors that are very strong in alert and alarm notifications, which are a key application domain the guide identifies. It is clear that the CC&C market is forming around the convergence a core set of critical capabilities centered on secure messaging, alerts and alarms, and a comprehensive integration capability.
Healthcare organizations need to reduce alarm fatigue for sure. They also need to go a step further and focus on reducing clinical interruptions as a means to significantly improving clinical communications and workflow.
Integration and Context
Coupled to the Right Architecture
Comprehensive integration capabilities are really becoming the cornerstone of the emerging CC&C market. But effective clinical communications also requires contextual data about the patient, events, clinicians, and care teams. Context is derived from a solid ability to integrate with many different source systems and devices.
Integration by itself will not address the challenge of streamlining communications. What is also required is a product architecture designed to capture real-time data and context from many different systems and devices and then store and apply rules to that data. What you don’t want is an architecture that cannot easily adapt to the ever-changing source systems. You want the freedom of changing out those source systems and medical devices without disrupting clinical communications. The real-time data and context come from the following sources:
- The electronic health record (EHR) – patient data, patient demographics, events, and assigned care team members.
- Enterprise ancillary systems – lab, radiology, and pharmacy data.
- Point of care systems and devices such as medical devices (alarms), nurse call (events), and nursing staff assignments.
- Real-time location systems (RTLS) – also referred to as “Location and Condition Sensing Technologies”. This provides the location of caregivers, which helps with improving workflow.
- Scheduling and staff assignment systems – providing assigned care team lists and access to caregivers on call.
Inclusive Planning for Workflow and Usability
One of the key challenges the guide identifies is addressing clinical workflow. It is imperative to bring clinicians, including providers and nursing, to the table very early in the planning process and not just for the decision-making stage. A CC&C solution has the ability to improve workflow but clinicians have to provide input because members of the clinical team (the solution’s end users) are really the ones who will determine a successful outcome of a CC&C initiative.
Closely related to clinician involvement is another one of Gartner’s recommendations regarding usability. Focus on the usability aspects of a CC&C solution and especially the usability and design of the mobile app used for alerts, alarms, messaging, and voice communications. Focus on the design of the mobile app and pay close attention to how it integrates alarms, alerts, and messaging; make sure the application is cohesive and easy to navigate. Focus on how easy it is to get to contextual information that will aid in event response and collaborative conversations.
Another key aspect of usability comes from the “network effect”. In the network effect, a CC&C solution becomes much more usable if the design phase considers all potential enterprise users. This is especially true for anyone directly involved in the care process including nurses, providers, and any ancillary support staff who are part of the patient care team. One of the immediate and tangible benefits of a CC&C solution is the ease with which a nurse can find the appropriate provider and the ease with which a provider can find the assigned nurse for their patient to facilitate a patient consult.
Uniquely Ready to Enable the RTHS
As the CC&C market takes shape, it is clear that there is a convergence of strategic secure messaging platforms and alarm management. The market is shifting to CC&C and the conversion of these separate technologies is a fundamental requirement for a solid CC&C foundation.
I believe our platform and company uniquely possesses all the elements and experience necessary to fulfill the requirements of the real-time health system (RTHS) – but you as a healthcare CIO are the one who needs to judge. I encourage you to download the guide and see for yourself.
Gartner Market Guide for Clinical Communication and Collaboration, Barry Runyon 15 November 2016
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