Anyone who has been in a hospital can experience this common experience. At 7am on the fourth day of admission, you hear the words you’ve been waiting for: “discharge.” The intern comes over and tells you you’re ready to go home. However, later in the day, you will be seen by another doctor who wants another test. But oddly enough, that test never happened, so you’re discharged home.
It turns out that there is a miscommunication between the teams and you should have this test as it will catch the GI bleeding that will eventually send you back to the hospital bed.
How did these things happen?
Sometimes accidents are minor – two people give different answers to the same question. But sometimes they matter, like the example I gave. We have made incredible advances in industry technology. The manual processes that existed twenty years ago have all but been eliminated. In many ways, the incentives to implement electronic health records nationwide have worked. But there are still gaps.
If you watch medical teams make rounds, even with the latest “workstations on wheels” and expensive EHRs in the most complex setups, the team will still carry a small amount of paper with them. Every hospital administrator and IT professional in the country wants to eliminate the use of paper, but they don’t.
Is it just stubbornness and non-compliance by clinicians? No, it’s not. It turns out that we—those who work in healthcare—are missing a tool that is critical to all other industries. It’s called a project management tool, and Gartner highlights it as an opportunity to create a “real-time health system” with better situational awareness.
Currently, there is no room in any EHR for real-time thinking or future planning for the patient as they evolve every moment. So this information is often written down or texted to someone before action is taken. All ideas like this are either written down on paper or shared informally with colleagues. When this happens, the ideas are siloed and static. The whole team can’t see them, comment on them, correct them when they’re wrong or add them when they’re incomplete.
Even as I write this, I can hear angry howls. Of course, there is a place to write this information – it’s called a progress bar. This is updated every 24 hours. Doodles, emails, sticky notes, texts, and other informal communications on paper are fluid. Progress notes are not interactive and are owned by one person. It is locked as part of legal records. The point is, it doesn’t help with care coordination and certainly isn’t a project management tool.
communication failure Over 70% of clinical errors, according to the Joint Commission. When we had manual systems, we had manual handoffs, print lists and other tools to make sure everything was communicated.
Now that we live in a digital world, rounded lists—the gold standard for all EHRs—will not help us solve our communication problems. To overcome these issues, we employ various workarounds in the form of digital communication tools, such as texts, emails, and alerts. These have become so common that almost everyone now suffers from alertness fatigue. Imagine trying to have a conversation with your doctor about a new diagnosis when her phone keeps ringing with urgent messages and calls.
I’ve been living, breathing, dreaming and thinking about how to solve this problem for the past 15 years. This included multiple efforts to find solutions, many of which were ultimately scrapped. When I started, the goal was to eliminate paper from our hospital system. But when you pull a wire, which usually happens, you find that there’s more than just one fiber connected.
What is clear to me is that we are missing a collaboration system. We have conversations, take notes, send texts, but we don’t do it in a monolithic system. I have nowhere to see what my peers are thinking, and most of our collaboration today requires synchronous communication. The important thing is that I can still “see” your thoughts when I am ready to think for the patient and you are not.
This won’t change overnight, as Dr. Vivian Lee elaborates in her book “The Long Fix.” That’s why we must start now. Each incremental step is an investment in future “fixes.”
It will lead partners from different disciplines to shift mindsets and implement necessary changes across the healthcare ecosystem. But it’s a cause worth fighting for to reduce preventable errors and improve patient care.
Image credit: ipopba, Getty Images
