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Betty N., 77, hospitalized for congestive heart failure, is weak and requires assistance getting out of bed. She is on diuretics and urinates frequently. At 10:05 p.m., Betty needs to use the commode and pushes the nurse call button. On the first try, the ward clerk is away from the station. On the second try, Betty reaches the clerk, who calls the assigned nurse, but is unaware she has left for the night. On Betty's third try, the clerk finds the right nurse, but 45 minutes have passed. The nurse finds the patient sprawled out on the floor and in pain, having attempted to reach the commode without assistance. Betty has fractured her hip in the fall, requiring hip replacement surgery. The situation is complicated by Betty's congestive heart failure, wound infection, and renal failure, followed by a month-long stay in a rehabilitation hospital. Betty is unable to return home and is transferred to a nursing home. Her family files a malpractice suit against the hospital.
Unfortunately, this is not a rare scenario in today's healthcare environment. Patient care requires effective coordination and communication among many individuals - patients, primary doctor, specialists, nurses, clerks, aids, interns, therapists, pharmacists, and so on. But the communications technologies used in most healthcare facilities are crude and unequipped to handle this task; there is a high communication failure rate, resulting in inefficiency, needless suffering, and even death.
In a study of communication patterns in a hospital where electronic communication was not available, practitioners were successfully contacted only 74 percent of the time, typically using only telephone and paging systems. The study also indicated that about one-fourth of the calls were associated with determining who needed to be contacted for a specific situation.
In a survey commissioned by Cisco
, Forrester Research
found that the majority of nurses felt that they would save 30 to 60 minutes per workday if they had access to experts - critical time that could be spent caring for patients directly - if they had instant access to experts. Eighty-four percent felt that the time they spent trying to reach people had a direct impact on patient care because of communication delays and time spent away from patients, while 65 percent estimated that they spent more than 20 minutes each day trying to contact people - many spending well over an hour.
The Cisco Internet Business Solutions Group (IBSG) developed a conservative economic model based on this data. The model suggests that $3.4 billion, or $500,000 in nursing productivity per hospital, is lost annually to communication delays. When adding in the cost of lost productivity of other staff and the cost of communication-induced medical errors and delayed patient discharges, this cost exceeds $10 billion.The Joint Commission
, charged with improving the safety of healthcare delivery in the United States, has examined sentinel events (events that signal the need for investigation and response) as a way of understanding dangerous medical errors. In their analysis of more than 4,000 sentinel events, The Joint Commission found that two-thirds were due to communication problems.Healthcare benefits of unified communications
A major problem in healthcare is determining how to reach appropriate people rapidly. Communications technology can improve communications efficiency across the healthcare spectrum by helping staff to reach the right person directly, on the first try.
Today, most healthcare providers rely on primitive technologies. Electronic pagers, abandoned by most industries, are the core devices for hospital communications. Mobile phones are often banned from hospitals, despite evidence that in most areas this technology is safe. E-mail is often discouraged for clinical communication for security reasons, and more advanced technologies, such as instant messaging, videoconferencing, or Web-based collaboration, are almost unknown in healthcare.
Implementing modern communications technologies is complicated by a lack of interoperability among databases and applications. There may be numerous directories, on-call databases, and coverage lists that must interoperate to streamline the process of identifying the proper contact.
Unified communications (UC) - the integration of disparate communications systems, media, devices, and applications - offers an effective solution to these communications barriers. UC, running on a Medical-Grade Network (MGN), enables healthcare institutions to employ multiple types of communications, including inter-computer, Internet Protocol (IP), voice, and video, while providing wireless access in a secure, comprehensive, and resilient manner. Web message
Secure messaging is a useful option for communication between patients and physicians. Web-based messaging uses a secure Web server to which users - patients and clinicians - log in. Once authenticated, users can send messages to designated recipients. When users have a message waiting in their secure Web-based in-box, the system sends an open e-mail, informing them that they have a message and inviting them to log in to read it. This assures that no clinical information is sent in an ordinary e-mail message, which can be intercepted and misdirected.
IP telephony provides functionality above and beyond simple voice communication. Using a standard wireless network, wireless devices can display information such as telephone directories, patients' clinical information, or even signals from biomedical monitoring devices.
Providing additional utility is a presence server, a database that collects information about a user's availability, and indicates users' preferences for how and when to reach them. For example, a physician may indicate that he prefers e-mail during office hours.
While each user may indicate status via presence servers, computer-based rules allow users to indicate alternate personnel to whom their communications should be directed. Such rules are based on staff schedules (day, date, or time) or on a user's physical location, if the computer system can track the location.
Server-based rules can help software applications automatically route certain calls. In this way, wireless IP communicators can be implemented as a nurse call system, replacing the traditional system where calls from patients are routed through a ward clerk at the central nursing station. In an IP-based nurse call system, a patient can contact his or her nurse through the nurse's wireless IP-phone using existing nurse-call hardware, or through IP phones or service panels located at the bedside.
Additional communication channels can augment the hospital's voice channel system. For example, videophones can connect patients to an interpreter who speaks their language. The interpreter can use an IP videophone, which is more effective than voice-based services because the interpreter can see the patient's body language, often critical to accurate translation.
Web-based collaboration is another effective healthcare communications tool. In a Web environment, medical staff can share a clinical image or data from a patient record, or draft a patient discharge plan. Communicating through one channel in a UC environment provides seamless transition among various channels. For example, a conversation may start with a phone call, move to a videoconference, and finally become collaboration around a Web-based document or image.Costly pain and suffering
There are many other benefits of Unified Communications for healthcare that cannot be covered here. Suffice to say that UC tools, supported by MGN architecture, promise tremendous improvements in healthcare by improving communications, quality of care, and staff and patient satisfaction. Recouping the estimated $10 billion spent in time lost trying to communicate via traditional channels would be a great improvement, but it pales by comparison to the advances that could be achieved in reducing pain and suffering.Related stories
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Daniel Sands, M.D., MPH, is director of IBSG Healthcare and Ciscos director of medical informatics. Sands is the recipient of numerous health IT awards, sits on the board of the American Medical Informatics Association, and has been elected to fellowship in both the American College of Physicians and the American College of Medical Informatics.
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