health care, communication, care coordination

1. clinicalMessage
transform care through realtime communication
Abstract
clinicalMessage® is a robust Provider-centric communication platform that facilitates realtime care collaboration across the entire interprofessional frontline clinical team. clinicalMessage® is not a solution to substitute for pagers or to replace the essential Electronic Health Record(EHR). However, clinicalMessage® is a pragmatic solution that fundamentally transforms how clinicians communicate in the patient care setting and enables a streamlined processes through the use of best practices, and secure Smartphone information technology.

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Copyright © 2014 iCareQuality Inc.
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Document No. 08201405
Published by iCareQuality Incorporated® in 2013, 2014
Any comments relating to the material contained in this document may be submitted to:
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 Phone: 610 732 8500
 PR@iCareQuality.org

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Table of Contents
Abstract ................................................................................................................ 1
Problem Background with Rising Cost and Complexity ................................... 4
Transform How Clinicians Communicate ......................................................... 5
clinicalMessage® Built-in Capabilities ............................................................... 7
Mobile Communication and BYOD .................................................................. 7
Patient Handoff and Care Transitions .............................................................. 8
Closed-Loop Messaging Communication ......................................................... 8
Enhanced Patient Experience ............................................................................. 9
Industrialize Evidence Based Practices .............................................................. 9
Performance Measurement and Business Analytics ....................................... 10
Access to Expert Community for Learning ...................................................... 10
clinicalMessage® Architecture .......................................................................... 11
Deployment Options ......................................................................................... 13
Summary and Call to Action ............................................................................. 13
References .......................................................................................................... 14
About iCareQuality Organization .................................................................... 15
About Our Team ................................................................................................ 15

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Problem Background with Rising Cost and Complexity
In considering the home care, primary care office, patient centered medical homes, hospital or long term care setting, the need to communication and collaboration can occur in the management of urgent medical issues when a clinician is needed in a real-time. They can also occur in non-emergency situations when multiple members of the interprofessional care team contribute to resolving a patient’s issue such as, diagnosis, care plan, discharge planning etc. Depending on the complexity of the patient’s condition, care must be coordinated across multiple disciplines and specialties. This includes the nurse, the pharmacist, and other allied health staff, along with the various specialists involved such as cardiology or critical care and often family members. Most of this communication is facilitated through the use of numeric pagers and so it is inefficient and interruptive. Transfer of care from one shift to another occurs multiple times a day for a patient and so is another source of errors when communication breaks down.
The literature has also suggested that eliminating these communication inefficiencies and failures will significantly improve patient safety and quality of care. [1-4] Poor communication in hospitals also contributes to a significant burden of rising healthcare costs. A 2009 report estimated that communication inefficiencies among care providers in

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U.S. hospitals cost the country $12 billion per year.[5] In Canada over the last decade, the government’s federal health care expenditure has more than doubled from $97.6B in 2001 to a forecasted $200.5B in 2011. Per capita spending during this same period has increased from $3174 to $5811 per person (84%).[6] In comparison, the GDP for Canada across all industries between 2001 and 2010 increased at a rate of 19% ($1041B to $1234B). [7] Research indicates that the greatest sources of waste in healthcare – time and money (54%) – are largely due to increases in patients’ length of stay that stem from poor care coordination and slow discharges.
In the midst of these economic challenges, the public still expects to receive high quality health care, with greater quality of life, increased safety and shorter waits. Therefore, a new approach is much needed, and research highlights that investing in healthcare information and communication technology (ICT) solutions that dramatically help streamline communication among caregivers as well as patients and families; and can improve the quality of care while shifting the cost curve downward at the same time.
Transform How Clinicians Communicate
clinicalMessage is a robust provider-centric communications platform that facilitates care collaboration across the entire interprofessional frontline team. clinicalMessage is not a solution to replace pagers. However, clinicalMessage

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fundamentally transforms how clinicians communicate with one another by enabling streamlined processes through the use of information technology. The real-time system was designed by experts from the University Health Network (UHN) in Toronto, Canada that have been developing and evaluating communication solutions for the past eight years. Key principles that have guided the development include:
 Patient Centred: The solution is designed with the patient at the centre of all interactions and functions, rather than the clinician.
 Focussing on the Process: Most of the issues relate to the complexities inherent with interprofessional collaboration and technology is simply an enabler.
 Intuitive and Easy to Use: The application must be simple and intuitive enough that a clinician who has received no training can immediately use the primary functions of the system. This is critical in an academic teaching environment where the clinicians are very transient.
 Extensible: The solution can be easily and quickly modified to support innovation and the development of new care processes.
 Engaged Stakeholders: improvement is not limited to selected few, all affected stakeholders including care givers, patients, family members and vendors must have the ability to suggest improvement. These opportunities must be processed through active Learning Organization.

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 Real-Time Evidence of Success: To improve adoption, the system must show evidence of success through real-time dashboard that is based on data collected through natural workflows.
clinicalMessage® Built-in Capabilities
The specific capabilities that clinicalMessage has been designed to enable include:
1. Mobile Communication
2. Patient Handoff
3. Closed-Loop Messaging
4. Enhanced Patient Experience
5. Industrialize Evidence Based Processes
6. Performance Measurement and Business Analytics
7. Expert Community for Continuous Learning
Mobile Communication and BYOD
Mobile devices, particularly Smartphone’s, are becoming an integral part of healthcare and clinicians have adopted their use to improve productivity. Clinical Message supports the mobile clinician and provides the primary functionality on any device. Advancements in mobile device technology requires the solution to be device agnostic (ie. not associated

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to any single platform), ensuring it can be adopted by a large academic teaching hospital or a small community based hospital.
Patient Handoff and Care Transitions
The patient handoff module supports the transitions in care that occur between clinicians at shift change. This solution supports the physician sign-out process, nursing handover, huddles, rounds and facilitates key interprofessional communication activities that were traditionally facilitated through the nursing Kardex. clinicalMessage facilitates the communication of key summary information data to ensure everyone in the patient’s circle of care can make timely decisions when an issue arises. It also ensures everyone is aligned regarding the patient’s overall care plan, improving efficiencies and expediting the discharge process.
Closed-Loop Messaging Communication
The messaging module facilitates communication between healthcare providers for coordinating patient care. However, it is not simply a feature that allows text messaging. It utilizes rules and logic to separate urgent and non-urgent communication to ensure critical issues are addressed immediately while at the same time allowing less critical issues to be addressed with less priority. The closed loop feature allows notifications to be sent when less critical issues remain unaddressed, ensuring nothing “falls through the

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cracks.” This reduces the amount of interruptions experienced by clinicians, improving their overall efficiency and productivity.
Enhanced Patient Experience
The Patient Experience module would introduce patients to their clinical team so they know who is caring for them. It would provide patients and their family and friends a high level overview of the care plan so they can remain informed and be active participants in the care being provided. There is the ability for the patient to provide real-time feedback to the clinical team on the quality of care being provided, allowing changes to occur while the patient is still in hospital. The module would also provide an interface for the patient to remain connected with family and friends when they are not in hospital for added support.
Industrialize Evidence Based Practices
Evidence-based practices are available to promote the standardization of care, improving the quality and safety of care provided. clinicalMessage® employs the use of checklists to facilitate alignment of patient care activities with best practices and scorecards to measure performance and adherence to these best practices. Rules and logic are used to provide reminders when a best practise is not being followed, allowing clinicians to adjust their care on a real-time basis. For example, if an intravenous line has been in place for more

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than 72 hours, the nurse will be reminded that the site of an intravenous line needs to be changed every 72 hours to avoid phlebitis (inflammation of the vein).
Performance Measurement and Business Analytics
Key performance metrics and data required for regulatory reporting is captured, monitored and tracked in real-time, allowing issues to be identified and interventions employed before issues arise. Operational inefficiencies can be more readily identified, allowing process improvement activities to be focussed on areas of primary concern for the organization. Functional dashboards and business analytics tools provide many views and approaches for organizations to improve their operational effectiveness. For example, various metrics around the emergency department disposition process can be monitored and if a bottleneck is identified, such as an inpatient service delaying consultation, escalations to the service’s clinical director to remove this bottleneck can occur.
Access to Expert Community for Learning
clinicalMessage® is not just a communications solution, it is also a community of experts that collaborate to improve the quality and efficiency of patient care. While every organization may face similar communication challenges, the priority associated with each challenge may be different. One organization may focus on improving one process, while another organization focuses on improving another. By

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creating a central knowledge base that allows healthcare organizations to learn from one another, everyone benefits and can improve their processes in a shorter period of time.
clinicalMessage® Architecture
clinicalMessage® allows patients, families and clinicians to collaborate both in synchronous and asynchronous manner using their own mobile or desktop devices (see Figure 1). Collaboration initiator decides on when the response is required. If an urgent response is required, the system alerts the parties via SMS (no PHI information is transported via SMS), otherwise message is posted in responder’s inbox and alerts are sent as requested by the responder.
 Integration with Hospital EHR: clinicalMessage integrates with multiple EHR solutions and pulls the data using HL7 standards.
 Third Part Mobile Apps: QRS provides a secure and reliable integration mechanism for third party apps such as blood pressure, diabetes, patient location applications etc.
 SMS Gateway: Built in SMS gateway enables secure transmission of all messages at significantly reduced cost than cellular carrier.
 clinicalMessage® does not require real-time integration with core hospital systems. This reduces the complexity and cost yet provides most critical information to all stakeholders in real-time.

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Figure 1: clinicalMessage Integration Architecture

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Deployment Options
 Public Cloud: leverage the QRS managed cloud in your jurisdiction and interact with clinicalMessage™ using your own mobile device
 Private Cloud: let us build and maintain your own private cloud
 In-House: Deploy clinicalMessage in your own datacenter
Summary and Call to Action
In summary, clinicalMessage® is not a replacement of the Electronic Record System (EHR) or the traditional pager system, but an adjunct to both systems. Having a complete patient record is critical for appropriate care delivery. The accuracy of a patient record is important and the entire patient experience should include BOTH the EHR and the clinical communication record. Thus with a complete record, it is important to manage costs and to make the patient electronic health record available to essential and care team Providers in realtime.
Thus, access to real-time essential information helps improve quality of care, patient satisfaction, staff satisfaction and brings real transparency and accountability of care delivery. With clinicalMessage® deployment, healthcare leaders can accomplish this without investing millions of dollars in a risky EHR enterprise rollout.

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References
1) Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Consensus Report: National Academy of Press, Washington, DC.
2) The Advisory Board Company (2012). Strengthening Interdisciplinary Collaboration, Best Practices for Enhancing Partnership and Communication. Nursing Executive Center, Washington, DC.
3) M Smits, M Zegers, P P Groenewegen, D R M Timmermans, L Zwaan, G van der Wal, C Wagner1,, Exploring the causes of adverse events in hospitals and potential prevention strategies, BMJ, Qual Saf Health Care, 2010
4) Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med 2004 February;79(2):186-94.
5) Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004 May 25;170(11):1678-86.
6) Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in U.S. hospitals. J Healthc Manag 2010 Jul;55(4):265-81.
7) Canadian Institute for Health Information. National Health Expenditure, 1975 to 2011. Nov 3, 2011. Available: http://secure.cihi.ca/cihiweb/products/nhex_trends_report_2011_en.pdf
8) Statistics Canada. Gross Domestic Product by Industry, 2001 to 2010. Available: http://www5.statcan.gc.ca/ bsolc/olc-cel/olc-cel?catno=15-001-X&lang=eng&chropg=1

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About iCareQuality Organization
iCareQuality, Inc. is a benefit corporation registered in state of Delaware United States with head office in Springfield Pennsylvania. We believe systematic engagement of care providers is key to building a sustainable healthcare system globally. To support our mission we build provider engagement tools, enable care providers develop new knowledge and freely disseminate this knowledge to care providers globally. As a benefit corporation, we pledge 40% of our profits to our providers, 50% for reinvestment and 10% for our investors.
About Our Team
Chief Architect
 Jason Uppal, P.Eng.
 Jason.Uppal@iCareQuality.org
Clinical Support
 Kate ONeill, MSN, RN
 Kate.Oneill@iCareQuality.org
Sales and Business Development
 Bryan Weston
 Bryan.Weston@iCareQuality.org