On Communication and Patient Safety

Interoperability

Efficiency and effectiveness in medical communication creates a culture of trust and excellence, which in turn generates and reinforces value to care teams, patients, and families. The clinical transition process, an integral part of patient care, is a perfect example of the need for strong communication. Communication between clinicians regarding patient condition, treatment plan, and care directly relates to the quality of health outcomes and system success. A study by the Joint Commission on Accreditation of Healthcare organizations found that communication errors were the root cause of almost 70% of all sentinel events (Joint Commission, April 19, 2015).

Examples of where care transitions happen include hospice, physical, speech, and occupational therapy, labs, radiology, and ambulatory care.

Effective communication is a complex concept requiring skill, insight, empathy, and understanding. Variations and inconsistencies in hand-off practices, together with an apparent lack of best practice guidelines, contribute to increased risk for patients and interruptions to the continuum of care.

Opportunity for Best Practices enabled by Technology

According to the Centers for Medicare and Medicaid Services (CMS), hospital readmissions significantly contribute to increases in health care costs and to decreases in patient safety. The CMS is actively engaged in an effort to adopt a pay-for-performance payment methodology to reduce hospital readmission rates. The three diagnoses currently selected for study are acute myocardial infarction (AMI), heart failure (HF), and pneumonia.

An analysis of the current state of readmissions helps to quantify the opportunity for improving the clinical transition process. This analysis found that the total number of patients readmitted in the identified diagnoses, over a 1-year period, was more than 1,500. Of the total patients readmitted in these diagnoses, 400 were within 30 days of discharge. The assessment included financial data, such as the cost of a readmission, the likely penalties incurred if readmissions remained unacceptably high, and the cost to the health care system for repeated rehospitalizations. The unadjusted cost per case related to 30-day readmissions is $8,033 for HF, $10,549 for AMI, and $7,816 for pneumonia. This translates into an annual excess opportunity cost of $359,505. If hospitals are not successful in reducing 30-day readmissions, the penalties could be severe. The cost in reimbursement for the federal fiscal year 2016 was 1% of total Medicare reimbursements, increasing to 3% in 2017, resulting in $1.8 million at risk annually (Vol. 19/No. 2 Professional Case Management).

Reducing readmission and improving clinical and financial outcomes requires a clear, comprehensive view of care for each patient as they transfer from an acute to a post-acute care environment. By tightening transitions and moving away from siloed healthcare systems where communication between hospitals and skilled nursing partners is neither standardized nor coordinated, all parties not only improve their processes, but also set the bar for new best practices in transitions of care.

Clinical medicine and public health have historically operated somewhat independently, despite having the common goals of supporting the health of individuals and communities. Emerging opportunities for drawing the health care and public health sectors into collaborative efforts aimed at improving population health have revived enthusiasm for integrating clinical medicine and public health (Institute of Medicine, IOM, 2012). Developing strong partnerships between clinical medicine and public health can help improve transitions from clinical to community settings and has tremendous potential to improve health outcomes, reduce health disparities, and advance population health. As we face challenges of health reform and pandemics such as COVID-19, such partnerships offer the opportunity to reinvent the health care system by emphasizing preventive care and population health.

While much time and expense goes into deciding how to solve issues around interoperability, Direct Secure Messaging and Cloud Fax offer a simple, low-cost way to share key patient data that support cross industry collaboration. Organizations can use these technologies within and between all clinical and financial systems to simplify document and data patient referrals, transitions of care directives, and appointment scheduling. Optimized workflows with bi-directional information enhance both safety and quality across the care continuum.

Cloud fax in particular enables communications between disparate health systems that need to share patient data across care settings. Cloud fax technology eliminates the need for paper and supports safe HIPAA compliant document transmission. As the industry continues the work of interoperability and data standards and structures, cloud fax supports information exchange for the comprehensive longitudinal care record required to treat the patient and family with complete information.

Secure and dependable communication is fundamental to managing patients across varied care settings. With the continuous rise of sentinel and adverse events due to ineffective communication, it is time for healthcare teams to start implementing effective cross-system technologies and workflows to improve patient safety and communication. The rising importance of patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores required by the CMS are causing a shift in how hospitals evaluate and manage their health care organizations today. An improvement in patients’ ability to assume greater control and responsibility for care decisions enabled by information/communications technologies also advances many of the IOM’s six aims for patient-centered, quality health care. Information/communications technology systems give patients access to timely, effective, and convenient care and greatly improve patient compliance with guidance/treatment protocols, including preventive measures. Greater compliance with clinicians’ guidance—preventive or palliative—and more timely intervention in case of illness not only benefit the health of the patient but also reduce the costs of caring for the patient over time.

Brenda Hopkins. MBA, BSN, RN
Chief Health Information Officer
J2 Global – Cloud

Brenda Hopkins