Healthcare providers use Yammer to stay connected
BRAMPTON, ONT. – Every once in a while, a new technology comes around that completely shakes up the way healthcare providers do things – just think of the impact made by the discovery of anesthetics, disinfectants and X-rays.
More recently, the Internet has been roiling the medical world, producing a communications revolution that includes telehealth and portals for doctors and patients. In the latest chapter of the story, an application called Yammer is being used by physicians, nurses and allied health professionals to keep in touch with each other in ways never possible before.
Yammer has been likened to a private Facebook network for businesspeople that connects members locally or around the world with a high level of security. The system was launched in 2008 by entrepreneurs David Sacks and Adam Pisoni. It was purchased by Microsoft in 2012 for $1.2 billion. (www.yammer.com)
Here in the Canadian healthcare sector, the Wise Elephant Family Health Team (www.wiseelephantfht.ca) in Brampton, Ontario, started using Yammer last September to connect the 10 doctors working at its three clinics. The system also links the pharmacists, nurses, psychologists, occupational therapists and community care workers who deliver care to its patients.
It worked so effectively, the Wise Elephant physicians launched a not-for-profit organization and opened the system to other family health teams and medical organizations. Since September, more than 2,500 individuals across southern Ontario have joined, and the numbers are quickly growing.
“Our vision is to connect every healthcare provider in the province,” commented Dr. Sanjeev Goel, a family physician at the Brampton Wise Elephant Family Health Team. To help achieve that objective, Dr. Goel now employs a squad of seven software and application developers who work right in the building.
The not-for-profit is called the Health Quality Innovation Collaborative and the development team is busily devising computerized solutions for the Yammer-based network.
Just as members of the general public habitually check and post to Facebook throughout the day, healthcare providers on Yammer keep each other informed with short messages.
“One of my patients had her baby at the hospital in Brampton, and a member of the team at the hospital was able to let us know, right away, on Yammer,” said Dr. Goel.
More urgent questions constantly come up through the day that can be quickly answered using Yammer. “A doctor may want to know the best way to burn off a wart,” said Dr. Goel. “Someone else may want to know if slim bands are covered by OHIP. My receptionist may have a patient calling with a problem, but she doesn’t know who on our team should see the patient. She can post to find out if I’m the most appropriate person, or whether we should send the patient to our nurse practitioner or another caregiver.”
All of these problems can be solved in minutes – members of the network can answer the questions in short, online responses. And it doesn’t matter where the physician or caregiver happens to be – all he or she needs is a smartphone, tablet computer or workstation.
That contrasts with the time-consuming process of tracking down individual doctors or nurses by phone. Members can also post about meetings – recent messages on the Yammer-based network, known as Synapse, include posts about a continuing-medical education dinner. They can even record the minutes of meetings so that others can see what took place.
Finally, medical encounters can be captured and pushed into the electronic medical records used by clinicians. At the Wise Elephant FHT, they use the Oscar EMR, and the Yammer application has been integrated with it. Right now, Yammer isn’t integrated with other EMRs, such as Nightingale, QHR’s Optimed or Telus’s MD Solutions, but that could all be done in the future, said Dr. Goel.
He noted that while electronic medical records do help automate clinics, EMRs were originally designed to be used inside offices and typically don’t offer quick methods of communication with caregivers in the outside world.
“Our doctors are working in our three clinics, at the local hospital [the William Osler Health System] and we’re sometimes making house calls,” said Dr. Goel. “We didn’t have access to our EMR from the hospital, and we didn’t have easy access to other members of the team.”
To solve this conundrum, HQIC deployed Microsoft’s Sharepoint server solution and commissioned its developers to create systems that enable care-givers to tap into the EMR from remote locations. The developers also created a ‘cloud’ that allows other healthcare facilities – such as laboratories – to quickly transmit patient information. That information is then integrated with the patient records in the EMR.
HQIC has also created solutions for patients using its Sharepoint server. Just released is a system that sends out appointment reminders to patients 72 hours prior to the appointment, by e-mail or SMS text. Patients can confirm or cancel right on their smartphones, and the EMR is immediately updated.
A patient portal (www.midash.ca) has been launched that enables patients to book their own appointments; they can also view their own lab results. The system converts the data into easily understood charts for patients showing normal and abnormal test results. In addition, the patients can send messages to care-givers and also converse with each other. miDASH was announced as one of the winners of the Canada Infoway Imagination Challenge at the May eHealth 2013 conference in Ottawa.
“About 2,000 patients are on it,” said Dr. Goel. The HQIC has also produced an e-referral system that quickly enables care-givers to communicate with specialists, send patient information, book appointments and determine the wait-times to see various medical specialists. “We’ve got about 30 specialists on the system,” said Dr. Goel.
What’s more, patients are looped into the system – they’re told right away if an appointment request has been sent, if it has been accepted, and where the specialist is located. Now, the team is integrating various Sharepoint applications with the Yammer solution. Dr. Goel’s group has put $500,000 into developing the HQIC ecosystem using Yammer; he hopes the future development will be aided by outside investments from government, universities or even private corporations.
Recently, the Family Health Team has been working as a Brampton co-lead for the government of Ontario’s new Healthlinks program, which is designed to coordinate networks of care for patients with complex conditions. The idea is to use the Yammer-based HQIC to connect the various individuals who make up the care team for complex care patients – physicians, nurses, physiotherapists and occupational therapists, community care and home care administrators and care-givers.
Members of the team will be able to quickly update each other about the status of various patients – including test results, changes in medication or treatments, and other issues.
According to the Ontario Ministry of Health, complex care patients represent only 5 percent of the population but account for two-thirds of total healthcare spending. By improving the coordination of care, it’s believed that ER visits, unnecessary hospital admissions and readmissions could be averted, thereby improving the quality of care for patients.
Already, 20 of the 186 family health teams across Ontario have joined the Synapse network. In addition, the solution has also attracted groups of users at a variety of other healthcare organizations, including Cancer Care Ontario, the Ontario College of Family Physicians and hospitals.
Most of them are located in the greater Toronto area, but there are now pockets of users in Hamilton, London and Ottawa. Dr. Goel is easily able to show usage stats for the network of caregivers, those associated with the three Wise Elephant clinics. In a seven-day period, 167 people had ‘engaged’ the system, and had posted 2,858 messages. The stats also show a breakdown of device types that are being used. Apple iPhone users made up 64 percent of the group, followed by Android users (25 percent), iPad users (5 percent) and BlackBerry users (3 percent).
In future, HQIC will continue devising new apps for its Yammer-based solution, as usage snowballs across the province. “The users will drive where it’s going,” said Dr. Goel. “We’re constantly getting feedback from them.”
“This is a great example of how healthcare providers are leveraging the Microsoft platform to build out some amazing solutions,” commented Peter Jones, industry lead, Canadian healthcare, at Microsoft Canada, based in Mississauga, Ont.
Single sign-on touted as a remedy to computer connectivity woes
By Jerry Zeidenberg
When patient tests and records are computerized, so the theory goes, it’s fast and easy to access them – all you need to do is click a few keys. In reality, clinicians can be bogged down when they encounter the dozens of databases and repositories that accumulate in a hospital or clinic. It’s just too hard to log-in and out, let alone remember all of those passwords.
That explains why many Canadian hospitals are now investigating single-sign on (SSO) solutions – which tie multiple systems together and enable users to seamlessly enter them with just a single log-on.
According to ongoing HIMSS Analytics research, only about 18 percent of Canada’s hospitals currently have single-sign-on systems deployed. But that figure could easily double, as another 13 percent have either signed a contract to use SSO or are now installing a solution; what’s more, an additional 5 percent plan to acquire SSO in the near future.
A new survey on the topic of computerized patient records, conducted by HIMSS Analytics and commissioned by Imprivata, found that among Canadian hospitals, ‘speed’ was a key concern, and that their clinicians simply weren’t able to access the data they needed in short order. The survey organizers interviewed 12 information technology executives in hospitals and health regions across Canada.
Most of the participants, the survey observed, indicated that having to log into multiple systems was a major concern. One participant said it was his organization’s biggest challenge.
“We’ve actually seen pushback from clinicians when there’s too many systems and they can’t get into them,” commented Dr. Sean Kelly, an emergency physician at Beth Israel-Deaconess Hospital, in Boston, and chief medical officer with Imprivata, a leading provider of single sign-on systems. “Not only are the clinicians slowed down, but their thought processes are interrupted by the constant log-ins.”
Indeed, getting into and out of multiple computer systems can be a mind-numbing business. “An emergency physician can log-in and log-off several hundred times a day,” commented Dr. Kelly, who speaks from first-hand experience at Beth Israel-Deaconess and also refers to studies conducted by Imprivata.
The constant interruptions are irritants to doctors, but they can also affect the flow of work in a busy emergency room or hospital department. “When a patient presents with a stroke, we’re dealing with a very time-sensitive condition,” said Dr. Kelly. “It’s a big problem if you’ve got to log into and out of different systems.
“You’ll likely need to get into a medication management system, the radiology system, and the patient registration system,” he said. “You’ll also need to contact an on-call neurologist.”
A similar process will be needed for numerous other patients – heart attack victims, those with gunshot wounds and other traumas, serious allergic reactions or adverse drug events. In these cases, time is of the essence, and it’s important to have rapid access to data and expertise.
For its part, Imprivata has installed single-sign-on solutions in many hospitals – including over 60 in Canada. In the United States, about 35 percent of hospitals have implemented SSO; of these, Imprivata claims a 30 percent market share.
Through experience and measurement, Imprivata has found that SSO can save a clinician from 30 minutes to an hour each day. At one large hospital using single sign-on, the Johns Hopkins University Hospital in Baltimore, Md., Dr. Kelly said the time savings are amounting to 2,500 hours each month.
“Single sign on is about saving clicks,” commented Ed Gaudet, chief marketing officer at Imprivata. In many instances, he said, “it takes too many clicks to get to where you want to go.” SSO in hospitals can reduce the barriers – and the clicks – so that clinicians are able to focus on patient care.
Single-sign-on systems can also ease the creation of a ‘virtual desktop’ in hospitals. Using a virtual desktop, a physician can log-into system upon arriving at work, and if called away to a different exam room or department, may call up the document he or she was just working on simply by tapping a badge or swiping a fingerprint on a nearby workstation.
In effect, the work follows him or her around the hospital.
Dr. Kelly noted the system can be customized for each individual, so that key programs boot right upon log-in. For example, a physician may want to see his or her patient list for that day – that, along with several other documents and programs, can power-up immediately and reside in memory for quick access.
About half of the participants in the HIMSS/Imprivata survey reported that SSO is being used or piloted in their organizations at the present time. Several of them are first testing SSO in their emergency departments, as these are high-traffic zones in which doctors need to quickly access data from various systems.
Intelligent system promotes communication, provides decision support
By Jerry Zeidenberg
OTTAWA – The Ottawa Hospital – renowned in high-tech circles for acquiring over 3,000 iPads and integrating them with its clinical systems – has now developed an automated communication system that runs on the mobile devices and keeps clinicians in touch with each other.
Developed in conjunction with IBM, the new Care Management Platform also boasts analytics and decision support capabilities that tie into various computerized databases and alert clinicians to possible problems with their patients.
Together, the communications system – which keeps whole groups of caregivers in touch with each other – and the decision support that goes along with it has led to better patient care.
In a pilot phase, the system was tested with cancer patients, and the analytics component caught 500 patients at high risk of suffering venous thromboembolism (VTE), something to which certain cancer patients are prone.
In VTE, a clot in the leg is in danger of breaking off and travelling to the lungs, resulting in a life-endangering situation.
“The system allowed us to provide prophylactic care instead of emergency care,” commented Dale Potter, senior vice president of strategy and transformation. Potter also pointed to the cost savings for the hospital. “Treating each VTE patient can cost $9,000 to $10,000,” he said. In October 2012, the system was rolled out into a larger pilot phase that includes 100 beds in the 1,000-bed hospital. The Ottawa Hospital is finding it be an invaluable tool, as it enables clinicians to build teams around the particular needs of patients.
Instead of tracking down different types of caregivers – pharmacists, physiotherapists, social workers and others – the whole care team appears in an online grouping. A physician can display updates on electronic whiteboards or mobile devices to individual members of the team, or inform the entire circle of care about a recent patient test result or change in the care plan.
“Instead of showing up on the ward and asking the patient, ‘who is your social worker today?’, I can see who it is, right in the system,” said Dr. Glen Geiger, chief medical information officer at the Ottawa Hospital. Previously, if the patient didn’t know, and many don’t, as they are unwell, the physician would have to start asking around – a time consuming process.
“None of our systems could tell us who the members of the care team were, and who was on duty,” noted Dr. Geiger. In future, he would like patients to have access to this portion of the system – possibly on monitors in their rooms. “We can even post photos of their doctors and other caregivers,” he said.
By checking the notes and postings made by various members of the care teams, physicians can keep better tabs on the progress of their patients. In many cases, it allows them to coordinate care without sitting down with each care team, resulting in a huge time saving. “I may have patients on eight different wards, on different floors of the hospital,” he said.
It’s a lengthy process to visit all of them to check on their progress. Instead, the Care Management Platform can provide the necessary insights, and convey whether a team meeting is needed.
The system also provides a patient list and task list. If a physician is away or running behind, he can send a message asking a colleague to perform a task; if that physician is unable to fulfil the request, the system then pings another clinician until the job is done. “It’s a closed loop, and it ensures that you don’t lose track of these things,” commented Dr. Geiger.
For the patients, it means that all of the care they’re supposed to receive is actually provided – nothing slips through the cracks.
And for clinicians and the hospital, it’s a clear record of the work that various team members have performed. “I like this solution,” said Dr. Geiger. “The hospital knows what work I’ve done. It also shows me that I’ve done everything I’m supposed to do.”
The Care Management Platform is also giving clinicians a much more realistic idea of when patients can be discharged. Under the current modus operandi in hospitals, clinicians are often expected to forecast a discharge date as soon as the patient is admitted. This, however, is difficult to do, as the condition of a patient may change radically over the course of his or her stay.
Cameron Keyes, director of healthcare process transformation, calls it “process variation”, with clinicians often determining the new discharge date just by the way a patient appears.
The Ottawa Hospital now waits until the patient is stable before determining the discharge date. That ‘medically ready’ date is reached with the help of the Care Management Platform, which uses algorithms to ensure the patient is stable.
The new system has resulted in much more accurate discharge dates, which helps with bed management and resource planning. It also helps with patient satisfaction, as it’s terribly disappointing to be told you can leave on certain date, only to find out later that you’re staying several more days.
Keyes observed that the Care Management Platform was devised to solve clinical problems. “We asked our clinicians what the biggest problems were,” he said. “They told us they needed better communication with each other, improved tracking of tasks, and a better way of predicting discharge dates.” With the solution that was created, The Ottawa Hospital has made progress on all three fronts.
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