Four Keys to Great Communication in COVID 19
Era for Post Acute Care

Communication-in-post-acute-care

In these hectic times, communication becomes more important than ever. Frontline healthcare providers need both factual information and emotional support in a regular flow. Effective leaders will distinguish themselves now by providing appropriate context for communications, using best practice tactics and deploying leading edge tools. Even if you’re already “in the thick of it”, there’s time to take a deep breath and assure you are communicating well.

PROVIDE CONTEXT AND SUPPORT

Watch your language: In uncertain times, teams look to leaders to pull teams together with resolve and steadiness. Choose your words carefully using “we” instead of “I”. Show empathy and compassion for your team. Focus on forward looking actions that deliver progress. Avoid words like “struggle”, “fear”, and “worry”. When communicating a problem, use “U turn words” like “although”, “nevertheless”, “on the other hand”, “in contrast”, “yet” that demonstrate strength in the face of challenge.

Build trust to maximize communication: Remember that communication is a receiving phenomenon. What individuals receive and hear is based on their mindset and ability to process information. By following through on commitments, leaders build trust and lower the level of anxiety inherent in challenging situations. Listen for concerns and share solutions and commitments to solve problems. Invite collaborative problem solving to avoid the expectation that people wait for someone else to resolve issues. Underpromise and overdeliver.

Focus on your organization’s actions: In times when it appears things are out of our control, it’s helpful to demonstrate concrete progress. Highlight where your team is reducing risk. Share where mandates are being implemented quickly. Build a picture of step by step actions over time demonstrating progress. Make sure that the latest Covid19 best practices are being shared and fully implemented. Give a clear plan and follow through. The plan should be adjusted as new information comes communicating “here’s what we learned and here is what we are doing now”.

Provide emotional support and encouragement: Staff need to be appreciated when they are going above and beyond. A few words of gratitude and care go a long way in reinforcing their energy. Every communication should include thanks for the extra effort required to manage through the challenges of the crisis. Families are also under tremendous stress and will need regular communication to cope with the challenges.

USE BEST PRACTICE TACTICS

The Virtual Daily Update/ Standup: To keep the teams on the same page, start each day with a quick 10-30 minute huddle of relevant work groups to give everyone the relevant developments of the last 24 hours. Invite questions and idea generation that might be teed up today and followed up tomorrow or in weeks to come. These can be via conference call, Zoom, Google hangouts or other means. The 

“Daily” standup may need to be “Twice a Day” in buildings with may patients with quickly changing status.

Action Teams: If an idea for improved care or safety comes up in a Standup that requires more than a couple of minutes to think through and implement, assign an accountable person or team to follow up and share the plan following the Stand Up. It’s okay for those teams to come back and say, “We checked it out and it’s not an opportunity for now because (we don’t have the resources, we can’t do it effectively right now, etc.). We’ll revisit in the future when the situation changes.”

Virtual Town Hall Meetings: At least monthly, have the whole cross functional team together. Even while we are practicing social distancing, virtually bringing the team together matters. Make sure referral partners, front line aides, therapists, nurses and the whole team can share questions and ideas. Leadership can communicate the path forward and provide the necessary context for the team to pull together

Cascading Messages: The most credible information comes from direct supervisors who have the messages their team needs. A quick email, handout, or text letting them know the key things to share with their team helps them feel knowledgeable, aligned with their team, and on top of the plan. Supervisors may need to spend more time communicating one on one to hear staff out on fears and manage concerns.

Coordinating Patient Centered Care: Assure the complete team is in the loop on relevant patient information.

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COVER KEY COVID19 CONTENT

Department of Public Health Guidance: Make sure your team is following the latest mandates for handling Covid 19.

  • PPE requirements
  • Isolation expectations
  • Hospital capacity and positive case trends
  • Alternate care sites and transfer plans 

Reiterating the “basics” of infection control: You cannot remind people often enough how to reduce risk with fundamentals of environmental cleanliness, isolation, appropriate PPE use, and healthy behaviors like hand washing, avoiding touching the face,6+ feet social distancing and using hand sanitizer. Staff traveling from location to location should be reminded to change clothes, particularly before entering a COVID19 Naive environment. There are enough fun memes being created to keep this new daily!

Hospitalization warning signs: Covid 19 patients and PUIs need close monitoring for the following:

  • Difficulty breathing (O2 saturation<91% or a decrease of 3% or more)
  • Increased respiratory rate
  • Muscle aches, malaise, and diarrhea may be indication for increased monitoring to avoid rapid decline
  • Altered state/ cognition below baseline may also require increased monitoring
  • New Confusion or inability to arouse
  • Bluish lips or face
  • New seizure or seizures that won’t stop
  • Comorbid conditions increasing risk include Hypertension, Diabetes, chronic respiratory disease, cancer

Who is NOT eligible for hospital transfer: Reminders may also be helpful to avoid unnecessary hospitalizations when staff might be likely to over-react. Your policies may vary, but clarity such as the following is important:

  • Hospice patient flags should follow end of life wishes to avoid hospitalization
  • Anyone with advance directives inconsistent with hospitalization should remain in place
  • Testing for Covid19 alone is not a valid reason to hospitalize

DEPLOY LEADING EDGE TOOLS

While it may seem a challenging time to use new tools, it’s essential to save your team time and effort going forward. When everything changes every day, it can be a positive change to add a powerful new tool.

Telemedicine Solutions: As mentioned above, there are a variety of inexpensive ways to virtually communicate with teams. Some of the most cost effective and easy to deploy are ZoomGoogle Hangouts, and Webex.

HIPAA Compliant Messaging: As a complement to many of these best practices, HIPAA compliant text messaging can improve communication. Hucu.ai is being used effectively to support many of these practices:
  • Notifications so nothing is missed when there are updates including the ability to tag specific people or teams
  • All team channels including #resident-mgmt, #staff-mgmt. #ppe, #environment-mgmt, #visitor-mgmt, #qapi, #supplies-mgmt, and more
  • Direct messaging to individuals to offer encouragement and support
  • Hucu Honors to recognize staff for high quality behaviors
  • Patient lists prioritized based on flags, condition and communications
  • Patient centered messages including
    • Flags based on risk such as Covid-19 PUI/ Covid-19 +ive/ Covid-19 -ive, Acute Change in Condition, and more
    • Ability to upload images and files for labs, medication lists, and more
  • Ability to launch telemedicine session with a click

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Communication Tools Can Reduce Hospitalizations from Nursing Homes by 50%

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Unnecessary hospitalization of residents in nursing homes is quite frequent and it is emerging as an important area of concern for policy makers. Such hospitalizations can result in disruption in care, iatrogenic events, major complications, morbidity and Medicare expenses that can cost more than a billion dollars per year. But can these hospitalizations be avoided?
Lack of physicians at the nursing homes during off hours is one of the main causes of avoidable hospitalizations. When a medical issue comes up during evening or over the weekend that cannot be addressed over phone, the on-call physician has the option to either travel to the facility or recommend that the resident be transferred to a hospital. More often than not, the on-call physician will recommend the latter. This finding is a result of qualitative research done on the subject to determine the main factors leading to hospitalization of nursing home residents and whether or not those could be avoided. Let’s have a quick look at this research. Since these highlight one of the main causes for such hospitalizations to be the lack of a physician present in nursing homes during off hours e.g. weekends or after midnight during weekdays, we will also talk about how important the role of communication is in a medical setting.

Research by Georgia Medical Care Foundation

six-month prospective quality improvement initiative conducted by the Georgia Medical Care Foundation, the Medicare Quality Improvement Organization (QIO) for Georgia found that a substantial percentage of hospitalization can be avoided and the saved money can be re-invested to improve the quality of nursing homes in the US. In the project, three participating nursing homes were given communication and clinical practice strategies and tools to help reduce the potentially avoidable hospitalizations. These included:

  • Use of an early warning tool (Stop and Watch) for communication between licensed nurses and nursing assistants.
  • Introducing an SBAR (Situation, Background, Assessment, and Recommendation) tool using case studies on common reasons for avoidable hospitalizations.
  • Establishing communication protocols for reporting change in condition from nursing home staff to primary care clinicians
  • Facilitating interaction between the nursing home, emergency room and acute care hospital staff through site visits to understand role and abilities.
  • Access to telephonic support by an advanced practice nurse.

The research found that although no facility fully implemented the communication tools and strategies, the partial implementation led to a staggering 50% reduction in the overall rate of hospitalizations during the six months study period. The research also concluded that while INTERACT (Interventions to Reduce Acute Care Transfers) tools were valuable in everyday practice; they cannot be used as frequently. The main barrier is the perception of additional paperwork which results in many of the forms not being used.

Research by AB Cohen: Avoiding Hospitalizations from Nursing Homes for Potentially Burdensome Care

Another qualitative study published in 2017 had sought to understand the reasons why some nursing homes are more successful than others at preventing avoidable hospitalizations. The study was conducted in Connecticut nursing homes with hospitalization rates in top or bottom 10%. It was found that:

“Facilities using publicly available data (http://www.ltcfocus.org) and conducted in-depth, semi structured interviews with key staff members, using a standard interview guide, until theoretical saturation was reached. Interviews occurred at 4 high-hospitalizing and 4 low-hospitalizing facilities and involved directors of nursing, facility administrators, physicians, advanced practice clinicians and other staff. Participants at all facilities recognized that residents were hospitalized for potentially burdensome care and identified a common set of barriers that made it difficult to avoid such transfers.”(Cohen AB, Knobf MT, Fried TR. Avoiding Hospitalizations From Nursing Homes for Potentially Burdensome Care: Results of a Qualitative Study. JAMA Intern Med. 2017.)

The set of barriers mentioned in the study included:
  • Families’ guilt pushing them to do everything they can in an emergency situation includes hospitalization.
  • Families’ belief that nursing home provides inferior care.
  • Unavailability of clinicians at nights and weekends
  • Difficult decisions faced by staff in relative isolation.

Research on Factors Contributing to the Hospitalization of Nursing Home Residents

A new study of residents in traditional Medicare who were discharged to nursing homes between January 2012 and October 2014 concludes that residents who did not get an opportunity to be seen by a physician were more likely to have a poor outcome like:
  • Return to the hospital
  • Death
  • Failure to return successfully to the community
The study suggests that ensuring physicians see residents after they are admitted to a nursing home could lead to fewer re-hospitalizations. For many years, lack of adequate nurse staffing levels has been linked with re-hospitalization of residents. Published thirty years ago, a three-year long study of non-clinical factors contributing to the re-hospitalization of residents finds that insufficient and inadequately trained nursing staff who could not help with residents’ complex health care needs caused the latter’s re-hospitalizations. (J.S. Kayser-Jones, Carolyn L. Wiener, and Joseph C. Barbaccia, “Factors Contributing to the Hospitalization of Nursing Home Residents,” The Gerontologist (1989))
A paper by Kaiser Family Foundation and Lake Research Partners in 2010 confirms these earlier conclusions about the causes of re-hospitalizations.

Can Communication Help in Avoiding Hospitalization of Nursing Homes Residents?

Communication can play a vital role in reducing the avoidable hospitalizations in nursing homes. If the staff at nursing homes has detailed access to the patient’s health data, forms and information related to possible risks, they would be better equipped at handling a medical emergency in-house. In situations where the medical emergency is complex and beyond the staff’s ability, remote communication with the on-call physician can deal with the problem effectively without rushing the patient to a hospital. This will not only save costs but will reduce the number of avoidable hospitalizations in nursing homes. But how can be such communication made effective?
A study that experimented with telemedicine found out that by making medical consultation available to nursing home patients and their families via two-way videoconferencing, hospitalizations can be avoided.
While telemedicine is effective, equipping and training nursing homes with video-conferencing and high resolution cameras for wound care is difficult. Since the turnover of nursing staff is high in nursing homes, new staff will always have to be trained to use this service which can be time consuming. An ideal solution would be to have a platform that is instant, stores patient data in one place and allows effective communication in emergencies.
This is where Hucu is solving the problem.

Hucu’s Patient-Centered Communication

Hucu is a free HIPAA compliant texting app that allows healthcare professionals to flag patients when changes in condition occur and to notify the relevant staff members immediately. The Hucu application allows medical teams to communicate with each other without the need to fill and submit forms. Its real-time communication allows critical information to be passed quickly to the front line staff. One of the key features of Hucu is reporting that helps with accountability.
Reporting is available for quality assurance team members, administrators and DONs to learn which staff member is communicating effectively and how that affects the patient’s chances of hospitalization. The transparency offered by Hucu.ai allows medical professionals to identify high performing staff members and needs for further training.
As indicated by the research, lack of communication with a physician in a timely manner can lead to hospitalizations that can be easily avoided in nursing homes. Hucu can empower the staff members to communicate with relevant healthcare professionals effectively from a remote position and as a result take better care of the patient round the clock.
This simple shift in the communication channel can reduce avoidable hospitalizations in nursing homes.

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Is Text Messaging HIPAA Compliant?

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In simple terms, no, general text messaging is not HIPAA compliant. Perceived as a social and causal norm, text messaging is not the ideal means of sharing patient information in a healthcare setting. It is an informal exchange of messages that is easy, quick, and convenient. The HIPAA security rule has”national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity”. Therefore, normal text messaging on an smartphone device is missing an extra layer of security ensuring protection of personal health information.

On the bright side, there are growing number of HIPAA compliant text messaging platforms that can be leveraged by the healthcare industry ensuring patient confidentiality. This can be done by integrating HIPAA standards with text messaging thus creating a recipe for success- a HIPAA compliant text messaging solution. The big advantage here is that texting is second nature to most people, hence, a HIPAA compliant text messaging platform would be fairly easy to comprehend and use.

Technology is delivering HIPAA compliant text messaging

Continuous advancements in technology have encouraged the healthcare workforce to implement HIPAA compliant texting in their facilities. Two main stakeholders benefit from this innovation; the healthcare workforce and the patient. As we are in the midst of a full transition to value based care, our thought process and decision making is patient-centered. 

Therefore requiring more coordinated effort across organizations as compared to fee for service models. Health care providers need to communicate among each other to efficiently come up with the best treatment plan for their patients. Hence, HIPAA compliant texting is an ideal solution to be in the loop of a patient’s follow up plan without physically being there.

Continuous advancements in technology have encouraged the healthcare workforce to implement HIPAA compliant texting in their facilities. Two main stakeholders benefit from this innovation; the healthcare workforce and the patient. As we are in the midst of a full transition to value based care, our thought process and decision making is patient-centered. Therefore requiring more coordinated effort across organizations as compared to fee for service models. Health care providers need to communicate among each other to efficiently come up with the best treatment plan for their patients. Hence, HIPAA compliant texting is an ideal solution to be in the loop of a patient’s follow up plan without physically being there.

HIPAA Security Rule

HIPAA already has standards in sharing confidential patient information. However, in terms of HIPAA compliant text messaging or emailing HIPAA information, the Department of Health and Human Services has introduced the Security Rule. “A major goal of the Security Rule is to protect the privacy of individuals’ health information while allowing covered entities to adopt new technologies to improve the quality and efficiency of patient care”. HHS is in favor of experimenting with technology but has some rules to ensure patient confidentiality.

The point of interest of the Security Rule is to protect ‘Electronic Protected Health Information (e-PHI)’, There are 4 general rules to follow in order to make any app or electronic platform, essentially HIPAA compliant:

  • Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit
  • Identify and protect against reasonably anticipated threats to the security or integrity of the information
  • Protect against reasonably anticipated, impermissible uses or disclosures
  • Ensure compliance by their workforce

It can be inferred that patient data is not readily available to anyone. Authorized individuals only can access and manage patient information.. In addition, e-PHIs cannot be destroyed in an unauthorized manner.

HIPAA compliant text messaging platform: Hucu.ai

Piecing the information thus far, a HIPAA compliant text messaging app has certain rules to follow but is a superb addition to the healthcare industry on both the acute and pot-acute side. An example of a HIPAA compliant messaging app is Hucu.ai, which complies with the Security Rules of HIPAA..
Hucu.ai is a FREE person-centered messaging network with real-time patient health & staff attrition risk reporting. Innovative post acute care physician groups and skilled nursing operators are downloading the mobile app (available both in iOS and Android) and improving communication and collaboration immediately. They help solve key healthcare problems that cause inefficiency and frustration for everyone involved in a value based care model. For instance:
  • Non-HIPAA compliant fragmented communication using outdated 1-1 methods (phone, fax, paper, email and text) with no accountability
  • Lack of visibility of individual patient risk among myriad treatment partners impacting timely care
  • High staff turnover and lack of performance transparency.
Hucu.ai solves these problems with:
  • Easy and FREE patient-centered HIPAA compliant messaging apps, that allow various professionals across healthcare (hospitals, SNFs, Home Health, etc.) to communicate with each other in (i) context of patient, (ii) groups, or (iii) 1-1 direct-messaging.
  • Patient risk visibility
  • Built-in employee appreciation tools
Apps like Hucu.ai are bridging the communication gap between the patient and provider. In summary, today, text messaging is not HIPAA compliant but can be.

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Trailblazers in value based health care – Omair Siraj, CEO of Chestnut Health

Omair Siraj

“The argument of value base care is systematic not scientific” – Omair Siraj

The field of medicine itself is not changing. The challenge, rather, is the rapid growth of the patient population and the provider community keeping up. We interviewed Omair Siraj, CEO of Chestnut health, a privately owned medical group catering to the fast changing needs of acute and post cute care industry in Chicago. 
In a value based care model, there are three patient attributes healthcare teams need to be aware of to reduce risk in patient care delivery:  the current status, fluid status, and the fast status. A delay or gap in any of these will affect the patient directly. Hence, technology is the piece that keeps everyone connected and in the loop.
Siraj clarifies that we don’t need new technology, per se, we need technology that understands the multidimensional aspect of the healthcare industry. We have providers addressing different tiers of the human body and need technology to communicate with one another in real time.  
The challenge today is the availability of sophisticated technology that lacks understanding of the healthcare industry. Hucu.aiBest HIPAA Compliant Texting App holds the expertise to adjust to the fast paced changes in the industry. Hucu.ai is the best choice there is out there of a HIPAA compliant patient centered communication app.

On a macro level, Siraj suggests the following in adapting a value based care 

  1.   Connect with like-minded individuals.
  2.   Look for opportunities during regulatory changes.
  3.   Focus on partners that understand your approach.

 



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Strategies to Improve Interoperability in Healthcare

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“Interoperability promises a superhighway of data, but some hospitals are stuck in the parking lot.” (Burril , 2019).

Interoperability impact in healthcare delivery

In value-based healthcare, more and more clinicians are using a digital domain to effectively share patient information amongst each other. With the right tools and technology, it is easy, fast, and secure. Interoperability simply means sharing patient data amongst health systems. This has become the foundation in creating an effective plan for patient care delivery. Information such as lab results, referrals, precautions, etc are needed right away in order to understand the patient and their needs better thus impacting the value of care. 

Often times these tests are performed at different facilities who tabulate this information in to their own Electronic Health Record (EHR).  However, if a patient is in the emergency room (or any other medical facility), the lab EHR may not be readily available. For some patients, any delay harms outcomes and risks a setback for the patient. In fact, reduction in medical errors, exchange of important data, and increases in the patient’s life expectancy are the main positive benefits of interoperability.

Challenges to achieving healthcare interoperability

A lingering challenge on the hospital front is sharing data amongst their platforms before they can even share it with their patients. Communication via fax, telephone, and email are still being used in many healthcare settings to gain and deliver information with all of the inherent limitations of these communication modes. Relying on fax, phone, and email often results in a lag in the delivery of care, multiple touches to verify completeness and clarity of information, and frustration with one-way asynchronous efforts to communicate when people are unavailable via phone. To improve interoperability in healthcare, Hucu.ai is a secure texting app that provides a platform of easy messaging to seamlessly exchange information among the patient’s healthcare teams so that everyone is on the same page, at the same time, accessing the same information.
On the legislative level, advancements are being required to improve interoperability in healthcare. The Center for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) have proposed a rule to the federal government intending to “improve access to, and the quality of, information that Americans need to make informed health care decisions, including data about health care prices and outcomes, while minimizing reporting burdens on the affected plans, health care providers, or payers.” If approved as proposed, the 3 main highlights will be:

1 - Integration of technology in accessing patient records

Patients will have the ability to access all of their health records via an application programming interface (API). This will enable them better manage their healthcare. Patients will know their diagnosis, medications, billing, etc. They won’t have to call in a doctor’s office to reach their doctor. With the API, all of that can streamlined digitally. 

2 - Improved interoperability amongst clinicians

Healthcare providers, clinicians and hospitals are ensured to have access to the patient records regardless of where they’ve received medical care. Better interoperability will reduce the burden on healthcare providers. Also, this will reduce any potential medical errors. Healthcare physicians are busy and on-the-go, hence, it is important to have current data to make decisions in a timely manner. 

3 - Easier access to payment information

Through API software, entities that pay for healthcare would have an easier access to their payment information from different providers. This change will also lead to providing access to a given plan’s network that is easy to understand and would lead to patients more easily identifying providers that are a better fit for their needs.

These proposals are some examples of improving interoperability in healthcare. Organizations are also working on ways to provide better healthcare delivery to patients. 

Solutions to increase interoperability

The healthcare industry is constantly evolving. Various healthcare systems are experimenting with strategies to implement within their network. The Wall Street Journal provides 4 strategies that hospitals and health systems could consider:

1 - Resolve internal data issues.

Healthcare systems should run an internal evaluation for their digital system regularly to identify the data elements that need to be shared and then standardize a method that can be shared across their system. By doing so will also provide trends and patterns of the organization that can be used for comparison. 

2 - Work with vendors and physicians to improve EHR usability and interoperability.

EHRs represent the paper charts of the patients and are used for billing purposes. They are great to have, however, the problem lies in multiple EHRs used by different healthcare providers for an individual patient NOT connecting with one other. For example, a patient’s lab results from a month ago might be available but not the results from a week ago due to different sites of care and different EHRs. This creates potential confusion, inaccuracies, and delays in the delivery of care. 

3 - Relinquish control of data.

Healthcare providers should not hold back any data. It should all be available to the patient. This creates transparency in the clinician-patient relationship. 

4 - Build Trust.

 “Data security and privacy should be at the center of the evolution toward interoperability.” (WSJ, 2019). Healthcare systems and health plans need to trust each other in sharing information. Nowadays health data is being generated via apps, wearable devices, at home medical devices, etc rather than at a doctor’s office. Therefore, interoperability is important. In the midst of a complex healthcare ecosystem, Hucu.ai’s innovative platform is committed to minimizing traditional healthcare boundaries. Our HIPAA compliant, Free Hipaa Compliant Messaging App is created to assist busy clinicians. Features such as sending images and attachments, and real time messages to the different healthcare teams makes it a smoother process in providing efficient and effective care to the patient.Hucu eliminates the need to fax, email, and phone by bringing clinicians together on a simple, easy to use communication network. Click here to join our email list.

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Trailblazers in Value Based Care – Dr. Bader Almoshelli, CEO of Community Physicians

Trailblazers in Value Based Care

When it comes to leaders who are trailblazing their way through Value Based Care, Dr. Almoshelli (CEO of Community Physicians) is certainly one of the key figures in the midwest. Community Physicians is one of the fastest growing multi-specialty provider groups in the region bringing hospital level care to many facilities (SNFs, Rehab, ALs, ILs, and more).

In a recent conversation with Dr. Almoshelli, he shared his perspective around post-acute care and the industry’s shift to Value Based Care. 

According to Dr. Almoshelli, the industry is transitioning to value based care from the decades old fee for service model; which still is the dominant model. However, for any organization to start moving toward value based care, there’s one most critical and absolute realization it must make. That is, majority of the focus should be on the patient. Those organizations doing what’s right for the patient in a timely manner and adjusting their operations accordingly, while also reaching a positive bottom line, will be the leaders of the future. Dr. Almoshelli is a strong advocate for meaningful communication for his patients, which simply means caring for the patient in real time and communicating with other stakeholders efficiently so best decisions can be made timely – not just doing things (entering information in EHR, waiting for fax to arrive, leaving voicemails and hoping a call back, and so on) for the sake of doing things.

In order to achieve goals in value based care – desired outcomes with positive bottom line, organizations should think about building a strong foundation on 3 critical pillars:  

  1. Excellent Providers (Physicians, NPs, RNs, and more) who work as a team and support not only each other but also partner organizations (post acute facilities) most efficiently
  2. Multidisciplinary Team (Cardiologists, Podiatrists, Physiatrists, Psychiatrists, and more) that becomes an extended team for partners (post acute facilities) so patients do not have to wait for referrals and instead right specialist can jump in at the right time to take care of a given situation
  3. Leveraging meaningful technology to enhance care through standardized and optimized processes (higher quality care) while generating necessary analytics for on-going improvements and tweaks
Finally, in order to accomplish each of the above, an organization has to find ways to ensure that they have the best culture, incentives and tools that make the providers’ lives easier every single day. This allows the organization to not only have dibs on the best talent but also have structure put in place to retain the same. And since Community Physicians’ providers are spread out serving many different locations across different geographies, one of the key success factors is open and streamlined communication not only within the team but also with staff working at partners’ post acute facilities. 
It all boils down to “meaningful communication”, as Dr. Almoshelli mentioned earlier, driving real-time care decisions for the most important aspect of healthcare – the patient.  It is the glue that ties everything together, and that’s why Dr. Almoshelli chose Hucu.ai as Community Physicians’ HIPAA compliant messaging tool because of its ease of use, and ability to be used across multiple facilities and across different partners, yet all such communication is organized around each specific patient (patient-centered).

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CMS Proposed Rule on Interoperability in Healthcare

interoperability proposed rule

On March 4, 2019, The Center for Medicare and Medicaid Programs (CMS) Interoperability and Patient Access submitted an official document, a proposed rule, explaining new policies to address advancement of interoperability and patient access to health information. The vision is to put the patient in the center of their health care and grant them easy access to their team of healthcare providers.

Currently, our healthcare system focuses on providing the latest healthcare services to patients. For instance, healthcare providers have started to implement infrared imaging devices for detecting veins to do blood work. However, according to CMS, one critical issue in the health system is that consumers cannot easily access their full health information. Healthcare providers usually have to piece information together in order to get a complete picture of a patient’s medical history in order to create the best health plan. This creates a lag in healthcare delivery and runs a risk of making errors.

The proposed rule suggests that patients have the ability to access their administrative and clinical records throughout their medical journey. A public comment posted by AMDA- The Society for Post-Acute and Long-Term Care Medicine on this rule showed support and suggestions for the future. Practitioners working in the various post-acute and long-term care (PALTC) settings are in need of interoperability because they see patients at multiple locations. In general, they have burdensome paperwork to keep track of in order to avoid any penalties. A concern is maintaining patient privacy whilst increasing interoperability.

2020 Interoperability Program Overview

By October 1, 2020, under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), “Long Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs) and Home Health Agencies (HHAs) are required to transfer an individual’s health information and care preferences when transitioning to another setting”. Providers are required to update Electronic Health Records (EHR), however, what is being proposed is an implementation of electronic sharing that would connect a patient’s different EHRs and thus provide a comprehensive picture of a patient’s medical history.

 CMS, in it’s final rule, has four main objectives for the 2020 fiscal year.

  • Electronic prescribing – providers are required to prescribe medication electronically.
  • Health Information Exchange – support electronic referral loops by sending health information
  • Provider to Patient Exchange – provide patients access to their EHRs
  • Public Health and Clinical Data Exchange –  have a synchronized reporting system.
At Hucu.ai, we have taken on the initiative of providing a seamless process in communicating regarding patient status via a free HIPAA-compliant messaging app. We understand how complex the healthcare ecosystem can get. Therefore, Hucu.ai provides features such as: sending hipaa compliant messages, uploading images for teams to access, seeing real-time availability, and easily communicate with other healthcare providers. These features are replacing the traditional calling, sending faxes, emails, etc that risk data safety and take time. Our messaging app is catered to provide HIPAA compliant access to shared information.
In conclusion, steps are being implemented to bridge the gap between EHRs and patient access. It is a work in progress and at Hucu.ai, we are working on increasing interoperability by making the communication process simple and less burdensome.

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Importance of Effective Communication in Healthcare

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FOUR Reasons Efficient and Effective Healthcare Communication is Critical

Good communication builds good relationships.  Efficient and effective communication is fundamental to all teamwork. In healthcare collaboration, communication is even more important. Lack of timely and secure communication and collaboration could result in many different bad outcomes not only for patients but also for organizations caring for patients.

  1. Increased Malpractice cases: In fact, Crico Strategies’ reports that healthcare communication failure was a factor in 50 percent  of medical malpractice cases. Specifically, communication regarding patient condition was cited in 26 percent of cases.
  2. Increased medical errors: The Institute for Healthcare Communication has reported, “Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period.” Furthermore, the Joint Commission Center for Transforming Healthcare found that “an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients.”
  3. Lack of timely collaboration among different providers: A recent Commonwealth Fund study reported that “Fewer than half (49 percent) of U.S. primary care providers receive information from specialists about changes to their patients’ care plans or medications…”
  4. HIPAA related penalties: Healthcare providers are also subject to more HIPAA related fines than ever before. Organizational attention to HIPAA compliance by safeguarding patient information and treating it appropriately is no longer optional. Hucu.ai bridges the communication gap with fully featured HIPAA compliant messaging Free, including attachments and images.

In a typical post acute care setting, professionals are struggling with effective and efficient communication. Nurses on duty have difficulty tracking down the multiple physicians, therapists, and other healthcare professionals involved in a patient’s care. They spend time emailing, faxing, and phoning that could better be spent caring for patients. And that is after taking the time and energy to track down the appropriate referrals and contact information. While collaboration is critical in healthcare teams, the tools available have lagged behind the needs.

Each facility has implemented a complex EHR (Electronic Health Records system)  which isn’t integrated with EHRs used by partner organizations. HIPAA compliant text messages have been unavailable or expensive.

Improving Communication in Value Based Care

Healthcare teams can certainly continue to use 1-1 old tools like phones, voicemails, faxes, paper, etc. However, now there’s one solution in all of healthcare communication apps, that allows different healthcare workforce to effectively communicate with each other in a 1-1, 1-many and in context of a patient (patient-centered messaging). Hucu.ai provides such messaging capabilities for FREE. Innovative post acute care physician groups and skilled nursing operators are downloading the mobile app (available both in iOS and Android) and improving communication and collaboration immediately. Hucu.ai offers the following capabilities:
  • Unlimited FREE user licenses for your organization 
  • Unlimited FREE user licenses for staff not working in your organization but your organization is collaborating with
  • Unlimited FREE patient profiles and related storage
  • Send/Receive HIPAA compliant messages
  • Share real-time availability with other caregivers or team members 
  • Send attachments (.pdf, .ppt, .xls, .jpg, etc.)
  • Share  photos, videos, links, etc. 
  • All shared media is stored in Hucu’s secure cloud, without wasting individuals’ phone storage
  • Receive push notifications when others send messages via direct 1-1 messaging or via a group channel
  • Create public and private channels 
  • Build patient centered channels and collaborate with teams across different entities 
  • Appreciate and recognize collaborators 
  • Enable professional communication channels so that personal communication is separate (“work is work and personal is personal”)
  • Admin reports and dashboards for amazing insights around your best and “not so best” team members so proper incentives can be put in place to retain good employees 

In a recent “Trailblazers in Value Based Care” interview, Dr. Bader Almoshelli of Community Physicians, a multi-specialty provider group, said, “It’s tricky to navigate, but for anyone looking to position themselves to stand out in value based care, the #1 focus has to be the patient. That is the bedrock of any healthcare proposition. Beyond that, to achieve success in value based care, yes, it’s about the outcomes and metrics. But to achieve that, there has to be a certain level of sophistication with regards to care coordination.

It comes down to the team. The way the team is successful is through meaningful communication. To achieve the outcomes we want, communication is the lynchpin to hold it together. For better or worse, it’s a disconnected and disparate system throughout the healthcare continuum and really more in post acute care than anywhere else. 

Meaningful communication is useful to the providers and impacts patient care directly. It’s more than checking the box and providing data just because you’re supposed to.”

Post Acute Care is being redefined by organizations like Community Physicians to provide a higher quality of care as the new step down unit of the hospital. As the complexity of patients has increased dramatically, Community Physicians is bringing hospital level care to Skilled Nursing settings. This enables more value based care to be delivered in patient centered practices. Community Physicians brings specialists in cardiology, nephrology, physiatry, and transitional care to work in teams serving patients in post acute care facilities. By having an integrated team of specialists, Community Physicians is able to provide hospital level care using leading edge clinical communication solutions.

Tim Martinez, CEO of MPAC Healthcare talked about their role in another episode of  Trailblazers in Value Based Care. “We have to be very efficient in providing patient centered care, … lot of it comes down to communication and collaboration. Our providers become what I would describe as “the quarterbacks” on site with the patient. They are there first and foremost to provide care to the patient, whether it’s our Nurse Practitioner providing medical care or our Clinical Social Worker providing mental health care. They are there to support the facility staff. We bring a higher level of clinical capabilities to that staff so they feel supported. We’re also there to collaborate with the existing medical team who are often not on site. We sit right in the middle, so communication and collaboration is key to assure that we’re all working together to drive the same goals.”

The Future of Post Acute Healthcare is Patient-Centered Communication

As innovative post acute care organizations focus on the patient, they are finding that the right technology is incredibly valuable to efficient and effective patient centered communication and collaboration. Easy to use tools like Hucu.ai enable affordable HIPAA compliant communication for healthcare professionals. Improved communication improves collaboration driving better outcomes and resulting in enhanced quality of patient care. Join our email list here to get additional updates from hucu.ai.

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A Shift to Value-Based Healthcare

nursing home healthcare Hipaa
Healthcare Delivery From an Economic Lens
On a macroeconomic level, on-going efforts are being implemented in reducing the cost of healthcare in the US. Since the enactment of the Patient Protection and Affordable Care Act (ACA) in 2010, more people now have access to healthcare. The combination of increased utilization and increased prices is driving increased urgency to address rising healthcare costs. In a report by Peter G. Peterson Foundation, healthcare spending is increasing largely due to the older population and chronic healthcare conditions including overweight, diabetes, heart disease, kidney disease, and cancer.. This places increased pressure on the acute and post-acute care industry to reduce costs, primarily by avoiding hospitalizations.

 

On the other hand, this implies that healthcare providers have a larger pool of patients to treat. By focusing attention on early diagnosis and intervention, more complex and costly health conditions can be avoided. With effective patient centered care, expensive trips to the emergency room and hospital admissions can be avoided. It is important to note that not all healthcare is delivered equally.

Delivery of patient centered healthcare services depends on the patient’s risk profile and needs while maintaining a low cost. The transition to value based care is the only way to balance an organization’s budget while delivering better healthcare outcomes.

Four Big Differences between Value Based Care and Fee For Service Healthcare

Value based care cannot be described in a sentence.The thinking is focused around quality, outcome, and cost. The shift from the traditional approach, fee-for-service (or volume based) and the quality of care delivered is necessary for the future of healthcare delivery.

Fee for Service
Fee for Value (Value-based)
Focuses on the quantity of services provided
Based on quality of services provided
Fragmented specialist care focused on high intensity intervention
Coordinated integrated team approach to collectively deliver patient centered care with focus on prevention and early intervention
Compensation determined on the services used. The more tests/ services, the higher the compensation
Reimbursement determined based on patient’s outcomes
Control within care episode setting only
Visibility and care collaboration across healthcare settings with particular attention to patient centered transitions
The Shift to Value Based Healthcare in 2020
The Patient Protection and Affordable Care Act (ACA) provided new elements to the push in value based care. According to the Fox Group, LLC (2019), Congress created a “new payment methodology for physicians based on merit and quality of care provided”. What this means is, for example, that physicians cannot prescribe a list of tests unless the patient really needs it. Seems simple but healthcare is a complex system.
Paving the way to value-based care, the interaction is not just between one doctor and a patient, it is between a team of doctors, nurses, rehab specialists, etc. Instead of going through a checklist of symptoms and prescribing medicine, providers need to stay in the loop on the patient’s progress/ healthcare plan. This can be done via effective and fast (almost instant) communication amongst the team to assure that hand off communication in nursing teams is effective. One leading example of a value based care compensation model is PDPM (the Patient Driven Payment Model). The Centers of Medicare and Medicaid Services announced that as of October 1, 2019, ‘the Patient Driven Payment Model (PDPM), will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay”. The goal of PDPM is to improve payment accuracy (to providers), be more patient focused rather than the volume of services, reduce administrative burden, and improve SNF payments. In a nutshell, instead of going through a checklist of symptoms and prescribing medicine, providers will be working be working together to improve healthcare outcomes.
PDPM consists of 5 components or ‘bundles’
  1. Physical Therapy (PT)
  2. Occupational therapy (OT)
  3. Speech Language Pathology (SLP)
  4. Nursing
  5. NTA

These 5 components must be tailored to each patient. Every patient is different, therefore, will not utilize all 5 components equally. Some may require more services than other. Hence, payment is based on the appropriate usage of these bundles.

This transition has an overall effect on population health as there will be an improvement in healthcare delivery in an efficient and value based environment. The core of the problem or gap is effective communication amongst the healthcare team. Yes, we live in a technology advanced age, however, with fast paced work environments, crucial information can get lost in translation. The goal of value based healthcare delivery is to provide effective healthcare innovatively and efficiently. This can be done seamlessly with technology.

The Role of Technology in Value Based Care

As healthcare moves towards more Value Based Care models, healthcare apps for patients have become increasingly important. EHRs (Electronic Health Record systems) provide the opportunity to track more and more data and make it accessible to providers. The challenge has been communicating across providers in multiple healthcare organizations. In order to provide effective patient centered care, primary care physicians need real-time visibility into their patients’ changing conditions.

Specialists and hospitalists need to communicate with downstream care organizations about recovery needs and appropriate therapies. Nurses in post acute settings need to be able to seek advice about potential complications as they monitor patient status.

Hucu.ai enables the patient centered communication and collaboration necessary for effective value based care. Hucu.ai bridges the communication gap with easy to use tools that makes it easy for the team of providers to stay on top of the patient’s care cycle. Everyone is on the same page on the patient’s health. For example, if a patient’s GP alters a medication and records it in Hucu.ai.

The patient then goes to an allergist who can immediately see the medication change in Hucu.ai. In a traditional setting, the allergist’s nurse would have to call/ request a fax of the new medication, thus, losing time, efficiency, and a delay in catering to other patients. Hucu.ai (HIPAA Compliant Messaging) makes it simple to communicate. More and more innovative value based providers are joining the Hucu.ai network. To request and invitation to the Hucu.ai communication network, click here.
The shift to value-based healthcare will deliver high quality care and improve population health at a low cost. Medical communication apps like hucu.ai will pave the way. Click here to be notified of news.

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Importance of Communication in Nursing

Communication in Nursing
FOUR MAJOR HEADACHES IN NURSING COMMUNICATION
Communication is one of the most critical aspects of providing care, especially for seniors. If nurse to nurse communication or communication with other care team members (primary care, specialists, therapists, etc. ) doesn’t occur in a timely manner, it may result in  delayed critical decisions for the patient and the patient my end up in an ER. More specifically, nurses are at the forefront of healthcare delivery and play a pivotal part in a patient’s path to well-being.
Behind the scenes, nurses work in dynamic teams that are changing by the hour due to shifts and availability. They are responsible for relaying masses of detailed information to fellow nurses during shifts and importantly between shifts as well as to various other healthcare professionals. The burden of sharing large volumes of accurate and timely communication can be very stressful.
Yet, effective timely nursing communication is critical to ensure that everyone is on the same page. Nurses also serve as voices for patients who may not be able to communicate, hence,  open and clear interaction in nursing is vital to ensure that a patient is getting the right care.

Challenges Facing Nurses in Improving Communication

Implementation of Electronic Health Records (EHR) has not helped much, primarily because EHRs are built and used to get insurance billed and providers paid. They are not optimal tools for patient related timely communication. No wonder text messaging, phone calls, voicemails, and faxes are still the most standard communication tools in healthcare. Accordingly, many challenges still exist among nurses when it comes to timely communication about patients.
There are several factors driving delayed communication in nursing.
  1. Extraordinary workload: ‘Workload’ does not necessarily mean the number of patients, it rather means the needs of the patients (medications, precautions, length of stay, etc). A research study in Finland assessed 732 patient reports from 2 acute care hospitals. They wanted to see if there is a correlation between patient safety and nurse workload. The results confirmed that fewer patients-to-nurse ratio resulted in fewer incident reports. It can be inferred that a patient’s outcome is dependent on the communication and collaboration of the healthcare team. One cannot control the number of patients in a hospital, however, what can be controlled is how patient information is being delivered.
  2. High turnover of nurses and other employees: especially in post acute care, depending on the region, staff turnover can be between 40% to over 80%. There are multiple factors contributing to this issue, which we will cover in another blog so make sure to subscribe to our blog if you would like to learn more about reducing turnover. High turnover results in bringing new team members on-board and getting them trained on existing nurse protocols and processes, only to do the same all over again when the hired  nurse leaves. On the flip side, new nurses and employees also bring their own past training and experiences around nurse protocols and processes, which may contradict and conflict with the current facility’s existing processes. All of this creates confusion around taking care of patients and further complicates the critical communication among nurses. 
  3. Limited one-to-one communication: 1-1 communication is widely prevalent in healthcare, whereas there are usually many different care team member usually involved in caring for a single patient. This means that 1-1 communication is highly ineffective because it only allows two people to get on the same page while leaving all the others out of sync.
  4. Use of old communication methods: 1-1 communication is further delayed and exasperated by the use of text messaging, voicemails, phone calls, hallway conversations and faxes. Important information can easily fall through the cracks created by these old tools.  

Communication Techniques in Nurse to Nurse Communication

It is estimated that by 2050, nurse practitioners will comprise 1/3 of the workforce (Troxel et al., 2018). This means increased responsibility and liability. Therefore, focusing on ‘how nurses can improve communication’ to improve timely care delivery, better outcomes, and reduce malpractice  is important. A research study conducted by the Doctors Company assessed medical malpractice claims among nurse practitioners, family medicine and internal medicine practices from 2011-2016. It was found that 10% of nurse practitioner claims were related to lack of proper communication among providers. In addition, the frequency of nurse practitioner claims have gradually increased and are expected to rise.
The data showed that there is a discrepancy between the convenience of EHR and malpractice. Many claims have been for the following factors which can be prevented with improved collaboration (Troxel et al., 2018):
  • Failure to adhere to SOP (standard operating procedures).
  • Inadequate physician supervision.
  • Absence of written protocols.
  • Deviation from written protocols.
  • Failure or delay in seeking physician collaboration or referral.
The study concluded by providing 13 risk mitigation strategies that can help nurse and physicians to decrease injuries by bridging the communication gap.
  1. Collaboration agreements. Nurse and physicians should agree on the level of supervision that will be used.
  2.     Complete a thorough clinical history and physical examination for each patient.
  3.     Physicians, NPs, and office staff should take the time to explore patient complaints, especially when similar complaints are made on return visits.
  4.     If there is uncertainty about a diagnosis or about the appropriate testing to establish a diagnosis, the NP should ask the supervising physician to evaluate the patient.
  5.     Clinicians should consider new and unrelated illnesses when patients with chronic illnesses present multiple times for treatment.
  6.     Thoroughly evaluate all age groups of patients presenting with chest pain.
  7.     Train office staff to recognize complaints from patients or families that warrant immediate follow-up.
  8.     Document the details of telephone calls, including any recommended follow-up.
  9.     Have a clear policy and procedure in place for tracking diagnostic test results and referrals and verifying that reports are received and reviewed.
  10. Use read-back or repeat-back techniques to confirm that patients understand discharge instructions, follow-up care, and medication plans.
  11. Document patient non adherence to treatment plans, medication plans, and follow-up appointments.
  12. Provide a list of community resources that can help the patient receive needed treatment and services if he or she has a limited ability to pay for medications
  13. A physician cannot delegate responsibility for obtaining informed consent to an NP if the procedure will be performed by the physician.
Although, the above list of actions are clear, however, they are not so easy to implement. Primarily because most of these are dependent on logging patient information in silo solutions (EHRs, etc.) across different care settings. 
This is why Hucu.ai ( a FREE person-centered, HIPAA compliant messaging network with real-time risk ratings and staff appreciation) was developed to simplify and streamline many of the above complex workflows and related requirements.

Conclusion – Vision of Communication Among Nursing Teams

Nurses are becoming more vocal for the need of improved communication which leads to better delivery of care. In a recent article by Arthur L. Davis Publishing Agency (ALD), a Certified Hospice and Palliative Care registered Nurse (CHPN) shared that in New Jersey there is a need to improve end-of-life-care planning for seniors. For this reason, a steering committee has been created, Hospice and Palliative Nursing Association (HPNA), to address this issue. HPNA believes that the nurse care is a combination of science and skillful communication to provide the best care for their patients.
To address nursing issues, New Jersey has already taken the step by forming the Nursing Workplace Environment and Staffing Council Commission. “This Commission worked on the development, education, and implementation for hospital-based Nursing Workplace Environment and Staffing Councils (NWESC) throughout New Jersey.” (Caruso and Edwards, 2020). The leaders of these councils are the Chief Nursing Officer and the direct RN staff of a healthcare facility. The purpose of this is to create a model to address health work environment issues (Caruso and Edwards, 2020). Already this shows staff empowerment and team work. The future is improved collaboration and communication amongst health leaders while providing compassionate care to patients.
The Office of Disease Prevention and Health Promotion provides interactive eLearning courses that highlight effective communication strategies within a healthcare setting. These trainings are geared to help health professionals broaden their skillset. Also, they provide lessons/ examples of what other states and counties are doing in promoting effective communication in nursing and other community leaders. 
Lastly, and most importantly, Hucu.ai is primarily developed to help various nurses and other care staff to effectively communicate with each other using a simple and Free tool. Hucu.ai is the best HIPAA compliant text messaging application for the healthcare industry. Nurses and other staff (irrespective of their employer organization) are able to communicate with each other via 1-1 direct messages, via specific channels developed for certain discussion topics, and via patient-centered messages with the entire care team in one place. Do you want to overcome communication challenges in nursing and within your care teams? Let us help you get started on Hucu.ai. Sign up now.