Bringing "Top Flight" Communications to the Academic Medical Center
Optimal Workflows Binds Teams
The world is full of workflows. At their most basic, workflows are procedures coupled with communication among groups of people. I cut my teeth at age 17 as a licensed pilot and have since learned that the archetype of well-honed workflows is U.S. airline aviation, where there have been zero passenger deaths in more than four years. How does this happen?
Before a flight, the pilot and dispatch office check the weather and, among many other things, decide on an appropriate fuel load given possible contingencies.
Pilots review the flight plan while separate ground crew members shepherd, fuel, and load the aircraft, then ensure to secure all doors, hatches, and safeties properly.
The copilot does an external pre-flight inspection while the pilot reviews the pre-flight documentation (including fuel delivered).
The cabin crew brief emergency procedures and set up safety contingencies.
And optimal workflows aren't just for flight and ground crews. Mechanics, airport operations, TSA, Air Traffic Control, and many others have their own to manage, including top-notch communication and coordination with all the other players. Teamwork makes the dream work!
Precision Workflows in the AMC
The parallels to an Academic Medical Center (AMC) are tough to ignore. Both airlines and AMCs strive to continuously improve outcomes and safety while driving efficiency, improving “customer” and staff satisfaction, reducing costs, and ensuring it can all be done again tomorrow. And the consequences of failure in either environment are dire.
But perhaps more than anything else, hospital workflows must ensure that teams can reliably communicate about patients. Communication and collaboration are more straightforward when a patient lives in the local catchment area and is 100% managed by network providers using the same instance of an EHR. But it becomes much more challenging when community providers are loosely affiliated and use different EHRs.
According to CMS, in a typical year, an AMC treats Medicare patients from 42 states, 188 counties, and 1,057 zip codes. Yet less than 19% of the primary care providers outside an AMC catchment area will receive useful digital information about a patient’s treatment, and one-third won't receive anything.
In other industries, companies use email and text or workflow tools like Slack and Salesforce. When communication gaps occur across an extended care team, we struggle with phone calls and faxes, but many things can fall through the cracks. Or we load up our Case Managers with spreadsheets, sticky notes, and telephone calls and lean WAY TOO MUCH on the patient to get information from A to B.
No wonder more than half of referrals fail!
Bind Together Care Teams with Seamless Workflows
What we need is a reliable communication mechanism that connects the AMC with the workflow at the cardiologist's practice. Let’s think of our well-oiled pre-flight workflow above as a patient discharge:
Discharge Orders by the attending automatically result in the hospital EHR sending the cardiology practice scheduler a note requesting a patient appointment with the cardiologist and giving enough details for that team to call and make the appointment.
Simultaneously, a digital summary of the hospital medical record is securely delivered to the patient’s record at the cardiologist’s EHR.
And this is completed in a way that respects the cardiologist team’s workflow preferences while providing an effective patient discharge summary upon which the provider can take action.
Whatever the EHR-connected workflow communications tool, it should work 100% of the time. We don’t accept an air traffic controller saying “… I don’t know, I sent him a message about the level 5 thunderstorm in his flight path… I guess he never got it….” any more than we should accept a dropped message about medication change, allergy, new complication, or time-sensitive lab or study results.
I’d be glad to learn more about what your AMC is doing to bend the communication curve. Email me anytime!
Peter
Peter S. Tippett, MD, PhD, is an internist, Emergency Medicine practitioner, a lifelong pilot with Airline Transport Pilot and Certified Flight Instructor certifications, entrepreneur, and technologist focused on Health IT.