Intelligent Communication
January 2009

Intelligent Communication : Madhukar Saboo, Head – healthcare & Life Sciences vertical, Avaya GlobalConnect

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An integrated approach to IT and communication systems for better patient care and higher operational efficiencies.

Healthcare workers live in a very dynamic environment where they constantly gather, communicate and analyse information to take clinical decisions and to monitor the effect of the decisions made. All healthcare workers will vouch for the fact that timely intervention based on real-time evidence saves lives everyday. The importance of collaboration and communication in healthcare delivery is exceptionally high as the industry deals with issues of life and death where time lost could result in the loss of life.

While information sharing and collaboration is definitely required, there is always a danger of information overload, more so for caregivers. Multitasking in a mobile working environment is true for all of them and information overload can reduce efficiencies. The need of the hour is not simply communication but intelligent communication of information. Intelligent Communication is about dealing with information end-to-end. It is about evaluating whether information is relevant, if it is relevant to whom it should be conveyed, how it should be conveyed, and once conveyed, help the person take appropriate action. Intelligent Communication solutions utilise advancement made in communication technology in conjunction with IT systems to manage information dissemination and collaboration requirements in different business contexts effectively, reducing unwarranted delays and human effort.

Consider a scenario which is very often seen in hospitals. A doctor orders the blood sugar test of a diabetic heart patient who has just undergone surgery. The test result is released on the IT system. The sugar level is out of limit and requires intervention; the doctor needs to be consulted. The responsible doctor is busy in another operation, so the information needs to be conveyed to another doctor. The other doctor is not in the hospital so the information has to be communicated on his mobile. Once the information is conveyed to the second doctor, he wants to talk to the floor doctor to alter the amount of insulin being given to the patient.

What we see here is involvement of multiple people through which information is analysed and communicated to the decision maker. Automating all the above steps so that there is no human or system latency, and the communication solution along with IT systems take care of:

  • Evaluation of information and deciding whether it has to be communicated or not.
  • Communicating information to the right person based on availability
  • Enabling the right person to take action based on information.

Intelligent Communication reduces human latency and makes organisations more responsive, thus increasing the overall quality of patient care while reducing information overload on caregivers and bringing in process efficiencies.

Healthcare providers have been investing in Hospital Management Systems (HMS) and clinical decision support systems (CDS). These help in capturing information and directing it to the right persons on desktop or tablets. But given the mobile, non-desktop nature of the healthcare delivery and the fact that generally doctors are attached to multiple healthcare organisations, the challenge remains to provide the right information to the right person in time. The solution lies in having an integrated approach towards IT Systems and Communication Systems so that together they are able to better serve business requirements.

Challenges before Healthcare Stakeholders

Patients, doctors, nurses, paramedics support staff and hospital management are four major stakeholders in any healthcare system. The primary challenges faced by each one of them are different. While the patient is mostly worried about the responsiveness of an organisation (given that he has chosen the organisation based on clinical expertise), for the doctors, access to the right information at the right time is the major concern. The nurses are occupied in coordinating between different departments for getting information, though by design they should spend maximum time in patient care. Hospital Management aims to increase operational efficiencies while providing good environment for best possible patient care and for practicing medical specialties.

If you look at the overall picture, all the above challenges have genesis in how information is being generated, handled, communicated and acted upon. IT systems like HMS and CDS do improve the process of information capturing and communication but do not go the entire length to solve the problem. Take for example, a nurse during her rounds notices some symptoms and registers the same in her notes in CDS. Based on the symptoms, she intends to consult the doctor immediately. The CDS sends an email to the doctor. The doctor if out of hospital remains unaware of the patient symptoms. The nurse does not receive any response and she realizes that probably she needs to personally call the doctor. The nurse calls doctor’s extension but no one picks the phone. She searches around for the mobile number and is able to reach the doctor on phone after encountering busy network problem a couple of times. The delay in reaching the doctor is systemic and no one can be held responsible for the same.

How the above scenario can change by the appropriate utilisation of communication technology can be seen as follows. As soon as the nurse notes her observations in CDS and her intention to consult the doctor is made clear, an e-mail is sent. Simultaneously, the communication system checks for the ‘presence’ of the doctor and notes that he is not available in the hospital. The system dials the nurse as well as the doctor’s extension number simultaneously. The doctor’s extension number is mapped to his mobile whenever the system detects he is not in hospital, hence his mobile rings simultaneously and the contact between nurse and the doctor is established. In case the doctor is not available on his mobile, the system can check who is next in line to take a decision and match the next doctor with the nurse. The benefits are for all to see. The nurse is free to attend to other patients instead of spending time hunting for the mobile number and then dialing it. The doctor is reached anyway and connected with the nurse. The overall responsiveness of the organisation increases.

The scenario described above requires a number of IT and communication technology components to work seamlessly. As we stand today, these components are all available in enterprise portfolio but are working in silos. Enterprise Communication System specialist companies like Avaya help healthcare organisations implement the right communication technology components and integrate them with existing IT systems to maximise business benefits out of investments made in both IT and communication systems.

Internet Protocol (IP) makes Intelligent Communication Solutions possible

Communications technology has evolved over centuries from beating drums, smoke signals to modern smart phones and embedded communications. Numerous technologies are now available for transmitting information from the sender reliably over any medium to the receiver. For decades we have been using TDM technology, which has served us well till the evolution of smarter solutions such as email, video, text messaging etc. Moreover, voice over IP technology has helped in converging traditional voice on desk phones and combine the same with video and other communication platforms enabling unified communication.

Unified Communications helps users to use their preferred device when they are on the desk, mobile or working from home, without compromising on functionality. It also allows customers or patients to reach doctors and nurses without worrying about their location. The presence of users is available which allows you to communicate with your peers in the preferred mode as you are aware of their status.

Since different channels of communication viz voice, video, email, instant messaging etc. have converged on IP technology, this provides a unique opportunity to use these communication tools in conjunction with IT systems – laying the foundation of Intelligent Communication Solutions. From a user perspective, one is least bothered about the bifurcation of underlying tools or systems being used. At the end of the day, the users want simplified processes to meet their business requirements and the same is achieved by integrating communication and IT platforms to devise Intelligent Communication Solutions.

Intelligent Communication Solution Examples

Technology investments need to be closely scrutinized for their business benefits. Communication solutions together with IT Solutions can provide following benefits:

  • Deliver faster access to critical information � push relevant information to the right person on right device or allow easy access to information on the phone.
  • Enable mobile working – manage the process of reaching right person on right device economically.
  • Promote collaboration- enable joint decision making or expert consult (second opinion) remotely and on the fly increasing decision making speed.
  • Increase process efficiencies -trigger alerts and notifications based on business rules decreasing human latency and optimising information delivery process.

Better patient care, lower average length of stay, higher staff satisfaction and retention, higher operational efficiencies, lower fatality rates, higher patient satisfaction and growth in top line as well as bottom line are business benefits accruing out of deploying communication technology intelligently with IT systems. Some of the examples of Intelligent Communication Solutions provided by Avaya are described in following paragraphs.

Emergency Management: In emergency situations time is of great essence. Time taken for information dissemination and analysis, decision making and execution, needs to be compressed based on type of emergency. Quick action within golden hour can save lives. Communication Solution can dial out predefined groups of people (based on therapeutic area, skills, time of the day etc.) on their preferred device / number depending upon time of the day to apprise them of the emergency situation. These people can be brought into an audio conference to discuss their availability and finalise action plan. For example: suppose a patient is brought into emergency department and a blockage is diagnosed. An angioplasty needs to be done immediately. In such a scenario, as per American College of Cardiology, there are two bottlenecks.

  • The team to undertake the procedure is not ready
  • The facility to undertake the procedure is not ready

Communication Solutions can expedite the process of contacting affiliated heart surgeons as well as support staff so that the procedure can be done in the least time.

Disease Management: Less average length of stay (ALOS) is beneficial to hospitals as well as patients. Less ALOS increases average revenue per day of hospitals and for patients it means less expenditure as well as reduced probability of catching Nosocomial infections (hospital acquired infections). Disease Management Solution helps healthcare organisations to remotely collect, monitor and analyse key health parameters of patients.

Patient-Doctor Connect: Patients like to spend more time with doctors and doctors are pressed for time as they have to manage multiple patients. Doctors generally also operate from multiple healthcare facilities and sometimes have to travel only to meet recuperating patients. Patient-Doctor Connect Solution allows doctor to remotely meet patients through video conferencing. While doing video conferencing with the patient and enquiring about his health, they can access latest reports of the patient on Hospital Management System. In case the doctor wants to get second opinion, the solution can be used to have video conferencing with the expert and patient information can also be shared real time. Patient-Doctor Connect solution can also be used for providing telemedicine on large scale wherein a virtual Out Patient Department (OPD) can be created and all specialties can simultaneously provide their services at multiple remote patient points.

Laboratory Test Reporting: Getting laboratory results in time to validate and further align line-of-treatment is one of the most common challenges that doctors face. The Laboratory Test Reporting solution integrates with the Laboratory Information Management System (standalone or a module of HIS) to deliver laboratory results intelligently through a Voice Call or SMS in case so desired by the doctor.

Intelligent Signage: Unavailability of information is one of the major pain points for out-patients. Intelligent Signage solution integrates various sources of information and displays the same in real time. The solution can display the queue status of patients (provided that is being captured in HIS) along with live television, advertisement and disease education related information from separate databases.

Patient Feedback Management: Ho-spitals thrive on word of mouth. The customers who walk out of the hospital are most prevalent, least expensive and most influential source of advertisement. Generally all hospitals have a feedback collection and analysis system (mostly paper based) with a view to keep a track of quality of their services. The major drawbacks of such paper-based systems are:

  • The system is reactive to the point of no recourse � If a patient is dissatisfied with hospital services and rates the hospital bad on some parameters, the hospital is not in a position to address his/her grievances since the system is paper based and till the time it reaches responsible people, the patient has already left the premises.
  • Manual process of analysis � the feedback forms have to be manually analysed. Real time information is not available.

 Patient Feedback Management Solution allows patients to give feedback on the phone. The patient can rate different services provided by the hospital. Business rules can be configured to take immediate remedial action (the call can be directed to a patient relationship executive or a mail can be triggered) in case the rating is bad. Automatic reports presenting statistical data on ratings can be configured. The patient can record his/her qualitative feedback. The top management can have a look at ratings in real time and can listen to qualitative feedback given by patients.

The above solutions only showcase some business scenarios during healthcare delivery where judicious use of communication technology can give good results. There are umpteen scenarios which can be thought of, which requires information dissemination to relevant people and management of communication/collaboration of people after information dissemination for decision-making and activity closure on the ground. The technology infrastructure components can be used in different scenarios, which not only increase utilisation of infrastructure but also provide higher returns on investment due to business benefits on multiple accounts.

Execution Approach

Communication Technology has progressed leaps and bounds. Given the role Communication plays in Healthcare delivery, Healthcare organisations need to have overall strategy for leveraging communication technology to the maximum by having an integrated approach towards IT systems and Communication systems. A phased approach towards execution of overall strategy should be taken for better adoption of technology by users.

First step in overall strategy should be to have basic building blocks of communication and their inter-operability in place. Multiple device and channels of communication is fact of life. Telephony, Video, E-mail, Instant messaging, Voice messaging, Paging, Cellular, SMS and Application alerts are some of channels being used for communication while Desktop, Laptop, Cell-phone, Desk-phone, Pagers, PDAs etc are devices commonly in use. The goal of unified communications involves breaking down barriers between different communication channels so that people using different channels of communication, different media, and different devices can still communicate to anyone, anywhere, at any time. The users should be comfortable utilising unified communication tools before any further step is taken.

Once unified communication tools are used extensively, embedding communication applications in day-to-day processes by integrating IT and Communication systems needs to be done. Intelligence has to be built and business rules need to be defined on IT systems to enable seamless usage of unified communication capabilities in different business context. Organisations need to fully leverage already established IT and Communication platform to meet business requirements. The goal of intelligent communication of delivering right information, to the right person, at the right time and on the right device can be achieved. Whereas IT systems help in filtering right information, the communication systems help in narrowing down the right person at that time and ways to pass on the information on the right device.

In conclusion, Indian healthcare provider industry is in the midst of unprecedented change. The demand for better healthcare services has increased tremendously and the entry of corporate players in healthcare and the booming insurance industry is redefining the way healthcare services are delivered and paid for. Taking an integrated approach towards utilisation of communication and IT technology can substantially increase quality of patient care through increased responsiveness of and collaboration between healthcare workers.

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