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Vertical Industry Communications: Inpatient Health Care: Page 2 of 3

Treatment Management Cycle

The key attributes of this process group are the giving of orders that define the treatment management plan, delivering the care elements, monitoring and charting patient progress with consultation as needed, adjusting the treatment plan when indicated, implementing a transfer or discharge decision, and tracking quality assurance. The services provided by ancillary departments such as laboratory, radiology, pharmacy, transportation, and housekeeping are considered part of the treatment plan. Orders are placed through the EHR, often integrated to specialized subsystems in the ancillary departments, and results, including images such as X-rays, MRIs, and ECGs, get posted through the subsystems and the EHR.

Patient monitoring has progressed significantly in recent years, thanks to advanced instrumentation, wireless communications, and video monitoring. While nurse call systems are still in use, the trend is to a specialized, central monitoring location for each floor or ward. Care providers can be dispatched from this monitoring location via wireless devices.

Clearly, this is communications-intensive, but much of the communication is now occurring through electronic monitoring and via recording and charting in the EHR. Thus, many health care organizations already have eliminated legacy communications delays or difficulties. For example, attending physicians receive up-to-date results via the EHR rather than needing to make telephone calls for information. Processes in this cycle include:

However, many communications are still required, especially at shift transfers of responsibility (or handoffs) and when treatment plans need adjustment. UC is already assisting many hospitals in this area.

We see the use of mobile devices -- especially computers on wheels and nursing station computers to locate the exact resource for the needed communication based on the physician on‐call and in-service assignments, other nursing assignments, and ancillary staff availability. Once the software finds the right resource, the communications can proceed using the best method.

Increasingly, care providers are using asynchronous text (instant messaging or cellular SMS texting) rather than phone calls. Efficient and accurate asynchronous communications can be a major improvement to the care process, allowing providers to avoid the interruptions of synchronous or real‐time communications while also providing an activity log for cross‐team or cross‐shift reference. When two or more team members need to speak by phone, the software can find those professionals at the most convenient location or number, thus saving significant professional time and accelerating the care process.

Note that a real-time call is the exception, not the primary tool. Consultations are best conducted with ad hoc or scheduled online meetings than with phone calls. Also, note that these communications are best when initiated from within the EHR software, rather than from an IP-PBX soft client.

Again, these processes are represented by the Production Usage Profile. Some UC vendors claim that the treatment plan processes are collaborative, and there certainly is some collaborative work done in a consultation between care providers. However, the necessary safety-oriented, disciplined, and procedural nature of patient care is much more of a production process and uses production-like methodologies.

UC benefits in these processes are primarily a reduction in the effort required to deliver the treatment plans; care providers spend less time in repetitive or redundant communications tasks and can often accelerate tasks such as shift handoffs. The results can be more time for patient attention and, in some cases, a reduction in the levels of shift overtime. Also, since communication events can be logged automatically, regulatory compliance is enhanced.