Centra Health, a Virginia cancer care center, began using clinical collaboration technology at its multidisciplinary lung cancer conference, primarily as a format to document the stage of the patient's tumor and share information with the entire team.
The healthcare organization had a big problem when it came to bringing together the opinions of different providers and directing a patient's therapy because the providers are in different offices or different organizations and on different EHRs.
The clinical collaboration technology worked. But it also began a complete restructuring of Centra Health's entire patient navigation through the cancer center and led to the realization of a longstanding vision that staff just didn't know how to bring to fruition.
"I know it sounds grandiose, but this simple app has allowed us to revolutionize what we are doing," said John Salmon, MD, a pathologist at Centra Health, which uses the technology, which is developed by QliqSOFT.
Once staff saw the communication benefit for lung cancer patients, they asked themselves: Why not do this for all cancer patients?
"And that led us to our most critical philosophical shift: We now identify all new cancer patients at diagnosis with a CareChannel," Salmon said, speaking of a communication thread in the QliqSOFT technology. "It may seem a simple thing, but the implications are actually quite profound."
Clinical collaboration is key to the successful delivery of healthcare, and as such there are many vendors providing different styles of clinical communication and collaboration platforms. These vendors include IBM Watson, Igloo Software, NTT Data, Vocera Communications and Windstream Communications.
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Centra Health staff use CareChannels to create a conversation among providers from different organizations and regions. They all participate in the care of cancer patients and use the CareChannels mobile and desktop apps to securely share patient information and send messages around different cases.
Any diagnosis of cancer is sent to the cancer care coordinator, a position designed from the ground up for this purpose. They start a channel on that patient and attach all of the appropriate providers, including primary care.
"This has given us the ability to begin taking care of the patient – making appointments, assigning a navigator, coordinating needed testing – often before the patient knows they have cancer," Salmon explained. "It has forced us to completely redesign our system, but has also given us the ability to create effective pathways for all patients, regardless of their diagnosis."
Not only does this process streamline communication, it engages a wider group of providers, improving the patient's access to all of the assets in the care community, he added.
Centra Health purposefully did not integrate the clinical collaboration technology with any other systems, like EHRs. It felt such integration might muddy the waters.
"This is the part I have had the most trouble explaining to people, whether providers, administrators or IT staff in all of our various community organizations," Salmon said. "We actually chose to not connect QliqSOFT to any EHR. We don't integrate it to anything else. And that is actually its greatest strength."
The biggest problem with communication in healthcare is not related to what information can be automatically added or pulled out of a system; fundamentally, the problem is communication, not being able to talk to each other, Salmon said.
"Because we don't have CareChannels connected to any EHR, it is able to provide visibility beyond the boundaries of those systems," he explained. "I have doctors who are part of their own ACO seamlessly communicating about patient care with doctors of other financially competitive ACOs. This is what patients want, and this is what we need to be doing as providers."
Centra Health is starting to add caregivers from completely different health systems out of town – an academic medical center, for example – to better coordinate patients' needs, he added.
Recently on a Saturday, Salmon saw a specimen from a patient who had bronchoscopy on Friday. The biopsy showed non-small cell carcinoma, but he needed some stains to tell what type before he signed out the case, so there was still no official record in the EHR.
"However, I didn't want to delay letting the providers know what is going on," he said. "So I started a Care Channel on the patient and I included our care coordinator, the nurse navigator for lung cancer patients, and the pulmonologist. I let them know that the patient does have cancer, but I am holding the report until I have more information."
Salmon quickly got a QliqSOFT message from the oncologist who was asked by the pulmonologist to see the patient, and of course he wanted as much information as Salmon could provide. So Salmon added him to the Care Channel.
"Now we are all connected; the patient is being seen and the next phases of treatment such as staging studies are being arranged, and yet the official report isn't even completed," he explained. "I don't know how you can do much better than that."
Ultimately, Salmon said that the interesting thing about communication is that one doesn't notice much when it is working; it's when it is not working that people are aware of it. He said it is hard to measure the efficacy of a technology like this with simple metrics.
"It is difficult to track a metric like, 'How often the right decisions were made because all of the important information was readily available,'" he said. "Also, we usually don't attribute mistakes to a lack of communication. In some cases we don't even consider that it is a mistake, provided the patient's care is not affected, and someone is going to pay the bills."
In healthcare, staff needs to be cognizant of metrics and data so that organizations do things that result in real improvements. But in this case, Salmon thinks it is time to stop getting stuck in the weeds and listen to everyone who is complaining that people need to communicate better.
"I don't need a spreadsheet to tell me that this type of solution is working for us," he said. "Examples like the one I just shared about the lung cancer show me that it is making an immediate, profound difference in the way our system is working together. And the better we connect the network, the more powerful everything on that network becomes."
Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com