Tuesday, November 6, 2012

Communication for Care Coordination



Ok, what do you think of the "after" graphic on the right, above? (It's from the Caremerge website.)

Me, I think it looks more organized and soothing than the "before" graphic. But it conveniently glosses over the truth that in fact, those many people surrounding the patient/resident do need lines of communication between them, and those lines need to be easy, open, and effective.

Last week, after a follow-up phone consultation with the family of a patient in assisted-living, I completed my charting and then directed my cloud-based EHR to fax copies of my note to the other involved providers.

It took longer than the charting did, since my EHR, MD-HQ, only allowed me to fax to one recipient at a time. So I wrote to my support person, asking if there was some way to fax multiple recipients in one fell swoop.

"How often do you see yourself needing to do this?" he wrote back.

"Often,"was my answer. "I just faxed to:
PCP
neurologist
home health agency
home caregiver agency
residential facility."
This is not an unusual situation when one cares for a geriatric patient (plus there's usually family and others in the unpaid care circle to communicate with too). Not only do we need power tools for medication reconciliation and all other in-visit clinician tasks, but we have power communication needs as well.

The good news for me personally is that MD-HQ is a small nimble company, so my support person is the lead developer. He's now updating my EMR, and it should soon be much easier for me to send a fax update to the many other providers I'm often coordinating with. (Thanks Ben!)

Still, even with faster faxing to multiple people, the coordination and communication feels hard for this day and age. And such a pity to rely on shooting pictures of text to each other, since those pictures do not usually turn into searchable text in the recipient's EHR.

When it comes to communicating, in medicine we are often using methods that feel distinctly clunkier and outdated than the technology we use in our non-professional lives. (If only Gmail were HIPAA secure and I could see my messages back and forth, properly bundled into conversations! Except I also want it to seamlessly connect to my EHR. Too much to ask, for sure.)

Any relief on the tech innovation horizon? Well, I haven't yet had the opportunity to try anything myself, but I'm certainly interested in whatever other clinicians have found works.

By the way Caremerge, a product designed for assisted living facilities, apparently offers a "clinical collaboration app," in order to "bring all offsite stakeholder together to collaborate and help make faster better clinical decisions for the residents."

I guess in my patient's case, the "offsite stakeholders" would be me, the PCP, the neurologist, the home health care RN, and the private in-home caregiving agency.  Hm. I'm certainly willing to try working with something like Caremerge, but admit I'm a little reluctant to have to rely on an assisted living facility's technology to communicate with a patient's many other providers.

Besides, I need options for when a patient isn't residing in a facility using Caremerge, or another facility-based communication platform.

Right now my preference would be some kind of secure messaging solution that feels like the email of today (rather than like the email of 1999). Preferably it would not be embedded within some comprehensive care management platform or EHR, because an independent physician like me is likely to work with other providers who are each using a different platform. I've recently tried ZSentry but doesn't seem good for more than the one-off secure missive. (I need secure back-and-forth with multiple recipients. You know, like real email.) [Note added 11/17: Zsentry subsequently contacted me to provide additional information on how the service works. For the record, it does allow secure back-and-forth with multiple recipients. I'm still trying to figure out how easy it is to view previous messages sent as part of the conversation, etc.]

So, I'm open to other suggestions, if readers care to share.

Specifically, I'm looking for a secure communication solution that:

  • Is EHR and platform agnostic.
  • Is supportive of ongoing communication with multiple providers
  • Allows one to easily track what information has already been exchanged (the conversation view in Gmail works for this, until someone changes a subject heading).
  • Bonus points if it's easy to forward the exchange when yet another provider gets involved.
  • Double bonus points if it's easy to get upload/download to/from a EHR.
We'll certainly need versatile communication solutions if we are to collaborate effectively, in the way that patients and families expect and deserve.
PS: For more info on what regular primary care practices are facing when it comes to coordinating care for complex patients, this AHRQ white paper from Jan 2012 struck me as a good summary.

Addendum 11/7/12 
A friend suggested I try Doximity.com. Just signed up, which was easy (impressive how they found my pic on Google and proposed it to me; talk about minimizing the work!).

I guess I could use it to communicate with the PCP and neurologist (who are not on, but I could invite them).

But this wouldn't allow me to communicate with home health RN, private caregiving agency, and assisted living facility.

Bummer. I'd like to find a communication solution that allows me to easily loop in the non-physicians.

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