Healthcare professionals provide patient care 24/7 and they are often urgently needed at unpredictable times and locations. For decades, healthcare has addressed the need for physician and nurse alert notifications with numeric and text pagers supplemented with overhead paging systems. These notifications were adequate but often uninformative, inconvenient, disruptive and most importantly, costly.
In this day and age, the traditional way of paging a specialist and waiting for a callback is inefficient. Messaging a provider via a secure messaging application, then going back to take care of your other patients, as opposed to waiting by the phone for a response, is more time efficient. Customer service is always necessary; this form of messaging enables the provider to have less interruptions.
In various healthcare environments, nurses continually need the ability to access clinical data as well as communicate with other members of the care team. With many providers regularly utilizing and carrying their smartphone with them everywhere, secure messaging seems an efficient way to communicate.
Secure messaging is utilizing a secure encrypted texting application that allows providers to respond at a convenient time, allowing for better productivity and improved patient care. Replacing pagers with secure messaging can save hundreds of dollars per provider, which can generate enormous savings with larger healthcare organizations while providing the HIPAA (Health Insurance Portability and Accountability Act) compliance needed.
However, secure messaging poses potential legal implications and potential breeches of patient information.1 For healthcare information technology leadership there is the need to improve on this clinical communication deficit; however, there also is a need to meet the compliance and security requirements. With IT security breaches constantly in the news, a secure communication device that enables healthcare workers to communicate efficiently is needed. The Imprivata Report on the Economic Impact of Inefficient Communications in Healthcare estimated inefficient communication costs U.S. hospitals an estimated $11.2 billion in annually in employee time wasted. Secure messaging alone, the study concluded could generate savings of about $5.88 billion lost to efficiency, or more than $918,000 per hospital annually. 2
Secure messaging has been called on as a way of providing healthcare organizations with a HIPAA compliant way of communication for providers. It was even recently approved by The Joint Commission for communicating patient information.3
Among the solutions are services that allow providers to receive encrypted email on mobile devices, as well as services that allow providers to coordinate care. However, security issues with these new technologies must be further explored. It is difficult to quantify the cost of preventing a breach of information either text wise or by loss of a flash drive. 4
The easiest way to determine the overall loss is to review breaches of facilities in the press, and calculate the cost it took to deal with the event. More importantly than what the lost covered is the loss to the hospital's reputation, and that is difficult to determine. With the continued emphasis on customer service, no organization can afford a loss of reputation in their community.5 With texting being difficult to control among providers, some organizations have implemented secure messaging applications in the hope of mitigating as much as possible.
Ease of Use
There are a variety of applications that are capable of providing secure texting, are user- friendly, and allow for effortless communication. An enormous benefit of secure messaging is that it addresses has three key features of security that are necessary to support HIPAA compliance. These applications also satisfy guidance provided by the Joint Commission on secure texting such as authentication, encryption and auditability. What makes these applications unique is they allow all users within an organization to participate in secure conversations utilizing a variety of assorted devices. Users access via computers, tablets or smartphones. The device doesn't have to be a company device, so users can download the application to a personal smartphone, eliminating the need to carry a secondary phone.
Previously, when discussing a case on a cell phone, nearby people could overhear, the call could be lost due to a poor connection or there could be a miscommunication. With these applications, the response is secure on your phone, complete with a time stamp.
Value to Nurses
It is important to recognize all disciplines are essential in providing patient care; therefore they should all be invited to access the application. Sharing this with as many disciplines in your organization as possible it also enables feedback on how to improve the application for your facility. As the technological needs increase this enables for the continuous quality improvement of this feature.
Nursing has always been a critical part of the healthcare team; such applications would be welcomed on any nursing unit, and will surely impact patient outcomes. An example of the benefit is a concerning EKG (electrocardiogram) in need of a second opinion. Previously you could fax it to the office and wait. Now you can have a response in minutes. Take a photograph with your phone, open up your secure messaging application, type a synopsis of the case, attach the photo, and send. With the application available on a nurse's mobile work station, she can resume her medication pass, and await an alert on her monitor to notify her that the provider has responded. This enables the nurse to remain mobile, fulfilling the patient care side of her position, as well as her care coordination role, which improves both patient and nurse satisfaction.
Another routine part of healthcare that could benefit from the use of secure messaging is consultations. Typically, just submitting the consult could be burdensome, which often could have a negative effect on the patient. With secure messaging applications, you can request a consultation as a preformatted secure text message and include specifics as to why the consult was placed. Secure messaging can help the patient outcome, by transmitting photos of the medical record to the consulting physician. The speed and efficiency this enables will surely provide an organization with increased satisfaction, and a decrease in length of stay.
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Utilizing the application in the emergency department is one way to see its benefits. With a constant influx of patients, time management has never been more important than in the ED. Physicians as well as nurses, are both under pressure with limited time. Secure messaging in this environment will help with patient turnover. The consulting physician can respond at their leisure, and the ED physician can tend to their patients giving 100% of their attention to the patient, and check their messages at their leisure.
When a patient is discharged, and a transition of care is initiated, the provider can contact the patient's primary care physician to alert them of this hospitalization as well as the discharge. Being able to provide patient-related information in a fast and secure makes an impact on a healthcare provider's ability to care for their patients and provide continuity of care.
In this day and age of patient satisfaction, organizations have to meet the needs of their patients, providing the best in customer service while not increasing their cost. With this need in mind all facilities need to determine their organization's readiness to embrace this secure messaging application. The Impriva Report on the Economic Impact of Inefficient Communication in Healthcare estimated that employees wasted an average of 91 minutes a day because of inefficient processes in patient care, communication with colleagues and prescription fulfillment.2 This is time that could be spent with the patient, which in healthcare should always be our primary objective.
1. Leventhal, R. (2014). Trend: Mobile and Messaging Green Light ON Clinician to Clinician Texting. Healthcare Informatics, 31(2), 28-29.
2. Januski, K. D. (2014). Secure Texting Could Improve Communication. AACN Bold Voices, 6(11), 13.
3. 3. Update: Texting Orders. Joint Commission Perspectives. May 2016. 36(5). 15.
4. McGonigle, D., & Mastrian, K. (2015). Nursing informatics and the foundation of knowledge (3 ed.). Sudbury, MA: Jones and Bartlett Publishers.
5. Prestigiacomo, J. (2011). Secure Messaging via the Cloud and Mobile Devices. Healthcare Informatics, 28(5), 24-29.
Cheryl Wilson is a Hospitalist advanced practice nurse at Virtua Hospital, Mount Holly, N.J.