How a N.J. Medical Center Saved Millions With mHealth Technology

A SMARTPHONE APP HAS IMPROVED EFFICIENCY THROUGH BETTER COMMUNICATIONS ACROSS THE MEDICAL STAFF BY RAJIV LEVENTHAL

Communication breakdowns in healthcare affect care teams and their patients at every stage of the care process, from diagnosis to treatment. Without a network to enable rapid connectivity and remote communication, clinician efforts are hindered while quality of care, patient satisfaction and cost efficiencies suffer.

To quantify the effect that communication breakdowns could have on health systems, The Joint Commission, a healthcare system standards and oversight organization, has indicated that nearly 80 percent of serious medical errors and medical mistakes are caused by poor communication between healthcare providers or healthcare teams, especially when a patient is transferred from one facility to another.

Undoubtedly, the time it takes for clinicians to reach each other drains staff productivity and creates delays in decision-making regarding critical patient-related issues. To this end, just a few years ago, officials at the New Jersey-based LibertyHealth Jersey City Medical Center estimated that medical staff spent about 15 percent of their day (or a month every year) trying to get hold of other physicians, rather than taking care of patients.

Additionally at the 300-bed facility, surgeons reported 2- to 4-hour delays between the time that consults were requested and the time that they were notified, while residents reported up to two days' lag time in getting response on consults. What's more, after procedures, surgeons also faced difficulties communicating their findings and recommendations to referring physicians, who were often disconnected from the hospital's communication system.

These numbers were derived from interviews conducted by Practice Unite, a Newark, N.J.-based subset of Navio Health, a healthcare communications vendor. Over a year ago, Navio Health's core product, Practice Unite-a customized, Health Insurance Portability and Accountability Act (HIPAA)-compliant smartphone application designed to improve communications and speed up workflow-was implemented at Jersey City Medical Center, with the goal of solving this increasing healthcare communication issue.

"In any industry, communication is always a challenge, as no matter the sector, communication is the key to holding together the workflow," says Stephen Li, Jersey City Medical Center's CIO. "In healthcare, with all the changes that we're witnessing, that communication challenge gets magnified because of the regulatory changes that are coming right after one another. Pagers are still common, but you have to wait until someone gets back to you. As such, society has embraced smartphones as the center of their communication," Li says.

Going beyond secure texting to help healthcare organizations make major efficiency improvements using practical, customized mobile applications, Practice Unite provides a platform for communication and collaboration that connects care teams and their patients. For instance, older patients who go into the emergency department might forget the medications they are currently on, meaning there might be some medication interaction that will potentially affect the patient negatively, explains Li. As such, the physician will have to check with that patient's primary care provider (PCP), which can be very difficult to do because PCPs are extremely busy people, Li says. "I experience this situation with my parents, who are both approaching the age of 90. They're kind of sure about their medications, but also not so sure," admits Li.

MILLIONS IN SAVINGS

Since implementation of the Practice Unite application, the results have certainly been there. After about a year of using the technology, Jersey City Medical Center officials believe that the app has saved the organization at least $2 million in three key areas. The first has been in the observation unit; like many hospitals, Jersey City Medical Center created a care unit specifically to manage its observation patients. The success or failure of this observation initiative has depended on the ability of care teams to diagnose, treat, and either admit or discharge patients in less than 24 hours. (The Centers for Medicare & Medicaid Services (CMS) reimburses hospitals for observing patients using composite ambulatory payment classifications, a system that reimburses acute care facilities for outpatient services).

Typically, when a patient enters the observation process, a cascade of phone calls begin that are meant to connect the treating physician with the patient's primary care physician, consulting specialists, nurse practitioners, nurses and therapists. These care team members must rely on inefficient forms of communication to share lab results and other clinical data in order to make treatment decisions. Depending on the nature of the case, this can involve repeated calls to operators and answering services throughout the patient's stay. Consultations requests transmitted through traditional hospital communication channels can take hours to reach specialists, and cause further treatment delays, according to Adam Turinas, CEO of Practice Unite, who worked with Jersey City Medical Center to obtain the details of the organization's savings.

At Jersey City Medical Center, people running the observation unit say they were able to discharge 20 percent of patients a day earlier because of the app, as physicians were able to receive and share critical patient information in the form of secure images, texts, and real-time laboratory feeds using their mobile devices. Doing so effectively eliminating all delays caused by traditional forms of communication, Turinas says, further estimating that this reduced length of stay translated into saving the hospital $720,000 a year.

Additionally with the app, communications are responded to six times faster, the medical center reported. Surgeons said that consult response times were reduced by from 2 to 4 hours to 15 to 30 minutes-just by implementing the mobile communication system that allows faster and immediate communication between physicians, nurses and staff. Emergency department physicians report moving patients through the ED 30 minutes faster than without the system, reducing ED delays by 15 percent, notes Turinas.

Lastly, the facility reported a savings of $120,000 per active physician user annually in referral leakage. This means that a patient who would otherwise be referred to a physician or service outside the area stays within the hospital network, Turinas explains.

Li expects to achieve further gains in clinical productivity as Practice Unite is integrated with its electronic health record (EHR), scheduling and laboratory reporting systems. "As time goes on and as the industry builds out its communication ecosystem, places will begin to implement these applications as technology foundations," he says. Using an analogy, Li says, "If you have a driver's license in New Jersey, but you're stopped by police officers in Florida, the officers can retrieve your information very easily. That's where healthcare is going, although it's not quite there yet. But that level of integration is what's necessary," says Li.

STAYING SECURE

When sensitive health information is shared among healthcare professionals, there is a need to ensure that the content is secure, as it contains patient-specific information which can be very sensitive to the individual. On the Practice Unite app, there is no information that resides on the smartphone, so there is nothing to worry about from a data perspective if the smartphone is lost, explains Li.

"I compare the current state [of healthcare security] to three years ago, and there is more public awareness of information security based on a combination of more stringent regulation and also events such as the Target data breach, so the pendulum has really swung in terms of public perception," he says. "They now understand it's a necessary evil-the bad guy will get his information if there isn't that level of protection."

When a healthcare organization evolves their communication ecosystem, this technology will help them with the security aspect, Li says. "You see the direction the industry is going. You're talking about communication within and outside the hospital to other caregivers, to a PCP, to another urgent care center that also provides care for the patient. Pushing care out of the hospital and ultimately into the home is where the government is looking to drive down cost," he says. "In the case of hospitals, volume is dropping, meaning revenue is dropping. You have to do more with less, and you thus need to look at vehicles that will gain cost savings and greater efficiency."

IF YOU HAVE A DRIVER'S LICENSE IN NEW JERSEY, BUT YOU'RE STOPPED BY POLICE OFFICERS IN FLORIDA, THE OFFICERS CAN RETRIEVE YOUR INFORMATION VERY EASILY. THAT'S WHERE HEALTHCARE IS GOING, ALTHOUGH IT'S NOT QUITE THERE YET. BUT THAT LEVEL OF INTEGRATION IS WHAT'S NECESSARY. -STEPHEN U