Maximize your health care messaging system investment with expert guidance
Health care messaging can effortlessly span the enterprise supporting staff, caregivers, hospitalists and specialists and community physicians, health care trading partners and patients across ambulatory and acute care settings with sophisticated features for security, reliability and workflow automation.What do you want messaging to do?
With more than 200 competitors, the health care messaging vendor landscape is vast and not a little confusing. Here is a list of common messaging use cases; if your use case isn’t listed it may still be available or configurable in systems from one or more vendors.
Alarm notification
This use case entails taking alarm notifications from medical devices or gateways and delivering them to the appropriate caregiver in a timely and reliable fashion. This use case is FDA regulated which imposes some structure on product claims made by manufacturers. Relatively few companies offer alarm notification solutions.
Care Management
This includes vendors who make similar claims such as care coordination, care plan management, care transitions, chronic care management and patient care management. These are variations of a basic set of use cases supporting care delivery: diagnosis, the cycle of therapy delivery, nursing vigilance, clinical interventions, etc. There is considerable feature overlap between many of the current alarm notification solutions and care management solutions.
Clinical Decision Support
This is workflow automation extended beyond messaging features and into clinical capabilities. Common applications include early warning systems to identify patient clinical deterioration, the early detection of sepsis and other conclusions or recommendations on data passing through the system, mostly of a diagnostic nature. Some of these solutions are FDA regulated, and the FDA’s approach to CDS is likely to change with the promised publication of an FDA guidance document.
Clinical Surveillance
This application displays near-realtime medical device data to remote users. Most commonly connected medical devices are patient monitors, but this can also include any other type of device found at the point of care. These solutions are FDA regulated. Alarm notification solutions can include remote surveillance as a feature. Some are standalone surveillance solutions that may be integrated with other care management messaging solutions or used to implement remote ICUs or other use cases.
Critical Test Results Management (CTRM)
Diagnostic tests with abnormal results require timely notification and response by responsible clinicians. The CTRM use case first arose as add-ons to diagnostic imaging applications and then expanded to diagnostic modalities beyond imaging. A messaging solution can provide CTRM support tailored to any diagnostic modality.
Emergency / Mass Notification
In certain emergency situations, it becomes necessary to notify a large number of individuals on a wide variety of devices (both personal or corporate owned). Typical use cases include major IT system outages, natural or man made disasters, or any other event where a hospital might want to call in a large portion of their work force. Most of the vendors in this group target horizontal markets of which health care is just a portion.
Medication Management
This includes claims for ePrescribing, medication adherence, meds administration and broader medication management. This set of use cases requires special integrations with internal pharmacy information systems, pharmacy benefits managers, retail pharmacies, etc.
Patient Engagement
Any use case that includes messaging with patients can be termed “patient engagement.” This category ranges from texting appointment reminders to patients to AI based coaching of patients to improve chronic disease management and reduce readmissions.
Patient Flow
Much of bed management and room turn over workflow is straightforward. Consequently a few messaging vendors have configured their systems to support these basic workflows, and/or complement more sophisticated standalone patient flow applications.
Population Health Management
In this latest generation of utilization review, population health management is the aggregation of patient data across multiple HIT systems (inter or intra enterprise), the analysis of that data into a single, actionable patient record, and the actions through which care providers can improve outcomes. This widely accepted definition is a perfect fit for messaging middleware, and a number of vendors agree as shown by their product offerings.
Referrals Management
Is the process of getting patients referred to an appropriate (and in-network) provider in such a way that the patient receives timely and proper services, and the referring physician gets appropriate data back to document the care delivery process and outcomes. As these transactions occur between trading partners (see this post) where the typical technology is a telephone and fax machine, a messaging solution offers many benefits.
Rounding
Is a daily process where a patient’s diagnosis, treatment and condition are reviewed within the context of care delivery. The output of rounding are messages to other members of that patient’s care team regarding action items and changes to the patients care plan.
Secure Text Messaging
Every messaging solution targeting health care provides secure text messaging as a basic (and required) feature. Rather than list every messaging vendor I’m tracking, I have listed only those that limit their claims to secure text messaging. I suspect that the market is starting to outgrow solutions that are limited to this first and most basic messaging capability alone. Like emergency/mass notification, secure texting includes a number of horizontal market vendors targeting health care.
Telemedicine
Provides virtual office visits via the patient’s smartphone, tablet or PC. Remote patient encounters of this type are typically limited by the absence of any medical devices to quantify the patient’s condition. Yet there are many primary care encounter scenarios that would benefit from this type of visit.
Workflow Automation
Like secure text messaging, this is more a feature than a use case. Workflow automation is accomplished by processing data from user and system message streams through a rules engine, machine learning or artificial intelligence software. Workflow automation is an essential capability for messaging systems, enabling things like message routing, the inclusion of contextual data with certain messages, sophisticated alarm and alert notification and much more. Few vendors use such a mundane term as “workflow automation” to describe their solution, however, some do make claims about more generalized or configurable ability to automate customer’s workflows. This contrasts with a larger number of vendors who use workflow automation to enhance overall messaging functionality and/or to automate specific use cases like those listed above.
Tim Gee
Principal
Messaging became a focus for me 15 years ago when I first wrote the requirements for an alarm notification system. Since then I have developed requirements for other messaging systems, completing messaging consulting engagements for medical device, health care IT and provider organizations. I have made it my business to cultivate a deep understanding of the technology (how it is built and how it evolves), vendor methods and limitations, and knowledge of provider operations, strengths and limitations. I've been writing about messaging for some time and the blog posts listed below provide examples of some of my knowledge and understanding of messaging applications.
Unlike most other consultants with provider backgrounds, I have sat on both sides of the table — over 25 years with both vendor and health care providers. As a consultant for 10+ years, my focus is workflow automation at the point of care — in both acute care and ambulatory settings. Besides process optimization and governance, the technologies found at the point of care are a big part of my practice.
Health care providers who chose their messaging solutions wisely, will adopt systems that become building blocks to an eventual enterprise messaging architecture.
If not, the acquisition and integration of follow-on messaging solutions will require the costly replacement of previous solutions or result in hard to use and manage messaging app proliferation.
Phases of a Messaging Engagement
Project Plan
Before any consulting project can begin, a detailed project plan or roadmap is needed to clearly define scope and the specific steps to be taken to achieve the goals of the engagement. This is usually a two day process. Project Roadmapping can be broken out as a separate project from the overall engagement, or included as the first phase of an engagement.
Needs Assessment
A thorough needs assessment documents immediate and medium term needs to encompass all potential users and workflows. The assessment considers types and locations of users and their roles, documents use cases and the interfaces, devices and IT infrastructure required.
System Requirements
The needs assessment is transformed into written system requirements detailing the operating volumes and characteristics of the messaging solution. A complete system requirements document ensures that all the required messaging features, user roles and use cases are specified, along with the necessary systems integration, communications devices and IT infrastructure. A roadmap aligns the various product life cycles for the key devices, integrations and infrastructure to years into the future.
Vendor Selection
A Request for Proposal is created based on the needs assessment and system requirements. RFP responses are assessed for conformance to stated requirements in the RFP, and vendors are ranked on how fully they meet system requirements. Selection of one or more vendors of choice is facilitated, and guidance is provided through the vendor demo and site visit phases. The client is responsible for the ultimate awarding of the purchase order.
Take your next step to adopting the best solution for your unique messaging needs.
Schedule a free 30 minute consultation to discuss your situation and next steps.
We will review your current situation, short and mid term objectives, and discuss next steps for moving you towards your goal.
Avoid these potential pitfalls when adopting messaging solutions
Focusing on product features rather than your needs
Most RFPs focus almost totally on specifying messaging features. Yet, a needs assessment that is incomplete can result in a poor fit between messaging solutions and buyer workflows. This can force users to have to change workflows to accommodate the new product, and maybe forego some workflows altogether.
Only looking at immediate needs
While most providers have yet to adopt their first messaging solution, many of those that took the plunge are looking for a new messaging solution to do all the things they learned they need to do since adopting their first system. Considering medium and longer term messaging use cases — and user groups — along with immediate needs can avoid costly replacements or messaging app proliferation.
Avoiding user and adoption landmines
Driving user adoption is hard, a solid plan and substantial effort are required for successful adoption. And once adopted, users develop an intimate relationship with their messaging apps. Getting users to move from one messaging app to another can make initial adoption seem like a cake walk. Any consideration of more than one messaging system requires careful consideration to avoid user and adoption landmines.
Messaging app proliferation
Users with more than one messaging app on their phone are often frustrated by keeping track of which message came from which app, which app to use for which type of message, and which user is available through which app. Mistakes, inefficiencies and inevitably, frustration, can result from unplanned app proliferation.
Poor systems-of-systems engineering
A messaging system integrates with many devices and information systems for generating, conveying and receiving data. The systems integration and required health care IT infrastructure required is substantial and span numerous organizational silos, sometimes even beyond the enterprise. Configuration management, change control and risk management must incorporate these many threads to ensure the reliability and safety of the system.
Inter-enterprise deployments across health care trading partners
Some use cases require a messaging system that spans beyond your enterprise to encompass patients and/or health care trading partners in your community. Electronic prescribing, patient discharge planning, avoiding readmissions and patient engagement are all use cases that require messaging with individuals beyond the immediate enterprise. Inter-enterprise messaging comes with special requirements and additional planning and implementation challenges.
Increase your messaging IQ
The following articles provide some background, analysis and a bit of prognostication on health care messaging.
Most purchases by health care providers are team efforts, but messaging solutions are even more so. Messaging deployments cover a wide set of users in various roles, departments and even separate organizations.
Bringing all these stakeholders together, taking them through an acquisition process and then agreeing on the best overall solution, well, that's a tall order.
As you continue your process to adopt a health care messaging solution, share the resources on this site with your colleagues. When you're ready, schedule your free 30 minute consultation to discuss your situation and next steps.
TAKE YOUR NEXT STEP TO ADOPTING THE BEST SOLUTION FOR YOUR UNIQUE MESSAGING NEEDS.
Schedule a free 30 minute consultation to discuss your situation and next steps.
We will review your current situation, short and mid term objectives, and discuss next steps for moving you towards your goal.
