A hospital unified communications system can converge messaging, create efficiencies

In hospitals, unified communications (UC) systems can improve patient care -- and the bottom line -- by porting all messaging and alerts to caregivers' smartphones.

Unified communications (UC) systems generally can be defined as loosely grouped bundles of software and hardware...

technologies mixed and matched to help workers keep better track of phone calls, voicemail, email, faxes, instant messages, texts and any other media through which co-workers and customers communicate.

In a hospital, unified communication systems typically port all those messages to a single phone so nurses and doctors are not loaded down with multiple pagers, cell phones and other devices that capture messages from different systems.

"They've got a pager for this, a pager for that. They have an office cell phone and a personal cell phone," said Chuck Christian, CIO of Good Samaritan Hospital in Vincennes, Ind. "They're looking like Batman wearing his utility belt." Christian is presently assessing his facility's need for UC technology en route to a pilot project that will build a UC system over several phased rollouts. "I really think we can leverage technology to bring all this stuff together," he said.

While there is no standard definition for UC, it usually involves replacing traditional phones -- known as both plain old telephone service (POTS) and public switched telephone network (PSTN) -- with Voice over Internet Protocol (VoIP) telephony and smartphones. UC systems also typically have "presence" features, which look at such indicators as chat status or availability, the latter of which is based on whether a user is logged in.

In a health care setting, presence is a crucial component of these new communications systems. By figuring out where a person is and which communication device he is using at that moment, and routing calls through one number, presence connects doctors with nurses, pharmacists and patients more quickly than paper messaging, traditional voicemail or pagers can.

Monetizing the benefits of unified communications

Unified communication systems give a physician's co-workers several messaging options, such as instant messaging, text message, email or phone call. In hospitals without a UC system, those choices are not always available or reliable, and all messages might go into a voicemail or paper message inbox that the physician checks only a couple times a day.

On the other hand, unified communication systems, for example, can give reception staff the choice of dialing or texting a doctor directly for urgent messages, or emailing when a message requires a less timely response. After a while, the physician learns that when the phone rings, it is probably for a good reason.

Christian said he is particularly excited about connecting doctors and nurses more quickly with UC technology when alerts from lab tests and diagnostic equipment show a need for a change in treatment. That is a pain point for his hospital right now, because it sometimes takes multiple attempts for nurses -- who are busy and can't stand around waiting for callbacks -- to track down physicians.

Meanwhile, at Children's Hospital Los Angeles, CIO Steve Garske is building the network at a new facility to make VoIP the primary phone system. Unified communications tools will port all messages, including faxes, to physicians' and nurses' smartphones. In addition, the facility's electronic health records (EHR) system will be ported to a number of mobile devices, including the iPad from Apple Inc.

Once the move to the new hospital tower is complete in July, the new unified communication system "will allow [doctors] to view the medical record off the iPad, look at X-rays and just about everything they want to do," Garske said.

UC technology starting to catch on

UC systems can fulfill objectives as basic as VoIP integrated messaging and as complex as telemedicine videoconferencing and deep EHR integration. The latter give clinicians access to patient data (and editing capabilities) on smartphones and tablet computers. In between are such uses as coordinating patient transport, routing housekeeping staff and enabling two-way doctor-nurse communications within a hospital building -- tasks that used to be done over desk extensions, pagers or even public-address systems. All this messaging is sent over the hospital's IP network, to smartphones or IP phones, and in some cases, virtualized to employees working at home or in the field.

"It's finding anyone, anytime, anywhere, using the richest media possible," said Andrew Gorski, UC manager for equipment distributor CDW LLC. "It's the ability to reach somebody quick[ly], reach them on the first try, to tell if they are available before you even try and contact them -- and if they're on the phone, to try somebody else." (See "Making rollout of hospital UC systems smooth and efficient.")

A relatively new application for UC technology in health care settings, Gorski added, is hardwiring radio frequency identification, or RFID, tracking for both locating patients and keeping inventory stocked.

According to current survey data from CDW, many health care organizations are on the verge of implementing some form of UC -- 35% are assessing UC needs, 36% are planning a deployment, 17% are implementing UC and 12% have implemented it already. This year, 69% of respondents indicated they had prepared a UC strategy or business case, up from 58% last year.

"I was impressed by that," said Lynne Dunbrack, program director at advisory and market research firm IDC Health Insights. "You think about how much more ubiquitous smartphones are becoming, particularly among professionals, and it was really only a matter of time before physicians and nurses [said], 'Hey, I can use this in my personal life to do so many things, why can't I use my smartphone in the clinical setting?'"

Selling a UC strategy to administrators

Last year health care providers surveyed by CDW said that increased productivity was the main reason for switching from ad hoc communications systems to UC, listing cost reductions as their No. 2 reason. In the 2010 survey, they flip-flopped, with 58% of respondents citing cost benefits and 49% indicating boosts in productivity as the most significant benefit from UC.

They've got a pager for this, a pager for that. They have an office cell phone and a personal cell phone. … I really think we can leverage technology to bring all this stuff together.
Chuck ChristianCIO, Good Samaritan Hospital

Both CIOs interviewed for this story said increased productivity was the main reason they implemented a UC system. The cost savings include lower phone bills and lower equipment costs because their hospital relies more on VoIP telephony and less on traditional phones -- but the savings are hard to directly attribute to the UC setup.

Starting small and attempting to prove return on investment might be the best UC strategy, as opposed to making a big splash from the start. "Be cognizant of the fact that, just because a solution has a high coolness factor, it may not be the best," Good Samaritan's Christian said. "Costs do come into play." Even though you cannot necessarily quantify this, it is worth mentioning to administrators that unified communication systems increase satisfaction among patients, nurses and physicians who no longer play phone tag and wait on hold, he added.

One tangible expense that UC integration should help cut is paper, Children's Hospital LA's Garske said. His facility is tracking paper use before and after the move to the hospital's new building, where the next wave of UC technology will be phased in. He hopes that faxes and most of the last vestiges of paper workflow in the EHR system will be eliminated with that, he said.

Cost, call quality can hinder UC technology adoption

According to the health care IT leaders CDW surveyed, installation costs and quality of service are the two major barriers to adopting a UC system. Not only does UC require a capital outlay for equipment and software; but a boost in network capacity also is likely to be necessary to support it.

More on reaping the benefits of unified communications

Making rollout of hospital UC systems smooth and efficient

News, tips, and advice for developing a UC strategy  

Although CDW's survey respondents deemed quality a concern, our sources said it is not an issue. It would seem that VoIP conversations theoretically might contribute to medical errors. For instance, a not-quite-POTS-quality connection might cause a nurse to mix up two similar-sounding drug names being prescribed by a doctor.

Not so, said the two CIOs we interviewed, who added that VoIP technology has made substantial gains in recent years and its sound quality pretty much matches that of POTS and cell technology.

At Children's Hospital LA, the VoIP system started as a virtual home-office pilot program, one where doctors and executives tested it by working at home with IP phones and access points. "We've had it in place for almost two years," Garske said. "It's better than a landline. We haven't had any issues."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in June 2010

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