Unified communications (UC) systems mirror medical equipment -- there are many choices that accomplish the same tasks, many different implementations and many features from which to choose. Building the right
Beyond software and hardware, "you need to throw in the other leg of the three-legged stool -- process," said Chuck Christian, CIO of Good Samaritan Hospital in Vincennes, Ind. "Just because you have really good hardware or software … if you don't do the process redesign to take advantage of that, the only thing you've done is smacked on another layer of paint that'll just peel off."
To that end, Christian suggests that hospital CIOs who are developing a UC strategy consider networking with other CIOs to find out how they rolled out their own UC plans.
Determine where the need for UC technology is greatest
To analyze communications processes at your facility, talk to representatives of every department -- from clinics to the back office to the warehouse -- and discuss how they communicate with each other and where they have problems. Identify the heaviest users of communication devices, said Lynne Dunbrack, program director at advisory and market research firm IDC Health Insights; if you do, you will likely find the friction points "where a unified communications strategy would actually have the most bang for the buck in streamlining issues."
In this way, noted Children's Hospital Los Angeles CIO Steve Garske, you can easily define what you are trying to accomplish. Establish your goals first, and you'll be less likely to be blown away by the feature sets you will see in UC systems once the evaluation phase begins.
The thing about UC technology that differs from a lot of the health IT initiatives that might be going on in your facility -- rolling out a complex new electronic health record (EHR) system, for example -- is that staffers already are doing a lot of the same processes that UC uses with instant messaging and texting and other various media, albeit in an ad hoc way. For that reason, a UC initiative probably will require less training than a lot of new products do, Garske said.
Furthermore, installing a UC system probably will reduce the likelihood that staffers are messaging each other in a way that is neither secure nor compliant with hospital policy or the Health Insurance Portability and Accountability Act (HIPAA), Dunbrack noted. UC systems help accomplish HIPAA and hospital security and compliance objectives, and allow network managers to control and secure which information gets routed to whom.
"It really would be wise for health care organizations to be part of that solution, so they're doing it in a secure fashion," Dunbrack said. "If clinicians are using SMS text messaging to communicate with each other instead of going through a device that's more secure, that could create a chance for a privacy breach," she said.
Dunbrack's suggestion that will help CIOs prove progress to administrators: When setting goals against which to measure the return on the UC investment, establish the metrics and get solid baseline measurements before beginning.
Upgrade infrastructure to accommodate UC systems
Before deploying UC systems to reduce communications bottlenecks, a facility must assess its infrastructure, Garske said. He has outlined a three-step process to ensure that the network is in tip-top shape before UC technology is brought online:
Unified communications is coming. It's something that all CIOs will have to deal with at
Steve Garske, CIO, Children's Hospital Los Angeles
• First, so the network can handle the additional traffic, build up capacity and redundancies.
• Second, replace or upgrade the servers and other hardware as the budget allows.
• Third, make sure all hardware that cannot be replaced is under a maintenance contract and is not an outlier that will break down, cause a network slowdown and become a time sink to replace.
Resist the temptation to rip out the plain old telephone service (POTS) and replace it with Voice over Internet Protocol (VoIP) technology. VoIP is coming in at Good Samaritan, Christian said, but for now they are piggybacking VoIP on the POTS system with special switches. It is one of the ways the hospital "squeezes the last bit of copper out of Lincoln before letting loose with a penny."
Meanwhile, at Children's Hospital LA, where a new building will open in July, the POTS system will be reduced to being a backup for a VoIP UC system: It will be used only if a catastrophe brings down the IP network or an external disaster requires more communications than the VoIP system can handle, Garske said.
Make EHR take advantage of UC technology
Having first helped Children's Hospital LA convert to a "96% paperless" EHR system, Garske recommends that hospitals implement UC technology after getting their EHR systems "as paperless as possible." This will allow EHR messaging features -- as well as access to lab results, medical images and even faxes -- to be integrated into the VoIP UC system.
More advanced UC implementations can hook into practice management systems as well: automatically opening a patient's chart when a clinician takes a call (thanks to caller ID), for example, and getting patients involved with booking appointments and interacting with nurses and physicians. Even patients' calls for a nurse from their hospital rooms will be routed through the UC system at the new Children's Hospital LA facility.
"[UC] is coming. It's something that all CIOs will have to deal with at some point," Garske said. "Allowing UC to come in and improve our communications and combine everything into one system … [is] going improve communications tremendously," he added.
Other hospitals are going in yet another direction with UC by branching into telemedicine, said Andrew Gorski, UC manager for equipment distributor CDW LLC. Rural hospitals whose physician resources are spread thin might be candidates for high-definition remote monitoring setups facilitated by UC technology. With such a setup, a doctor could write orders and make diagnoses at a location miles away from his patients. Consider that when planning a UC strategy.
Let us know what you think about the story; email Don Fluckinger, Features Writer.
This was first published in June 2010