The single biggest problem in communication is the illusion that it has taken place.
– George Bernard Shaw
Today’s medical world is complex, with a decades-long expansion of services within the field that continuously incorporates evolving technologies. With any new technology there are implications, and as the healthcare system grew more intricate over time, with new services, roles and tools being layered, information flow got lost. A value-based payment model allows a window for redesign because it moves the center of gravity of the system towards outcomes that matter to our patients. This is the new currency.
During our 51-year existence as a community health center, it has been our mission to provide high quality health care regardless of a person’s ability to pay. It is our integrated approach to care that is both unique and complex. Seamless Integrated care requires a way of communicating and sharing information, so that the individual work done by care team members come together into a coherent, customer pleasing and useful way.
What do I mean by information flow? As an organization that has been learning and applying lean thinking for years, we know for a system to work well, the seven flows of healthcare must be designed to ensure steady and predictable work without waits, delays, re-dos, or errors. These flows include: patient, family, staff and provider, medication, supply, equipment, and of course, information. I will focus on information flow in this post as the reliable transfer of information is critical to every patient-facing process.
Few of us who toil daily in the medical landscape would name information flow as a major impediment. Often in this fast-paced world we are overrun with information, but how much of that information is accurate, timely, and valuable? Spend any time with frontline healthcare staff and you catch the deep impact of information flow on the quality of care delivery and patient outcomes.
‘Patient Yves is on the phone, stating they are returning a call; does anyone know what this is about? Nurse Sam is out today; who is covering his assigned to-do list? Main Street Hospital is trying to reach Dr. Thiim; is she rounding this morning? I can’t tell from the office schedule!’
If we define flow as how work progresses through a system, a system that is working well would have the necessary information when it is needed.
Scheduling templates, admission and discharge algorithms, and EHR’s (electronic health records) that are most intensely designed, have been mostly done so with a financial and legal framework in mind. Whether one works in inpatient or outpatient healthcare, patients and staff rely on a multitude of technology to deliver information; electronic health records, online patient portal systems, data collection devices like vital sign machines, and email are just a few. Communication, especially through time and across independent institutions, is particularly challenging to coordinate.
Information systems affect process and flow in the clinical setting. When gaps are present between the technology developed and the processes that exist there is little value that can flow to the patient. Process and tools matter deeply but only in the service of outcomes. How many clinicians truly read through every home nurse visit note signed? For those working in multidisciplinary settings, is it routine to review the findings and insights of clinicians in other departments who share in caring for the patient? How many of us have been in conversations with colleagues (a receptionist, a specialist, a nurse, a therapist) who convey a substantively different picture from what is featured in the official documentation? We need to radically restructure three crucial facets of the information flow: between team members, between institutions and between the patient and any part of the system. Too much of the patient’s data remains fragmented information, never moving up the chain to become knowledge for the care team and wisdom for all. Part of patient-centered care is enabling patients to take an active role in understanding and managing their care, another good reason to bridge the gaps we have in creating a shared understanding with our patients.
The move to value-based payment allows for a recalibration of our knowledge needs: how should documentation and communication be designed so that the parts of a care team note that are important to a therapist are easily accessible, and vice-versa? For that matter, what about doing that for all roles? What kinds of patient-centered team meetings are crucial to advancing a patient’s quality of life? How do we simplify the patient-facing interface?
What part of the current state of information flow hamper your work daily? Which aspects would you prioritize as first to be challenged?
CEO, Lynn CHC
Inspired by a childhood divided between a war-affected third world country – the Congo – and a high performing first world one (Switzerland), as well as parents intimately involved in rural development NGOs, Dr. Kiame Mahaniah brings a deep passion for social justice and the fight against inequities to his work as CEO at the Lynn Community Health Center in Lynn, Massachusetts.