Developing a Sustainable Messaging Platform S 11 Beyond

Developing a Sustainable Messaging Platform S 11: Beyond Desktop: Mobile and Messaging Innovations to Drive Care Matthew D. Cain, M. D. Erick Christensen, M. D. , MPH, Seung Park, M. D. , Linda Wood, Lynn Napier, and Jason Schaffer, M. D. Regenstrief Institute and Indiana University Health

Disclosure • My wife and I have no relevant relationships with commercial interests to disclose. 2 AMIA 2020 Clinical Informatics Conference

Learning Objectives After participating in this session the learner should be better able to: • Attendees will understand the benefits of switching to secure messaging with an emphasis on setting up an easily sustainable communication system. Our hospital used Diagnotes, but these principles could be applied to other secure messaging platforms. 3 AMIA 2020 Clinical Informatics Conference

Outline • Background – Paging at IU Health • Technology gaps • Methods • Results • Conclusions • MCQ 4 AMIA 2020 Clinical Informatics Conference

Background • Like many institutions, Indiana University Health has depended on a paging system which linked to other messaging systems. • Automatic messages sent from EHR for various alerts • > 90 different alerts – example: Pediatric Early Warning System (PEWS) • Extensive group lists developed • Trauma alerts – extends to surgeons, administrators, charge nurses, blood bank, chaplains, and social work. • Behavior alerts – Police dispatch, chaplains, social work, charge nurses, bed control 5 AMIA 2020 Clinical Informatics Conference

Background • Indiana University Health opted to switch to a secure messaging platform in 2019 due to the following: • Security risks of conventional paging. These can be intercepted with a < $50 device off Amazon. And You. Tube videos exist on how to accomplish this feat. • Enhanced features and easier use with secure messaging. • • Potential to reduce delays in communication. Source of truth – modern software with better capabilities to maintain accurate schedules and groups. 6 AMIA 2020 Clinical Informatics Conference

Gaps • Limitations in the old software prevented easy generation of reports detailing individual names and departments with pager numbers. • Complications included specialized rules (“page copy”) that copied the message to cell phones and other pagers. • IU Health has over 300+ group alerts spread out across several hospitals. • These groups are difficult to review, often no longer used, and essentially none of these groups were rigorously maintained. • If an individual’s employment status, pager, or cell phone number changes, several groups may need to be updated to reflect a single individual’s change 7 AMIA 2020 Clinical Informatics Conference

Methods • Adoption of Diagnotes – a secure messaging platform developed by a local IN based company. • Developed “Rooms” (previously called “channels”) • Used for group messages • Can address large scale alerts, service lines, and “hot potato” pagers. 8 AMIA 2020 Clinical Informatics Conference

Methods • To facilitate development of rooms and transitioning from paging, we analyzed multiple spreadsheets: • Hospital groups • Individual pagers • “page copies” – an individual receives a page and then it is copied elsewhere. • Results illustrated the need for long term solutions 9 AMIA 2020 Clinical Informatics Conference

Results • Review of group contacts in the paging database revealed that 51/148 (34%) groups were not paged in the last 90 days. • Pediatric trauma, an outlier in group upkeep, had a source of truth spreadsheet available for comparison against the paging database – updating to the new system involved adding the trauma intern pager, updating the blood bank pager, and removing 20 obsolete cell phone and pager contacts. • It was also determined that several pagers copied messages to at least four unnecessary services (e. g. the congestive heart failure resident). 10 AMIA 2020 Clinical Informatics Conference

Results • To address group pages: • Development of rooms – these allow a group of individuals to receive a message. • Rooms can be public or private • Public rooms can be broadcast into and individuals can join • Private – users must be added by a member. Secure for internal communications. • Linkage of schedules to rooms – oncall tag • Cerner alert – consults and alerts within the EHR can go out to individuals and rooms • Rooms are different than text message to multiple users – this is a standing group of individuals. 11 AMIA 2020 Clinical Informatics Conference

Results • Maintaining Rooms • Access to Diagnotes automatically terminated when employees leave • Managers have access to edit the participants of a room • APT/BA (Behavior Alert) – Update • Originally, we had planned on having a single “room” that linked to three different channels • We now have a single APT/BA room with each member listed and maintained by their respective department. 12 AMIA 2020 Clinical Informatics Conference

Rooms 13 AMIA 2020 Clinical Informatics Conference

Rooms - options 14 AMIA 2020 Clinical Informatics Conference

Notifications 15 AMIA 2020 Clinical Informatics Conference

Contacting others and Rooms 16 AMIA 2020 Clinical Informatics Conference

Progress • The majority of the hospital has transitioned over to Diagnotes • Apheresis – single method of receiving consultations • APT/BA alerts – Go Live in roughly 2 weeks. Schedules linked. • PEWS – Cerner alert contacting the PICU room. On going development. • Many other successes throughout health system. 17 AMIA 2020 Clinical Informatics Conference

On Going Work • Establishing policies for bring-your-own-device • Addressing the needs of trainees and staff who may need a data plan • Compensation for using data • Etiquette • It is much easier to message someone than to page • Can lead to inappropriate messaging because of convenience • Ensuring Wi. Fi or cell coverage in all parts of the hospital 18 AMIA 2020 Clinical Informatics Conference

Conclusion • Secure messaging platforms offer a HIPAA compliant solution to communication • Workflow may need to be adjusted – new technology with new features, but still requires work. • By assigning managers to “Rooms”, group lists can be better maintained. • Additional work with policies are required • Addressing data compensation • Messaging etiquette • Wi. Fi and cell coverage 19 AMIA 2020 Clinical Informatics Conference

Questions A healthcare facility has decided to investigate secure messaging platforms to replace the current paging system. Each system has its pros and cons. Which of the following is a key benefit of transitioning to secure messaging? A. Secure messaging will be much easier to use for younger and older physicians alike. Therefore, education and policy changes will be minimal. B. Individuals have often abused the paging system whereas secure messaging naturally curbs inappropriate messaging. C. Secure messaging platforms are typically HIPAA compliant; pagers traditionally are not. D. Secure messaging is highly adaptable; therefore, services should not have to alter their workflow significantly. 20 AMIA 2020 Clinical Informatics Conference

Answer A. Secure messaging will be much easier to use for younger and older physicians alike. Therefore, education and policy changes will be minimal. Answer Option B. Individuals have often abused the paging system whereas secure messaging naturally curbs inappropriate messaging. Answer Option C. Secure messaging platforms are typically HIPAA compliant; pagers traditionally are not. D. Secure messaging is highly adaptable; therefore, services should not have to alter their workflow significantly. 21 AMIA 2020 Clinical Informatics Conference

Explanation Secure messaging platforms are typically HIPAA compliant, whereas paging has significant vulnerabilities. For example, it has been known for years that radio operators could intercept pages with PHI. Newer, secure messaging platforms offer a lot of functionality and security, which can lead to improved communications, but also take work. Policies must be updated to reflect the use of personal cell phone devices and an allowance may need to be implemented (especially for trainees and non-physicians). An outline for messaging etiquette is essential, as it is much easier to text someone than page. Unfortunately, there is a learning curve associated with secure messaging technologies. More senior personnel may not understand how messaging can replace paging or even how to use it. Furthermore, services may have to adapt their workflows to the new technology. Workflows heavily relying on pagers may have to adapt significantly to incorporate this new technology. 22 AMIA 2020 Clinical Informatics Conference

Thank you! Email me at: cainmat@iu. edu