Ms Melanie Ford

Patient communication and the digital health journey

Patient communication is closely tied to patient outcomes. The question is, how do we ensure that all forms of care-related communication are effective?

It is not an understatement to say today’s healthcare system is deluged with data and information on the daily. How that information is communicated to and between patients and clinicians, has a real impact on outcomes and safety.

“In the ideal world, both the patient and healthcare provider would have complete understanding of their clinical issues, interventions and ongoing treatments, including the best way to disseminate that information to both the individual and their family,” said Ms Melanie Ford, Clinical Industry Consultant ANZ at Lexmark Healthcare.

“Unfortunately, the communication of clinical data tends to be a “one size fits all” approach. It doesn’t always account for differences in language, comprehension, location of care or ability.”

Communication during clinical handovers

There is an “information asymmetry’ in healthcare, where the clinician holds more information on the effectiveness of treatment than the patient. “This isn’t necessarily a criticism of professionals. We have a large amount of information to digest and disseminate, to a multitude of people and systems with often ineffective ways of transmitting them,” Ms Ford explained.

Problems arise when patient information and data are not effectively communicated between hospitals and external healthcare providers (such as general practitioners (GPs) or allied health professionals).

Clinical handovers – where patient care is transferred between locations or clinicians, or when care levels change – occur between external care providers and hospitals, or from clinicians to the patient and their caregivers, and then to the patient’s care providers in the community. “More than 40 million nursing clinical handovers occur in Australian public hospitals each year. This would make handover one of the most critical forms of communication in the patient journey… the way information is managed is critical to the health and wellbeing of the patient,” Ms Ford pointed out.

Poor communication at this point lead to severe consequences. Data from the Joint Commission predict that within the hospital setting only, around 80% of serious medical errors were the result of poor communication between staff during clinical handover. A 2016 study estimated that communication failures in U.S. hospitals and medical practices were responsible (at least in part) for 30% of all malpractice claims, resulting in nearly 2,000 deaths and US$1.7 billion in malpractice costs over five years.

There have been efforts to set standards for more structured handover procedures. For example, the Australian Commission on Safety and Quality in Health Care (ACSQH) developed standards for clinical handover communication, as part of its National Safety and Quality Health Service (NSQHS) Standards. This includes defining the information that should be handed over, and emphasising the engagement of patients and caregivers in the handover.

However, one catch is that only public and private hospitals, day procedure services and public dental practices have to be accredited to the NSQHS Standards. For other organisations, they are merely a recommendation – and hence standardisation remains a problem.

Ensuring effective patient communication

From the patient’s perspective, it is crucial that they receive open, timely and appropriate communication about their healthcare, in a way they can understand. With incomplete access to or understanding of the options at hand, patients are not able to make informed decisions, Ms Ford noted.

While face-to-face is the most common method of provider to patient communication, “studies globally indicate that patient uptake and comprehension during this communication is not consistent,” she said.

This is because of a multitude of factors such as:

  • The quality of the communication (based on the skill of the communicator);
  • Learning issues such as auditory processing disorder;
  • The timing of the communication (before a procedure, waiting for results etc.)
  • Client factors (language, hearing etc.)
  • Usage of clinical rather than common terms
  • Social or cultural factors

As healthcare digitalisation continues at a feverish pace, interactions are taking place more often via digital means. This may further aggravate patient communication issues, especially amongst the less tech-savvy seniors who are also the largest users of healthcare. There are also patients who have inconsistent access to or support in managing digital health technologies, including those with no access to the internet.

Against this backdrop, Ms Ford highlighted that printed materials are both complementary to and where face-to-face is not possible, a valid alternative to face-to-face interactions and digital health solutions.

“Print media maintains consistency across transmission of data and can be presented in formats suitable to many learning issues, or adjusted to language and reading levels, or social or cultural factors,” said Ms Ford. “They can supplement information given in times of stress or clinical morbidities and replace clinical with common terms.”

It is also important to note that instead of pre-printed material, printing forms and instruction materials on the spot, at the point of care, helps boost accuracy of information, by reducing the risk of out-of-date documents. Clinicians can also choose to print according to the patient’s needs. Crucial information can be highlighted in colour to highlight key messages.

Print is also a key backup in situations of IT downtime. With patient data largely stored in EMR systems, system downtime seriously impacts clinical communication. The use of solutions such as Lexmark Downtime Assistant, which maintain the latest forms and patient data for access during downtime, supports care continuity.

Filling the gaps in EMR systems

While EMRs have proven to be extremely useful in maintaining holistic records and improving care efficiency and effectiveness, interoperability issues remain between EMR systems used by different hospitals. According to HIMSS, whilst 75% of systems have achieved foundational interoperability, only 36% have reached a common vocabulary that paves the way for accurate and reliable communication.

“EMR systems for primary or tertiary care solutions weren’t specifically designed to be interoperable with multiple other systems, let alone systems that were designed for different operational purposes,” said Ms Ford.

She pointed to differences in coding languages (Java, Python), data formats, vocabularies and interfaces that exist in different systems. Though FHIR (Fast Healthcare Interoperability Resources) and HL7 (Health Level Seven International) and nomenclatures such as SNOMED have addressed semantic interoperability on some levels, they have not reached deep levels of consistency as of yet – with HL7 noting that tools are still being developed to achieve that goal.

In addition, not all healthcare providers have adopted EMRs. While public hospital EMR rollouts have seen good progress in Australia, adoption is relatively slower in the private sector, and implementation differs across each state and territory. Even in those that have adopted EMRs, the rollout does not include 100% of  clinical operations or workflows.

As such, a relative amount of information remains non-digital or interoperable in healthcare. It is thus likely that patients will still present to the hospital with paper documents, and it is important that this information is captured accurately and readily to maintain comprehensive medical records and clinical communication.

Achieving this may not be as complicated as it sounds – as the solution may be found in the multi-function printers (MFPs), that most providers already possess in their facilities. Lexmark’s line of printers supports automated scanning and indexing of such papers, which will ensure timely and easy capture of clinical information.

Click here to learn more about Lexmark’s Patient Communication solution. You can also contact Lexmark’s Healthcare Consultant at Jason.tee@lexmark.com or melanie.ford@lexmark.com to learn more about Lexmark’s clinical solutions and assessment of your facility’s printing requirements.

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