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Today on This Week Health.

It was frustrating because not only did you not know who was on call all the time, but our nursing partners.

Wouldn't remember if Dr Jones like to get a secure chat versus a text message. Lack of good communication is at least a component of 70% of all serious safety events. So I think there was the safety component as well.

Welcome to TownHall. A show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

Hello and welcome to Town Hall on this Week Health. My name is Dr. Mark Weissman. I'm a C I O and C M I O at Title Healthcare and I am a guest host here today and I am pleased to introduce Dr. Joe Evans. Now Joe comes to us from Sentara Healthcare, where he is the C M I O. And I know Joe from my Sentara days, we worked together.

years ago and helped the organization with their adventures with Epic. But now, I get the chance to talk to Joe and pick his brain. Joe, welcome to This Week Out.

Yeah, Mark, thanks a lot for having me. It is good to be on the show and Look forward to it.

We're talking today about clinical communications.

I recently just went live with a change in our clinical communications tools and the whole strategy. I know you're going through the same thing. So, first, let's just start start off with tell me a little bit about what your day to day looks like at Sentara as CMIO. What do you do?

yeah, so, I've been the CMI here for about 3 years now.

so, yeah, so I work in all 3 of those spaces now have a leadership team within it, but then also work pretty regularly about 40 physicians that serve on our various clinical informatics committees.

Very nice. Very nice. So tell us a little bit about where you're at with your clinical communication strategy and maybe your vision.

What is the CMIO? I assume you have a very large role in setting the vision for this. Tell us what it looks like.

Yeah. So this for us at Sentara has been a, golly we're probably 18 months into this initiative. And this was requested. Not only by nursing, but also we had a a passionate physician who really said, we need to move into the 21st century and not run around carrying pagers.

We had a very variable communication strategy where some doctors like to use secure chat. Some like to use our vendor for emergency activations, that type of paging. Some people want to text messages. It was frustrating because not only did you not know who was on call all the time, but our nursing partners.

Wouldn't remember if Dr Jones like to get a secure chat versus a text message. So I think it was frustrating all the way around, lack of good communication is in kind of at least a component of 70% of all serious safety events. So I think there was the safety component as well.

So we formed a. A task force with executive sponsorship clinical champions and it's really a cross functional task force that includes I. T. R. operational leaders, C. M. O. S. And started to create that vision and strategy 18 months ago,

so we're gonna get a little tactical on this show today.

And with the transformation we just went through, we had to decide what was in scope and what was out of scope. And so we were already live with push notifications out of epic. So we really weren't going to readdress that. We were focusing on a lot of doctor to doctor communication nurse to doctor communication.

What about you? What's in scope? Where are you drawing the boundaries? Because this, this could go in so many different directions.

Yes, you're definitely right. So we decided for this 1st phase, if you will, we're going to focus exclusively on position communication, primarily physician to nursing. We have a separate initiative with our bedside nurses in the hospitals that is related.

That's separate. But this is really a communication to the positions that's going to encompass creating new policies around. Different tiers of communication for urgency channels need for closed, closed loop feedback, and it'll start with 11 of our 12 hospitals. 1 of our hospitals. Is being redone it doesn't have the infrastructure to support it.

But we'll go in a 2 phase approach over this year initially with 2 hospitals in the Western region of the state in Charlottesville and Harrisonburg. And that will kick off hopefully , in June and then we'll take some lessons learned there and apply it to the remaining hospitals and go big bang sometime in the early fall,

it sounds daunting to me.

So I've got, we're in 2 states also, but it's 2 hospitals in each state. You are spread out all over the place with 12 hospitals. It's a much bigger initiative. Talk to us about the challenges and how you're adapting to. Thank you. Rolling this out across such a large geographic footprint. You can't be everywhere kind of carrying this one over the finish line just by force of your own willpower.

So what does it look like?

Yeah. So, I mean, I think, without a doubt, the biggest part of this is going to be the change management part. We did choose specifically our western to hospitals because there's not a lot of back and forth between those hospitals. Unlike in the Hampton roads markets, we might have a cardiologist that sees patients that does procedures at 2 or 3 of the different hospitals.

So that's kind of, how we decided to lay out this initial phase of the initiative and, we have getting. Separate from the portion kind of vendor selection, all of that we started with some reaction panels. We had a position leader and a nurse leader create a couple of reaction panels by practicing clinicians.

That's a nurses to kind of understand what the pain points were understand where some of the anxieties. Came from and we use that to kind of create our communication matrix and our rollout plan. And we're just now starting to circulate through the medical executive committees of all the hospitals to get in front of them.

But there, there is no doubt that change management piece, the, the tech piece is much easier than the change management piece.

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No matter what I do with an initiative, I could be screaming it from the rooftops, put the flyers up in the physician's lounge. No matter what I do, someone walks in the day ago.

I can go. Oh, what do you mean? We're doing this new thing. So sure enough, it happened when we did our communications. ] How are you going to plan for that? And handle that eventuality of someone who's now questioning? Okay. What is this? And how does it impact?

it's a great question. We've leaned pretty heavily on our corporate communication team.

They've done a, a great job with some initial some awareness. This is coming. Some of our physician executives are also sending out information because this touches not only all of our employed physicians, but of course, all the independent physicians who use our hospitals. So as you said, getting that message out is key, and it's going to be one of those things where it's done seven times, seven different ways, and hopefully we will touch most people.

What's your biggest fear about rolling this out? It's the night before go live. What are you thinking about?

yeah, I think the biggest thing that will keep me awake at night as we lead up to this is really what kind of adoption will get, because there's going to be independent minded people out there that think the way that they've been doing it is the best.

And that's how they're going to continue to do it. And that's like, I said, that that change management piece without a doubt is going to be the hardest. But we have some great executive support support at the hospitals that, you know, this. This is going to be our policy, and this is kind of part of parcel of using our facilities.

So I'm hopeful that I won't get too many sleepless nights worrying about that.

Our teams were worried about that critical results that has to get to the provider, and they're using a means of communication that the provider hasn't adopted, and they're worried about, okay, this patient's gonna crash and I'm not gonna be able to reach the person, and you're messing around with this really important thing.

And there was a lot of anxiety, none of which panned out to be anything. Of course, on the day of go live it's, Oh, this tool's just so easy and everything's working fine. And we did have our protocols in place. This is when to use it for, this is when you don't use it. Are you anticipating? Any concerns or are you getting feedback of people worried about that?

Someone's going to get hurt because we're rolling out this tool.

Well, certainly I mean, safety is always, top of mind. I think the thing to our benefit is our kind of emergency activation. Those high priority messaging. Initially, that's not going to change. We're going to continue with the same solution that we have today.

It's for all of the less acute problems that the new solution will be in place. So hopefully. That portion of it shouldn't be too bad because the emergency activations, the medical response team calls, all of those will be just like they are today. So that will not change.

We did the same thing. We also didn't change the code blues or the respiratory distress type calls that coach strokes and stuff.

We left all that alone. We'll come back to it. We don't have to bite this all off at once. We did decide when we drew our what's in scope, we said. Hey, we really want the family's waiting at the bedside for you doc. You want to come by that kind of stuff was perfect for how to test this strategy out and.

Just make sure that we weren't going to hurt anyone. So let's wrap this up. Joe. I want to hear what advice do you want to give to another CMI out who might be going through this? I'll give my 2 cents. Then after go ahead. 1st.

Yeah, I would just say the best advice is to lean on all the people who have done this before you.

And that's certainly what we've done, whether it was. Connecting with people after presentations at or or even at him last year that's that's

the single best piece of advice I can give. And I think, especially, the CMO community. Is pretty generous of their time and sharing their lessons learned. So that would be my tip.

It's a good tip. Mine's going to be for CMIOs to think about the integration of. The on call list with the clinical communication tools.

I'm not finding that there's 1 great tool that does all the things that you're going to want. So you're going to end up maybe with some fragmented solutions and the on call list. There's a couple of big vendors in the market who are doing that, but okay, they don't do perhaps that that clinical communications and then you need an integration.

Think about that up front how you want to plan that. Because that can catch it that's 1 of those gotchas where, okay, , you're ready to go live. And now you're like, okay, how do I find out who's the cardiologist on call that I want to reach. So, I don't know if you're, if you're thinking about that, but that was 1 of the struggles that as we're going through this, we're just not finding the on call tool and the clinical communications tool all wrapped into 1 nice bundle epics.

We'll come straight out and say this is not on calls, not what they specialize in. That's not something that you can really do a lot of in there with a lot of rich functionality in their tool set. What do you think?

I mean, I agree. I mean, we did as part of this as we were researching vendors, we did go for a single enterprise solution for the call scheduling part, but then had to have the integrations Not only on the side, but also the tool that we use for emergency knowing that that tool might not be the same tool that we use in a couple of years and would eventually like to go to the all epic platform.

So, have the scheduling platform separate move to all epic. know that there's at least 3 health systems today. That use only the epic secure chat functionality for everything, including the emergency activations. But but agree, definitely thinking through trying to get people to a single platform.

Awesome Joe, thank you for coming on the show. It's great talking to you again. we tend to catch up. It's a couple of meetings. It's always good to catch up with you. Talk about this. I'm tempted to come back and get you, I don't know, maybe six months from now or so and see how your go lives have been and, and what's new and exciting on the other side of all this.

We'd love to have you back and hear from you again.

Yeah. Thanks Mark. I'd love to come back and kind of share what we learned so that for those who, come next they have a little bit of a headstart.

Awesome. Thanks for watching us on This Week Out. Thanks.

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