Communication in healthcare

Communication between healthcare providers can be divided into synchronous and asynchronous.

Synchronous Communication

Synchronous communication occurs when different parties interact in real time. The most common methods of synchronous communication (in a hospital setting) includes:

  1. Face to face communication
  2. Active telephone call
  3. Tele-health

The first two modalities already exist, and tele-conferencing is now starting to gain "market share." 

Synchronous communication is very useful in critical care areas such as ICU, emergency department and operating rooms. Tele-conferencing is starting to gain a foothold in some of these areas to to expand coverage, or when providers are not available on site (e.g., Tele-neurology to cover ED, Tele-ICU to cover ICU at night).

Asynchronous Communication

This communication method occurs when the different parties do not communicate concurrently. Several types of asynchronous communication tools already exist in healthcare today:

  1. Pagers
  2. Voicemail functionality in cell phones
  3. Text messages (especially HIPAA compliant text message apps on smartphones such as TigerText)
  4. Email
  5. Messages sent within EHR's

Traditional asynchronous communication has multiple failure points as it is not a closed loop communication system. A nurse sending a text page to a physician has no way of knowing if the physician received the message, and if the message has been read. This may potentially lead to delay in patient care and is a safety risk.

HIPAA compliant apps on smartphones help create a closed loop system by logging sent/delivered/read status, which is viewable to the sender. Other ways to improve the asynchronous messaging system include:

  • Escalation of the message to another responsible person, if the message is not delivered within a pre-defined span of time (e.g., message gets escalated to cross covering physician or an administrator)
  • Link on-call provider schedule to web/mobile front-end messaging system (e.g., paging system website), so that messages are automatically redirected to on call coverage
  • Ability to initiate messages directly from the EHR, which should also be linked to the on-call schedule

Therefore, we already have a number of communication tools at our disposal, and our arsenal is getting bigger. The challenge will be to implement these tools so that they are smarter and better integrated with healthcare delivery workflows.