- There is a fine line between implementing innovative technologies, such as secure texting solutions, and ensuring healthcare data security. Additionally, physician and clinician workflow must also be considered with any new systems or devices.
It’s important to keep things simple in IT and work on adhering to four main objectives, according to Halifax Health CIO Tom Stafford.
Customer service, maintaining operational stability, enhancing operational and strategic objectives, and maintaining ePHI are all key focus areas, Stafford told HealthITSecurity.com.
“We want to see that customer service is about being friendly, courteous, respectful, and providing feedback,” he said. “We never talk tech to our customer base. We also never say no. There’s probably 1,000 ways to solve every potential IT challenge and that’s probably something from my engineering background.”
Maintaining operational stability means “keeping the lights on,” Stafford explained. This has become more difficult with evolving cybersecurity threats, such as ransomware and malware strains.
“We work really hard to keep all our systems up, and obviously, in healthcare it’s more important than ever,” he stressed. “It’s a 24-7 operation.”
Enhancing operational and strategic objectives involved the initiatives for the hospital. Whether it’s bringing in another hospital and ensuring its structure is correct, Halifax wants to ensure that it remains innovative.
Keeping ePHI secure is also essential with the current healthcare cybersecurity environment, Stafford stated. That final objective was one of the key factors behind Halifax’s push to a new secure texting option.
“Through our annual risk assessment we noticed that there was a risk of clinicians or physicians texting each other back and forth on their cell phones that was in a manner that may not have been secure,” he said. “If you went to HIMSS two years ago, there was probably 80 secure texting vendors there and so at that time we started looking. One of the things we focused on was whatever solution we chose, it had to be the physician or the clinician had to want to use it.”
Clinicians or physicians have a choice when they use their phone, Stafford explained. An Android or iPhone will have a messaging or texting option, and now there will be a secure messaging option. It was crucial to find a solution that would offer more than texting so staff members would want to use it.
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“We knew that we couldn’t just check the box or just put in any old secure text solution,” Stafford recalled. “It had to have additional features that would drive our user base to use it. That was one of our requirements.”
Nurses’ daily workflow was also a top consideration in the decision making process. Halifax has workstations on wheels in most of its units, Stafford said. Nurses are often on the move, and might not be able to check their phone.
“When they work throughout their day they’re just focused on that pane of glass that’s around the healthcare information system,” he stated. “We had to have some way to alert them that they were receiving a message.”
“Unfortunately, a lot of the secure text technology that’s out there is web-based,” Stafford continued. “Because it’s web-based, we can’t really get an alert to the operating system of the workstations because it’s coming over the web. A nurse may not be able to consistently check text messages while on shift.”
Even if a nurse does check messages, it could be anywhere from 15 minutes to half an hour after the message was sent, he added. Receiving delayed information might not always be of value.
“We really needed to find a solution that alerted the nurses that they were receiving a text from someone,” Stafford said. “We narrowed down our search and we ended up going with Vocera. We went with Vocera because it doesn’t alert the computer. It sends an alert for the Vocera badge and it actually sends a text alert over the badge.”
The Vocera badge is a two ounce electronic badge with a screen, button, speakers, and microphone that is worn on a lanyard. It can be clipped onto a uniform or worn around a worker’s neck.
“It's really a hands free communications device and it’s a wireless device,” he explained. “It works in the wireless network across all of our campuses. If a nurse wants to talk to somebody all she has to do is hit the button, a genie comes up and says, ‘Who would you like to speak to?’”
The person on the receiving end is also wearing a badge, which will then say, “John Doe is calling. Would you like to talk to him?” You can say yes or no, Stafford stated, adding that it’s more like a walkie talkie system than a telephone.
“If a clinician is receiving a text message from a physician through the Vocera system, it actually is an audible alert and it then shows the text message on their Vocera badge,” he added. “The clinician does not have to go to the computer to see that they have a message. Vocera communicates the text alert to the doctor or nurse anywhere in the hospital.”
Vocera offered an ideal solution for Halifax because nurses in particular would not always have to go back to their computer to receive documentation or communicate with clinicians, Stafford explained. Halifax is also utilizing Vocera’s secure texting app, which essentially turns smart phones into a Vocera badge.
“We can send alerts to that phone that are very specific for that caregiver or provider about their patients,” he said. “But the other great thing is that outside of allowing it to send secure messages to contacts, which are other physicians or caregivers within the system, it also allows them to instantly talk to the specific nurse who is caring for their patient.”
For example, Stafford said that perhaps a physician would be out to dinner when he realized something about a patient but could not get to a computer. That physician previously would have had to call a switchboard to find out the phone number to the unit clerk of the particular unit where the patient was admitted.
From there, the unit clerk would try and contact the patient’s nurse, but might be unable to immediately reach the nurse. By the time the nurse receives the message, the doctor has likely already hung up the phone. Then, the game of phone tag continues with the nurse trying to call the doctor back.
Benefitting from a secure texting solution
The secure texting app has eliminated numerous steps in the communication process, Stafford maintained.
“It really provided a lot of other content and provided more than just being a secure texting app,” he said. “We had more adoption and use because of that.”
The app can also deliver documents in a secure manner, he added.
“We just knew we had to have more and those extra tools gave it to us,” Stafford noted. “It broke down this workflow of a provider talking to a nurse from 20 possible steps down to about three, and then it allows us two secure options for that communication: either texting or audible.”
EHR implementation has eliminated old challenges providers faced in getting the complete “patient story,” Stafford said. Prior to online records, a physician would take a patient’s chart at the foot of the bed, and read through the information chronologically.
Now, physicians have to find information within the electronic medical record. They could be looking through a nursing assessment, another physician’s notes, or a patient’s vitals.
“There are potential barriers and gaps to get the complete patient story, and the easiest way to solve those gaps is instant communication,” Stafford stressed. “The path we chose with the secure texting app, and also having Vocera be our clinical system, has helped our clinicians avoid those gaps and get the story quickly and efficiently, which is better for prompt patient care.”
Secure messaging and secure texting options are critical tools in the healthcare industry because maintaining ePHI is essential, Stafford said.
“You can tell caregivers not to text patient information on their phone, but do they really do it or not?” he asked. “By using a secure texting app, you give caregivers the ability to do it and they feel secure when they’re doing it.”
“By having a tool for caregivers to use – and not just a secure texting tool but a tool that provides other functionalities for them – they’re more apt to use it,” Stafford stated. “That allows me to sleep a little better at night because I know that they’re using the tools we provided and it’s helping clinicians care for patients in a secure way.”
Healthcare providers should look for solutions that provide more than just texting, he added. Physicians want tools that will help in patient care, but that will not impede their daily workflow.