Telecommunications in Healthcare

Editor's Notes

1. Telecommunication is also called telecommunications or telecom (Alliance for Telecommunication Industry Solutions [ATIS], 2007).
2. Communication and tabulation were necessary ingredients for the exchange of information and for mathematical computations in all early societies (Englebardt & Nelson, 2002, p. 453). Examples of ancient methods of communication included speech, cave art, smoke signals, running messengers, drums, flags,the use of Oriental characters for writing, and hieroglyphics(Englebardt & Nelson, 2002, p. 453).With the inventions of the telephone by Alexander Graham Bell, the radio by Guglielmo Marconi, and the television by John Logie Baird in the mid to late 1800s, telecommunication soon became integral to the communication and business function of the whole world (Zelizer, 2008). Other great strides came to the telecom field, and it quickly became inundated with the improved technological advances that we see today.
3. Healthcare informatics is a growing field in telecom with dozens of new integrations discovered regularly (Hebda, Czar, & Mascara, 2006, p. 122). The field is so vital to healthcare that 7.8 billion dollars was spent in 2008 alone on healthcare informatics and telecom systems (The Insight Research Corporation [IRC], 2006, p. 8).Communication: Telecom enhances communication between providers, staff and patients (Hebda et al., 2006, p. 17). An example is for physicians that get view text pages sent via the hospital system to their Blackberry. This increases the physician’s ability to be in a remote location yet still get necessary data on their patients. Networking: Telecom improves networking by providing access to hospital staff both in and outside of the hospital system (Zelizer, 2008, p. 124). Staff can access the hospital portal from home and perform basic functions and check hospital email. Diagnostics:Telecom increases the efficiency of diagnosing conditions since more of the patients’ health record is available to the physician. Also remote diagnosing is improved via telecom. Education: With programs like Healthstream, telecom improves education of staff members. Continuing education courses, renewals and seminars can be viewed via the telecom system. Staff also have access to the hospital online libraries and online medical databases like Taber’s and Micromedex to improve knowledge and educational opportunities. Health Information resources: The telecom system is most widely applied to the electronic medical record (EMR) (Hebda et al., 2006, p. 19). This is a database created for all the patients admitted to the facility (or group of facilities). Having EMRs allows multiple users to access the patient’s health information from all over the hospital. This improves patient care, decreases wait times, and increases cooperation by the interdisciplinary team (Hebda et al.).
4. Phone system: Hospital numbers have a 5-digit extension. This includes patient rooms. Dialing externally from a hospital phone, one would need to dial a 9 first. Notifying patients of this is essential. Vocera: The Vocera® communications system is a breakthrough wireless platform that provides hands-free, voice communication throughout an 802.11b/g networked building or campus (Vocera Communications, 2009, p. 2). Each staff member in an essential position is given a Vocera pager, which is hooked up to a mainframe computer named Jeanie. Jeanie accesses the location of all staff members, and then transfers messages from one to another. Email: All staff members have a Microsoft Outlook Express email set up on hire. This is used to communicate departmental and organizational information and can be accessed from home.Pages and E-page: Nurses can text page physicians’ with essential data including but not limited to vital signs, lab results and 9-1-1 pages. This allows nurses to notify the physicians of that data so that both practitioners can effectively utilize time. E-trans: This is a software system used to communicate transportation needs within the hospital to the transportation department. The dispatcher then assigns the task to the nearest team member, and the nurse can look up a time frame from when the request will be filled. Cell phones: These are used to communicate with managers, doctors, supervisors and practitioners with a high demand like phlebotomists and respiratory therapists. This is the quickest way to get needs filled, but only used as an emergency result. Overhead paging system: This is used to make color coded announcements to the whole hospital to staff that patients cannot understand. For example “Alert Team, code Blue (emergency), Code red (fire), Code Pink (abduction), Code Gray (security needed).
5. Networking: Telecom equipment comprises of computers and laptops that are connected to the hospitals’ mainframe. Internally, theintranet provides personnel with the full range of programs on the hospital’s intranet page. The Internet can be accessed from the hospital and home, and this has no patient data but it has Google! Kronos is a punch in/out time-clock for employees. They can view time cards here and make changes as well.
6. The testsperformed above and others at my hospital require telecommunications in one way or another. The data is sent electronically to the physician (usually the radiologist) who reads the test and transcribes a report that is then sent to the local MD. Sometimes during night shift, the STAT tests are read by a radiologist that is not even on the hospital site (usually on the East coast somewhere). MDs can also check the results of the tests from their access point in a remote locale.
7. Healthstream: This is the education portal where all staff can fulfill their annual licensing educational requirements, sign up for real classes/seminars and participate in JHACO mandated courses. Healthstream is managed by the education department but employees can access Healthstream from home with their ID number.Micromedex: This is a program that the hospital uses for staff and patient education. CareNotes can be translated into other languages and provides an educational tool for diagnosis, diet, medications and procedures. Online Health Library: Through the Intranet, staff can access the online health library. There are many programs, books, articles and journals available that can be downloaded to PDAs for viewing later. Hospital Policies and Procedural handbook: The hospital policy and procedural handbook is located on the intranet page. Staff can search for the policies regarding various diagnosis, procedures and treatment plans.Physician’s Desk Reference and other educational programs provide a wide frame of education for nurses as well as physicians.
8. Patient Health Information [PHI] ResourcesElectronic Medical Record: The patient’s entire electronic medical record is stored in the database and can be accessed by trained and certified individuals only. Each provider must have a login name and secret password, and their access is restricted to only patients that they are providing direct care for. This is strictly monitored to protect HIPPA privacy laws. Clinical Practitioner Order Entry [CPOE]: Is used by physicians and nurses to order tests, lab work, meals, equipment, procedures and diagnostics. ClinDoc: This is the clinical documentation system, most commonly used by nurses, physicians and therapists. ClinDoc provides the multidisciplinary team with the overall medical history and treatment plan for the patient. Diagnostic Imaging Portal [DIP]: All diagnostic procedures that have been performed on the patient can be accessed here, even those from previous hospitalizations. Examples are X-rays, MRI results, CT scans etc. Bed Control Access Point: This is used by charge nurses, supervisors and managers to see the flow of patients, available beds, pending discharges etc. It is used as a tool to increase the flow of care. Qual-Com: Patients can file complaints or compliments via QualCom.
9. Improved patient care: Since there is more access to the patient’s history, a treatment plan that coordinates all aspects of their medical condition can be made quickly, improving patient care and outcomes (Brown, 2009).Remote monitoring of chronic diseases: Patients can have their progress monitored by their physician through telecom via email, phone or internet (Brown, 2009, ¶ 4). This helps to increase patient compliance, increase ease of care and decrease doctor visits. Kaiser Permanente has a great website for patients to email their physicians’, make appointments and refill prescriptions-all online (Brown). Decreased wait times: Patients that are healthy will have less of a need to come to the hospital if they can speak to their physician regularly. Also, patients in the ER will get treatment faster, decreasing ER overcrowding and patient wait times.Access to specialty consults in rural areas: Patients in rural areas can still get access to consults from a specialist since all their information can be sent via the system, and the consult doctor can call the local MD to give him a diagnosis so that treatment can progress (Hebda et al., 2006, p. 22).Increased integration of plan of care with multidisciplinary team: All members of the multidisciplinary team: like physicians, nurses, dietary, respiratory therapists, OTs and PTs can all see the plan for the patient and help to facilitate better patient outcomes. Training for isolated health practitioners: For those practitioners in underserved areas, telecom can provide them with training, conferences and educational opportunities to keep their skills up (Brown, ¶ 9).Increased patient satisfaction: Since patients’ needs are met adroitly with increased communication, they are more likely to be pleased with the customer service (Brown, 2009, ¶ 11).
10. Privacy violations: Since so much of the patient’s data is available to anyone with user access, protecting the privacy of patients’ information has become a paramount concern. In 2008, California became the first state to enact a law requiring providers to let individuals know if personal medical data had been breached (Zieger, 2009, p. 77). Now, the state has hit Kaiser Permanente's Bellflower Hospital with the second of two six-figure fines for failing to protect electronic medical record data from its own employees (Zieger).Misinformation to patients and families: Since so much information is available online, patients and family members do internet searches which might possibly yield harmful or unverified information. Many patients have come in with complications from trying alternative remedies or prolonged coming to the hospital after ‘reading something that said I was okay online’. More oversight needs to be in place to enforce that the right information is made available to patients and their families. System downtimes: Due to the fact that so much of the healthcare portfolio is accessed via the hospital network, when the system goes down, the hospital pretty much cannot function properly unless they have a backup system in place. Ensuring that the right policies are in place regarding downtimes will help to alleviate this problem. Expense: Last year 7.3 billion US dollars was spent by the healthcare industry alone in telecom implementation, training and management (IRC, 2006, ¶ 13). It is estimated that this figure will drastically increase in the next 5 years (IRC). Insurance companies presently do not pay for telecom services and this falls to the pocket of the hospitals, increasing their overhead or putting them in the red (Brown, 2009, ¶ 21). Loss of personal touch, skills or knowledge: Nurses and physicians might end up spending more time on the telecom system than at the bedside. Various tools are readily accessible (like drug calculators), which can decrease practitioner knowledge over time. With the introduction of robotics, physicians can lose their skills both at the bedside and in the operating room.
11. Medicine At Work delivers innovative medical instruments, telecommunications equipment, and, through its retained physicians, professional healthcare services directly to employees at their place of work. Using two-way video, the doctor providing services to Medicine At Work conducts examinations in real-time with the assistance of a specially trained on-site paramedic (IRC, 2006, ¶ 15). Global Telecom: The integration of medicine, healthcare, informatics and telecom will progress rapidly in other countries abroad. Westernized nations already have a system in place, with Asian countries developing rapidly as well. Telecom advances will increase dramatically worldwide over the next 5 years to all countries. Merging of Databases: Many states are now merging their pharmaceutical databases to help prevent prescription drug overdose. Soon, this merger will encompass not just pharmacies, but hospitals nationwide. Increased Oversight: To protect patient information, more states will follow California’s lead and create increased oversight on medical records. Remote Operations: Presently, physician’s can perform surgeries in another country while a specialist via videoconferencing walks them through it. In the future, specialists from across the globe will be able to remote operate on patients via robotic engineering. Increased Expenses: As systems become more technologically advanced, they will become more expensive. The cost of telecom will increase drastically in the next five years.