For example, consider the communication that should occur between physicians and nurses. In the paper chart world, the physician had to be where the patient's chart resided (typically on the nursing unit with the patient). That's also where the patient's nurse would be found.
The act of the physician writing an order in the chart set off a sequence of events that had several sets of eyes and hands on that written order before any action was taken. There were opportunities for the physician and nurse to communicate about a particular course of treatment or specific procedures that would assist in the diagnosis and treatment.
The paper chart was also the one place that you could be sure that the physician would go for information about test results, consults and other patient information. It was the place that could be used by anyone who needed to get a piece of noncritical information in front of the eyes of the patient's physician. Entire workflow processes were designed and perfected based on the paper chart being “communication central.”
Now, in the paperless or paper-light world of CPOE and electronic charting, physicians no longer need to be in the same physical location as the patient's chart. He or she can review results and outcomes, and enter orders from just about any computer where they can securely access the electronic systems of the hospitals where their patients are admitted.
In other words, the electronic systems we've been working so hard to perfect has become the root of another problem that potentially could be more serious than the issues we had originally hoped to solve. From the very inception of CPOE, the ability to enter orders electronically has potentially disenfranchised certain members of the care team, unless the processes surrounding good communications were not considered and redesigned.
That doesn't necessarily mean that we need to find an electronic solution. Good communication can come from two members of the care team just talking to each other. Unfortunately, there is so much that needs to be communicated that our workdays very well would be considered one large interruption (there are days that I'm sure many already feel this way).
There are many creative and innovate solutions to this problem, and the one that will work best in your organization will depend on your culture and how easily technology and change can be incorporated.
Don't let the search for a perfect solution stand in the way of action. Don't seek that perfect solution called “unified communication,” where everything is connected to everything else—where the nurse-call, IV pumps, critical results notifications, fall alerts, infant security and myriad other communications are all tied together and work with everyone's smart phone.
That ignores the process of communication, how people actually communicate. Take a good, hard look at how communication is working in your organization. If you've come up with a really good approach or process that you would be willing to share, send me an e-mail at [email protected].
Charles Christian
Vice president and chief information officerSt. Francis HospitalColumbus, Ga.
