Where: Stanford Hospital, a 613-bed academic medical center in Stanford, Calif.
The issue: Finding a secure, convenient way to communicate among members of the health care team.
When Stanford hospitalists started looking into how their medical teams could more efficiently communicate, they knew that texting wouldn't be acceptable under the Health Insurance Portability and Accountability Act (HIPAA). But they soon found that the way some clinicians used paging wasn't compliant either. “They tell us not to send any patient information, which is understandable for HIPAA, but it makes it harder for us to communicate effectively,” said Lisa Shieh, MD, PhD, medical director of quality in the department of medicine and clinical associate professor at Stanford University School of Medicine.
Paging was also starting to seem inconvenient, as more clinicians carried their Internet access in their pockets. “You have to sit down at a computer [to page] and type in someone's name or pager number,” said Dr. Shieh. Paging also only allowed one-way communication. “We recognized there was definitely a need for secure texting to improve two-way communication among groups.”
How it works
Conveniently, a Stanford medical student, Michael Chiu, had the vision to develop an application to provide secure texting, called Medigram (available free for iOS or Android online). To test the application, 3 of the hospital's general medicine teams were asked to use it for 8 weeks during the summer of 2012. The app encrypted the messages, and access was protected by a 6-digit password. Users could send individual or group texts to other clinicians through the app.
Use of the app was contagious, according to results of a post-pilot survey published online by the Journal of Hospital Medicine on Aug. 11, 2014. When attendings used the app, their team members were likely to also: 86% of those who were texted by their attending at least once a day sent texts themselves. Overall, more than half of the study participants sent at least 5 texts through the app, and more than a quarter sent more than 20.
The app eliminated not only the privacy issues but also the randomness of texting at work, noted Jennifer A. Przybylo, a medical student and lead author of the study. “You can't always find out a provider's personal cell phone number, whereas anyone who has the app can be contacted at the drop of a hat through a simple in-app directory,” she said.
According to the user survey, the app's group texting feature was one of the most popular aspects because it streamlined clinical information-sharing. “Sometimes you tell one person and that person then needs to tell someone else. If you can group text, then the whole team knows instantly,” said Dr. Shieh. The survey also revealed that most app users found the new technology superior to paging for both clarity and efficiency of communication and integration into their workflows. Eighty-five percent said they'd recommend it.
One limitation of the project was that only certain clinicians were on the app. “We had our case manager and other people like that on the app, and that was extremely effective, because then we wouldn't have to meet up all the time. She could just text us and say, ‘We found a skilled nursing facility for your patient,’” said Dr. Shieh. “If I was trying to get hold of a consultant, they were not on the app. That did limit use.”
Also, despite the success of the pilot, the app didn't gain wider implementation in the hospital because of other technological innovations happening at the same time. “We are currently looking at other apps that can integrate the current paging directory seamlessly into the secure texting application,” said Dr. Shieh. “What Stanford wants to do is integrate everything together. We want to either page or text through the new system.”
The process and results of testing the app confirms the Stanford clinicians' belief that secure group texting is the future of hospital communication. “There are a many companies out there trying to do it,” said Dr. Shieh. “Each hospital will probably choose one that's compatible with their system, but I would be really shocked if not everyone migrates to it soon.”
When secure group texting becomes widespread, the benefits will likely become increasingly apparent, predicted Ms. Przybylo. “It assumes the natural position of texting and takes out the risk,” she said. “Once everyone has an app like this on their phones, we'll see large gains in efficiency, which should translate into cost savings and better patient care.”