1. Instant Messaging A communication tool to enhance the medical home Grant M. Greenberg M.D., M.A. Helen Costis M.S. University of Michigan Department of Family Medicine

2. Objectives Understand types of communication, where it occurs Learn to identify areas of wasted effort Understand advantages and disadvantages of instant messaging technology applied to these aspects of communication

3. Typical Office Visit Communication Check-in desk to medical staff re: arrival of patient Phone Call Center to providers, MA, Nurse, clerical staff Medical Assistant to Provider Provider to Medical Assistant Nurse to Provider Provider to Nurse Scheduling staff to any of the above Check out staff to any of the above Referral Staff to any of the above (and vice versa)

4. Typical Office Visit Communication Any staff re: security issues Admin staff to MAs re: side door pts MA/RN to check in staff for printing of Patient billing forms Nurse to nurse to check on workload and team coverage

5. Instant Messaging Requirements for clinical use –Firewall/secure system –HIPAA compliant –Full utilization by staff and providers –Laptop/computers available at all times

6. Instant messaging is NOT paging IM facilitates quick response without having to leave the room to find a phone Paging is one way communication, IM is two way IM is a way of communicating in “real time”

7. Screen shot of IM

9. Diagram of process without IM

10. Diagram of process with IM

11. Other Options “Skype” Chat SMS text messaging “Google” Chat Walkie talkie (but not truly IM) E-mail associated chats (Yahoo, Outlook) Others?

12. Benefits to Clerical Staff (source: qualitative feedback) Clarify referrals, check out forms, provider orders, prescriptions Scheduling staff can “recruit” help during times of high phone volume Can facilitate overbook appt. directly with provider, nurse, or medical assistant Can inform provider of patient or consultant phone call/urgent phone call Can communicate with nurse re: “RED” call Don’t waste time physically locating a person

13. Benefits to non-provider medical staff Communicate information regarding late arriving patients, rescheduled patients Receive immediate answer to questions (e.g. which immunization to give) Get information without having to spend time physically looking for person Communicate regarding coverage and workload smoothing

14. Benefits to providers Communicate follow up/coordination with other team members Communicate with medical assistant regarding need for in-room chaperone, supplies, ECG, medical record, repeat vitals, etc. Inform MA/RN of time-sensitive clinical information Enhances safety (e.g. agitated patient)

15. Benefits to providers (cont) Minimizes interruptions during patient visit Communicate with RN for educational needs of patient Improve efficiency of resident precepting Communicate with call center for schedule changes

16. Benefits to patients Less time in waiting room/waiting in exam room Faster office visit Less phone tag/time on hold Better coordination of care needs

17. Data: Time saved Without IM –Chaperone to room 3 MINUTES –Correct billing form Up to 30 MINUTES –Clarify provider order Up to 30 MINUTES –Immunization order 3 MINUTES –Overbook request Up to 30 MINUTES With IM –Chaperone to room 1 MINUTE –Correct billing form 1 MINUTE –Clarify provider order 1 MINUTE –Immunization order 1 MINUTE –Overbook request 1 MINUTE

18. Time Saved During consecutive appointments can result in ability to see additional patients/spend more time face to face addressing patient concerns Outside of appointments can free up staff time to facilitate additional patient care issues/chronic care management for example

19. Potential Barriers/Problems If user not available, need to indicate Limited utility if don’t have 100% usage User has to be logged on in order to be accessible to communication Information may be important but is not part of a medical record

20. IM as Interruption? Not every interruption is disruptive Not as disruptive as inappropriate telephone call or face to face visit Allows you to obtain information rapidly IMs are related to immediate tasks

21. Conclusions Improved efficiency/productivity Improved patient flow/wait time Enhanced communication Improved patient, provider and staff satisfaction