Design and Integration of a Texting Tool to Keep Patients' Family Members Updated During Hospitalization: Clinicians' Perspectives.

An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators: (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers: (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls.

Implementing computerized physician order management at a community hospital.

BACKGROUND: In 2000, four community hospitals in the Cleveland Clinic Health System embarked on an electronic medical record (EMR) project to create an integrated information management environment and improve clinical decision making. METHODS: Executives and individuals from many departments and disciplines were organized into a project structure to launch the project, make decisions, and accomplish change management, which addressed communication, work-flow redesign, training, and support during transition to the new technology-enabled process. PROJECT: In 1999, a small group of regional information technology (IT) leaders for four community hospitals operated by the Cleveland Clinic Health System in the East Region developed a project for the implementation of computerized physician order management (CPOM). RESULTS: Huron Hospital, the first hospital selected for implementation, met its goals for a successful transition. After two pilots, implementation occurred on schedule and with a noticeable lack of major issues, both during rollout and thereafter. In addition, physician direct entry of orders reached the first-year goal of 40% physician entry in the first month and 75% within a year. CONCLUSIONS: Ensuring success required a systematic approach to the foundations of change management--work-flow redesign, communication, training, and support--during the transition.