Hospital-based clinicians’ use of technology for patient care-related communication: a national survey
OBJECTIVE
To characterize current use of communication technologies, including standard text messaging and secure mobile messaging applications, for patient care–related (PCR) communication.
METHODS
We used a Society of Hospital Medicine database to conduct a national cross-sectional survey of hospital-based clinicians.
RESULTS
We analyzed data from 620 survey respondents (adjusted response rate, 11.0%). Pagers were provided by hospitals to 495 (79.8%) of these clinicians, and 304 (49%) of the 620 reported they received PCR messages most commonly by pager. Use of standard text messaging for PCR communication was common, with 300 (52.9%) of 567 clinicians reporting receipt of standard text messages once or more per day. Overall, 21.5% (122/567) of respondents received standard text messages that included individually identifiable information, 41.3% (234/567) received messages that included some identifiable information (eg, patient initials), and 21.0% (119/567) received messages for urgent clinical issues at least once per day. About one-fourth of respondents (26.6%, 146/549) reported their organization had implemented a secure messaging application that some clinicians were using, whereas few (7.3%, 40/549) reported their organization had implemented an application that most clinicians were using.
DISCUSSION
Pagers remain the technology most commonly used by hospital-based clinicians, but a majority also use standard text messaging for PCR communication, and relatively few hospitals have fully implemented secure mobile messaging applications.
CONCLUSION
The wide range of technologies used suggests an evolution of methods to support communication among healthcare professionals. Journal of Hospital Medicine 2017;12:530-535. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
Communication among healthcare professionals is essential for high-quality patient care. However, communication is difficult in hospitals because of heavy workloads, rapidly evolving plans of care, and geographic dispersion of team members. When hospital-based professionals are not in the same place at the same time, they rely on technology to communicate. Pagers have historically been used to support communication in hospitals, but are limited in their capabilities. Several recent small studies have shown that some physicians have started using standard text messaging on smartphones for patient care–related (PCR) messages.1-3 Although potentially enhancing clinician efficiency, use of standard text messaging for PCR messages raises concern about security risks related to transmission of protected health information. Addressing these concerns are emerging secure mobile messaging applications designed for PCR communication. Although recent studies suggest these applications are well received by users, the adoption rate is largely unknown.4,5
We conducted a study to see if there was a shift in use of hospital-based communication technologies under way. We surveyed a national sample of hospital-based clinicians to characterize current use of communication technologies, assess potential risks and perceptions related to use of standard text messaging for PCR messages, and characterize the adoption of secure mobile messaging applications designed for PCR communication.
METHODS
Study Design
The study was a cross-sectional survey of hospitalists—physicians and advanced practice providers whose primary professional focus is care of hospitalized patients. We studied hospitalists because of their role in coordinating care for complex medical patients and because prior studies identified communication as a major component of their work.6,7 The Northwestern University Institutional Review Board deemed this study exempt.
Survey Instrument
Four investigators (Drs. O’Leary, Liebovitz, Wu, and Reddy) with expertise in interprofessional communication and information technology created a draft survey based in part on results of prior studies assessing clinicians’ use of smartphones and standard text messaging for PCR communication.1,3 In the first section of the survey, we asked respondents which technologies were provided by their organization and which technologies they used for PCR communication. In the second section, we asked respondents about their use and perceptions of standard text messaging for PCR communication. In the third section, we asked about implementation and adoption of secure mobile messaging applications at their hospital. In the fourth and final section, we asked for demographic information.
We randomly selected 8 attendees of the 2015 Midwest Hospital Medicine Conference and invited them to participate in a focus group that would review a paper version of the draft survey and recommend revisions. Using the group’s feedback, we revised the ordinal response scale for questions related to standard text messaging and made other minor edits. We then created an Internet-based version of the survey and pilot-tested it with 8 hospitalists from 4 diverse hospitalist groups within the Northwestern Medicine Health System. We made additional minor edits based on pilot-test feedback.
