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Why EHR Secure Chats Don’t Cut It: Top 10 Reasons

Why EHR secure chats don't cut it: Top 10 reasons blog banner

EHR Secure Chats – Yay or Nay

Electronic Health Records (EHRs) have evolved from mere repositories of patient data to indispensable tools at the forefront of patient care. They serve as the single source of truth across the patient care continuum, empowering care teams to make informed clinical decisions. Effective implementation of these systems leads to improved patient outcomes, reflected in lower hospital readmission rates and shorter average length of stays (LOS).

Recognizing the pivotal role of communication in healthcare delivery, a multitude of EHR companies have recently natively built secure chat into their platforms. While this product development may appear promising, a critical gap has emerged in the functionality of these native chat features. Specifically, the inability to facilitate critical paging within EHR chats has led clinicians to resort to additional devices or rely on outdated communication methods, inadvertently exacerbating the strain on an already fragmented healthcare system.

At OnPage, we believe that a paradigm shift is imperative, and clinical communication should be entrusted to the experts in these solutions. Clinical communication, irrespective of urgency or origin, must be unified under a comprehensive solution that synchronizes with EHRs in real time. Such an approach not only ensures seamless communication but also streamlines critical paging workflows, minimizing the burdensome inefficiencies and delays in communication that healthcare professionals (HCPs) have become accustomed to. 

Why EHR Secure Chats Fall Short 

Recognizing the urgent need for a more unified communication solution in healthcare, it’s crucial to explore why relying solely on EHR secure chats may not suffice for addressing the multifaceted communication requirements of modern healthcare settings. Drawing from publicly available feedback shared by healthcare professionals, particularly on platforms like Reddit, it’s evident that numerous concerns exist. Based on these experiences, we delve into ten reasons why EHR secure chats fall short of providing a comprehensive solution for clinical communication.

1. Lack of urgency 

A significant limitation of relying on secure chats within Electronic Health Records (EHR) is that they are not effective at prioritizing urgent messages and ensuring they are immediately noticed by healthcare providers. In other words, urgent messages may not stand out or grab the attention of healthcare professionals, potentially leading to delays in addressing critical issues. In a healthcare setting where timely communication can mean the difference between life and death, these chat features often fail to provide a mechanism for urgent messages to rise above the clutter.

As illustrated in the screenshot below, shared by a healthcare provider on Reddit, there’s frustration when attempting to communicate urgent alerts through EHR platforms

Reddit post that says "Yes to all of this. I tell the nurses that if they want anything that's time sensitive they need to page me. I don't check those frequently, it's like the last thing I check when I'm logging into Epic. The worst is when they use that to tell us about urgent information, like "patient has a START called on them." This has happened a couple of times. Plus, we're not always sitting at a computer, especially people in surgical fields. If I don't get paged I may not hear about the issue for hours."

Unlike dedicated clinical communication and collaboration solutions designed to lend voice to critical alerts and notifications, EHR secure chats may become buried amidst non-urgent conversations, administrative messages, or routine updates. Consequently, healthcare professionals risk overlooking vital information, compromising patient care, and potentially leading to adverse outcomes. 

Some hospitals are attempting to overcome this shortfall by treating every communication as urgent, but this approach risks alert fatigue among staff. See the accompanying screenshot where a Redditor shares how their hospital wants them to treat every communication sent over EHR as urgent, and perhaps stop what they’re doing each time a notification sound beeps! 

Reddit post that says "It sounds like it's better when you also still have pagers. They just took our pagers back completely so now Haiku and it's equivalent for our other EMR (we're a big residency covering multiple hospitals) are our "pagers." Every message is considered a "page." Every. Single. Stupid. "Thank you." Message. It wouldn't annoy me as much if I always had access to my phone to see/discard at my leisure but for surgeons is really annoying when you're scrubbed in. It does have its benefits, like talking with other consulting services, non urgent messages, etc. I just feel like it shouldn't be an all-in-one service."

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2. Lacks role-based messaging capabilities

In addition to the lack of urgency, another limitation of EHR secure chats is their reliance on healthcare professionals to memorize who holds specific roles within the hospital. 

Unlike dedicated clinical communication systems that employ automation to route messages to the appropriate recipients, EHR chats require users to know the organizational structure and current staffing to ensure messages reach the intended recipients.

A Reddit user can be seen below expressing their anguish over the inability to search for someone by role, forcing them to remember the exact name, which can be challenging in large healthcare organizations.

Reddit post that says "Generally yay. I did wish when you're in the patient chart, there are different chats for all the different people you communicated with regarding the patient instead of going back out to the chat window. I'd also like if you can search people by their roles instead of them. Sometimes I just want IR scheduler but I don't know the exact name."

3. Broken communication lines when EHR is down

Moreover, the reliability and efficiency of some EHR systems remain a concern, as they can be prone to periodic downtime. While the immediate impact of a downed EHR might not become readily apparent, the repercussions become alarming considering that some hospitals rely solely on it for communications.

This reliance on EHR for communication amplifies the risk of serious mishaps and fatal errors from communication lapses. In healthcare, where timely and accurate information exchange is paramount, any disruption in communication channels due to EHR downtime can compromise patient safety and exacerbate clinical risks. 

Reddit post that says "No but on signal it sometimes goes down."

4. Doesn’t integrate with Instant Messaging Software – Teams/Slack

Another significant drawback of EHR secure chats is their inability to streamline disconnected communication systems. Many hospitals utilize instant messaging platforms such as Teams or Slack alongside their EHR systems to facilitate communication among healthcare teams. 

However, the lack of integration between EHR secure chats and these external platforms creates siloed communication channels. As a result, important messages and updates exchanged on one platform may not be synced or accessible on the other. 

This fragmentation in communication leads to inefficiencies, as healthcare professionals may need to switch between multiple platforms to stay updated, potentially causing delays and misunderstandings in care coordination. The inability to seamlessly integrate communication across different platforms hampers collaboration efforts and diminishes the overall effectiveness of communication within healthcare settings.

5. Requires providers to continuously monitor their EHR app for critical messages

Providers are required to continuously monitor their EHR systems, even when using a mobile app, diverting their attention from direct patient care. This constant need to check for messages can create a mental burden as healthcare professionals are constantly reminded of pending communications.

Despite using phone apps for EHR access, the absence of reliable loud notifications for incoming messages adds to the stress. Healthcare providers may feel compelled to frequently check their devices to ensure they don’t miss any critical updates or requests.

Reddit post that says "You just have to do it on the sly. "Hey, I got that amp of D ready to push. Just need you bed side. Could you bring the bladder scanner...might come in handy." with a reply that says "It can be frustrating sometimes, because we are not logged in Epic all the time, some instances the nurse will message us through chat about some critical issue/questions of a patient, but we can't see it on time (compared to the more real-time pager system), it's potential safety issue. Just need to be careful and educate the nurses well about its use."

This interruption in workflow can disrupt the continuity of patient care and detract from the quality of interactions with patients. Additionally, the cognitive load of managing EHR messages alongside direct patient care can contribute to burnout and decreased job satisfaction.

Reddit post that says "They added it my second year. I hate it and it has made my floor rotations much worse. 1. Routinely secure chatted about urgent things that should be phone calls. Real life examples: BP of 70/30, "hey patient is not responding, what should I do?" and "patient had 30 second episode of VT" 2. Threshold for contacting me is much lower. People seem to think twice before paging but will secure chat any small thought that enters their brain. 3. I have Haiku app on my phone (useful for rounding and for taking pictures to put in media tab so I won't get rid of it) so unlike a pager which I can turn off, I continue to get alerts for secure chat after I leave the hospital. 4. THE GROUP CHATS. I do not ever want to be in a group message with the bedside RN, charge RN, case manager, intern, and attending but it happens all the time. 5. The "thank you" messages that are totally unnecessary 6. The expectation that I have to answer them ASAP. Half the time I don't answer within 5 minutes they just page anyway. The sheer volume of secure chats is way higher than my amount of pages ever was."

 

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6. Doesn’t integrate to live call/dedicated line communications 

EHR secure chats lack integration to dedicated line-based routing technology, crucial for efficient communication in healthcare settings. Ideally, communications from dedicated lines should be aggregated into the primary communication solution to leverage automation capabilities and urgency-based alerting/paging capabilities that promote seamless workflows. 

Clinical communication and collaboration solutions offer this capability, allowing for the consolidation of various communication channels into one platform. 

7. Doesn’t provide a reliable way to “page” the right person 

Another significant drawback of EHR secure chats is the absence of a reliable mechanism to ‘page’ the right person, exacerbating communication inefficiencies and compromising patient care. In addition to the inability to prioritize messages, there’s no guarantee that communications reach the intended recipient. 

Furthermore, the lack of receipt visibility undermines accountability, as there’s no way to confirm whether a message has been seen or acknowledged. Unlike EHR secure chats, clinical communication solutions offer robust features such as message audit trails and the ability to form escalation groups for urgent issues, ensuring that messages are reliably acknowledged and addressed by the appropriate healthcare professionals.

Reddit post that says "Both. And I say this because when used appropriately it is great. Decreases unnecessary pages, allows all involved parties to be involved in discussion. However, when urgent/important messages are sent with no follow up page etc. to the wrong person it can be very bad. Important or urgent matters should always get a page to the correct individual."

8. Difficult to truly disconnect from work 

EHR secure chats inadvertently contribute to healthcare professional burnout by lacking a mechanism to allow individuals to truly log out of their work. Unlike clinical communication solutions where messaging is primarily routed to staff who are on-call, messages in EHR secure chats may be sent indiscriminately, even to those who are on their time off or holiday.

This constant availability blurs the boundary between work and personal life, making it challenging for practitioners to disconnect from work completely when they’re not required to be on-call or on standby. 

In contrast, clinical communication solutions allow practitioners to have designated on-call rotations, ensuring that messages are sparingly sent to individuals during their time off, thereby promoting a healthier work-life balance.

Reddit post that says "As a surgery resident, it is miserable. I get texts throughout the day because I am "more available" through the app that continues into my post call/off days. It is easy to say to "turn off" the chat when off, but given that I am in and out of the hospital or on Q2 home call, it essentially is on continuously. Mind you, we have a call phone for interns in house so that nursing can get in contact with us, the chat feature is just mostly used instead and impossible to change that culture."

9. Lacks precision-based messaging to on-call practitioners

Another drawback of EHR secure chats is the lack of fine-tuning capabilities for escalation and on-call groups, two fundamental pieces that guide where communication is routed. 

Unlike clinical communication solutions that offer flexibility to create distinct groups based on specific roles or responsibilities and shifts, EHR secure chats often deliver messages to a broader audience, including individuals on different shifts within the same group.

This indiscriminate messaging approach results in unnecessary notifications being received by healthcare professionals who may not be directly involved in the patient’s care at that moment. 

In contrast, clinical communication solutions enable precision-based messaging by allowing users to create tailored on-call groups, ensuring that messages are delivered only to those who need to be informed, thereby enhancing communication efficiency and streamlining care coordination.

Reddit post that says "You can add and remove yourself from any particular service. The problem is when you're getting messages all day about patients you're not personally covering for a large service. Or for example, I'm on our trauma night shift, but the overall rotation is "trauma," it's just separated into day shift and night shift. And this includes ICU and floor level patients. So every night I come back to a thousand messages about patients about whom I know nothing, who have day shift problems, and whom I don't need to be messaged about at all. And I have to sift through those for a few that might actually involve me."   

10. Doesn’t integrate with existing scheduling solutions

Another significant drawback of EHR secure chats is the lack of integration with scheduling systems, particularly popular ones like Amion, further exacerbating the fragmentation of communication systems in healthcare settings. 

Unlike clinical communication solutions, which seamlessly integrate with popular scheduling solutions, EHR secure chats operate independently, leading to disjointed workflows and inefficient communication processes. 

The inability to leverage crucial information such as on-call shifts from scheduling systems means that messages may not be routed to the appropriate staff in a timely manner, potentially impacting patient care and workflow efficiency. 

Clinical communication solutions bridge this gap by integrating with native schedulers, allowing for the seamless routing of messages based on up-to-date on-call schedules, thereby optimizing communication and care coordination.

Need for comprehensive Clinical Communication and Collaboration

While the limitations of native secure chats within Electronic Health Records (EHR) are apparent, the solution lies in adopting a comprehensive clinical communication and collaboration (CC&C) platform. By integrating such a platform, like OnPage, healthcare organizations can address the existing gaps in communication workflows and strengthen their investments in EHR by complementing its capabilities on the communication front.

Unlike native secure chats, which often fall short in meeting the diverse communication needs of healthcare professionals, a CC&C solution offers a range of benefits that enhance communication efficiency and patient care. Here’s how:

  1. Reliable Paging Workflow for Urgent Communication: With OnPage’s robust paging capabilities, urgent communications are prioritized and delivered promptly to the right recipients, ensuring critical messages are never missed or delayed.
  2. Streamlined Communication for Regular Communication that Doesn’t Interrupt: OnPage provides a seamless communication experience for routine messages, allowing healthcare teams to collaborate efficiently without interruptions or distractions.
  3. Automated Communication Routing Based on On-Call Schedules and Escalations: OnPage automates communication routing based on on-call schedules and escalations, ensuring messages reach the appropriate personnel in a timely manner.
  4. Audit Trail with Full Visibility: OnPage offers an audit trail feature that provides full visibility into communication activities, including message delivery and receipt, ensuring accountability and compliance with regulatory requirements.
  5. Integration with Chat Applications: OnPage integrates seamlessly with popular chat applications, enabling bi-directional sync between CC&C and existing chat platforms, enhancing collaboration and information exchange across teams and platforms. Critical communications from chat platforms can be seamlessly synced back into EHR from OnPage.
  6. Integration with Dedicated Line-Based Technology: OnPage seamlessly integrates with dedicated line-based technology, enabling healthcare organizations to consolidate all urgent communication originating from dedicated lines within the OnPage platform. Further, OnPage’s bi-directional synchronization with the Electronic Health Record (EHR) allows information to be seamlessly synced back into the EHR as well. This creates a single source of truth for future reference, enhancing data accuracy and accessibility across healthcare workflows

In conclusion, a comprehensive CC&C solution like OnPage not only addresses the shortcomings of native secure chats within EHR but also elevates communication workflows to ensure timely, accurate, and secure exchange of information among healthcare teams. By investing in a robust CC&C platform, hospitals can optimize their communication processes and ultimately improve patient care outcomes.

 

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