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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

Setting the stage for IM and other real-time communication in healthcare

Setting the stage for IM and other real-time communication in healthcare

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The momentum towards IM in the Healthcare Provider industry has been gaining speed for some time now.  Many hospitals and clinics are using instant messaging – mainly inside the enterprise, but sometime outside too.

From a risk/liability perspective, the question of IM in the healthcare provider industry is independent of the technology. According to Les Jordan, a Microsoft Healthcare and Life Sciences technology strategist, Microsoft technology can handle whichever perspective (outlined below) is taken. In fact, Microsoft has made specific changes to the Office Communicator client application in response to a request from a large bio-pharmaceutical-medical device company. So it really comes down to the perspective of the legal department of the implementing hospital or clinic.

There are primarily two perspectives that have been taken by the industry: 

1. IM is the same as a phone conversation and should not be recorded unless specifically requested by a government warrant. In response to this position, changes have been made to the Office Communicator application to prevent File/SaveAs functionality so that it is not obvious to a general end user how to store the contents of an IM session. With appropriately written SOPs and company policy, this approach obviates the need to save IM sessions for regulators or the purposes of legal discovery and can save you a bundle on storage costs.

2. IM is the same as an e-mail or a document and should be archived and managed through a formal records management process. Microsoft’s approach to this perspective is to allow archival, and even reporting, of IM sessions. In fact, third party software companies have built canned reports on top of SQL Server that can be run for SOX and even HIPAA reporting purposes. Again, this should be governed by appropriately written SOPs and company policy.

Even with the new law on legal discovery that goes into effect in December, both approaches appear to be valid.  According to Mr. Jordan, neither approach has been questioned by regulators nor by the judicial system. Depending on how your legal department writes their corporate policy around records retention (defining what electronic data is “readily available”) will determine the approach that you take. At that point it is a matter of “do what you say you’ll do in your SOPs”. You’ll need to work with them to explain both approaches – and the ramifications of each.

The business case for instant messaging is relatively straight forward:

· Soft-costs – with potentially the greatest impact: IM allows for better coordinated and faster care team management by making collaboration more real-time and on-demand. A typical scenario lies around team and cross-team patient care and especially in matters related to clinical trial investigator interactions. How do you allow collaboration to happen such that questions are not forwarded – in a send and wait process – but are answered when they arise in the investigator's head? With IM, you can know when your co-collaborator is online, when they are on the phone, when they are available for conversation, and you can reach out to them in real-time, in context with the action you are taking.

· Hard-costs – with less of an impact, but easily measured: This includes reduced tele-communication costs. By allowing people to reach out via IM, you can potentially reduce the number of phone calls that are made, including phone calls that result in “phone-tag” messages that leave increasingly lengthier voicemails.

The business case for real-time, "unified communications" on the PC platform continues to grow.  This is the foundation for improving communication and collaboration in patient care.  It also sets the stage for greater use of such technology in the delivery of health information and certain kinds of medical services virtually, wherever and whenever appropriate.

Bill Crounse, MD         Healthcare Industry Director     Microsoft

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