David Pike

Extension Engage – Critical Lab Result Notifications with Advanced Event Response

Challenges Concerning Critical Lab Results Reporting

Laboratory and point-of-care testing are integral parts of delivering high-quality care in acute settings. While laboratory services generally consume 5% of a hospital’s budget, the results are leveraged for 60% to 70% of all critical decision-making processes.1 Despite the importance of critical lab results, alerting systems can delay the alert process and typically do not comply with The Joint Commission’s (TLC) requirements, which is to notify and receive acknowledgment from the ordering physician within one hour. Delays in the delivery of critical lab results can also negatively impact service metrics and patient safety.

Standard Critical Lab Results Alerting Process

Although alerting systems widely vary, communications concerning critical lab results are often initiated from the laboratory technician to the covering licensed caregiver. In other processes, critical lab values are auto-validated, recorded, and stored electronically until the caregiver responsible for a patient locates a computer to retrieve them. Critical lab results workflows also require a voice call to the lab technician to validate the results and confirm the test details.

Alerting systems used in most hospitals were not designed for bi-directional voice, event-driven, secure text messaging, or health-critical alarms. These simple pager or email notification systems only address one function in a broader communication process, and their lack of contextual information restricts physicians and nurses from appropriately responding at the point-of-alert reception. These partial solutions can introduce new gaps into an already time-consuming, inefficient process and can increase patient safety issues due to potential delays in care.

Optimized Critical Lab Results Notification Workflow

While basic clinical alert and messaging systems can assist in improving patient care, next-generation clinical alarm systems are designed to accommodate a workflow that provides expedited result context and an intelligent, flexible, rules-based escalation path that allows clinicians to meet TLC requirements. These advanced systems provide a user interface with simple, single-button capabilities to quickly acknowledge reception of critical lab results and engage the patient’s care team for collaboration. Additionally, implementing a comprehensive alarm solution establishes a central point of management for hospital-wide clinician and staff alarm notifications, and the solution would avoid redundant, silo-based investments in additional systems to address care alert and communication gaps.

Extension Engage is a unified clinical alarm notification, event-driven, secure messaging, and care team collaboration solution offered by Extension Healthcare. Extension Engage provides the ability to deliver critical lab reports with contextual information that allows clinicians to immediately determine the most appropriate response no matter where they are located. Notifications are delivered to clinicians via their preferred wireless device, which means they are now able to receive vital patient information and engage with the entire care team through event-driven, secure texting or by phone.

Benefits of the Critical Lab Notification Solution

Extension Healthcare is solely focused on refining the clinical alarm and notification processes currently existing in most hospitals. Extension Engage, our clinical alarm event response solution, assists in addressing these issues, and it provides sustainable improvements in care delivery and associated performance metrics, all through a single system. By addressing these issues, Extension Healthcare helps achieve true healthcare improvements.

  • Routes Critical Lab Results Based on Optimal Workflow: Extension Engage’s advanced rules engine intelligently routes critical lab results along alternate distribution paths or to alternate physicians, including team-based escalation, if the primary care provider is unable to respond, which helps facilitate the care delivery process.
  • Facilitates Compliance: Extension Engage helps facilitate compliance of TJC’s National Patient Safety Goals related to critical alarms and reporting lab values.
  • Tracks End-to-End Event Response Process: Extension Engage tracks the complete event response process via a task-level, time-stamped audit log, enabling the systematic measurement of the clinical workflow without requiring any additional documentation from clinicians.
  • Supports Alarms with Extensive Information: Extension Engage intelligently delivers contextual data for each step of the clinical workflow process, including expedited notification to the ordering physician, as well as voice call and read-back requests to lab techs. Extension Engage also provides a retrospective view of patient information, including patient-specific reference ranges and trending patterns.
How Extension Engage for Critical Lab Notifications Works

The Extension Engage platform applies advanced rules to ensure the delivery of near-real-time critical lab result notifications. Extension Engage aggregates and stores data, including alarm, event, clinician location and availability, and other contextual information, from multiple clinical and patient information sources. These sources can include nurse call systems, with information gathered via Web Services or the TAP protocol, and electronic medical records (EMRs), computerized physician order entry (CPOE), and admission discharge transfer (ADT) systems, through HL7 integration. Advanced rules are applied to intelligently compile appropriate content concerning the patient’s condition. This information is then delivered to the staff’s preferred wireless device

The advanced rules engine assembles, filters, and delivers relevant data to a clinician’s wireless device. Upon receipt of a critical lab notification, the clinician can choose to respond in a number of ways. For example, using pre-programmed buttons on their keypad or smartphone, alarm recipients can request order instruction clarification from the ordering clinician via event-driven, secure text messaging or a voice call. Secure smartphone and Voice over Internet Protocol (VoIP) texting allows care team members to share patient information without compromising protected health information (PHI). A true collaboration solution, Engage can reduce inefficient gaps in the diagnostic process and reduce key time-to-treatment metrics.

Key Differentiators from First-Generation Medical Alerting Systems
  • Value-Added Critical Lab Notification Functionality for Physicians and Nurses
      • Routes context-based critical lab result notifications, which include patient diagnosis and recent lab values, to virtually any mobile device
      • Ensures persistence in delivering critical lab notifications through an advanced rules engine
      • Distributes critical lab notifications via a complex, multi-path event response
      • Offers the capability to quickly locate and communicate with individuals and groups using name or role-based staff directory, standard unit roles, presence, and favorites
      • Provides hands-free awareness through distinctive ring/alarm tones and annunciated alarms
      • Leverages existing staff assignments from a variety of sources, such as nurse call systems, EMRs, or the Extension Engage staff assignment module
      • Delivers consistent alarm or order notification, including desired escalation sequence and logic, within the hospital network or off-premise via cellular data networks
  • Ease-of-Use for Hospital Information Technology Departments
      • Offers one data center appliance that is completely scalable to a hospital’s needs
      • Supports all enterprise integrations, including EMRs, labs, nurse call systems, real-time location systems (RTLS), clinical document architecture (CDA) documents, and presence (time clock, staff assignment, clinician and patient proximity, etc.) through numerous data protocols, such as Web Services, TAP, and HL7
      • Leverages existing investments in directory services, telephony, networks, and unified communications
      • Balances security and clinical usability through flexible personal identification numbers (PIN)/password protection
      • Ensures complete data privacy through industry-approved security measures, including Health Insurance Portability and Accountability Act (HIPAA) compliance, data encryption, role-based user security, and adherence to each hospital’s data retention policies
      • Reduces dependencies and licensing costs through physical or virtual appliance deployment
      • Facilitates selective expansion of event-driven secure messaging and presence services through standards-based federation (XMPP)
      • Integrates with a variety of medical-grade communication devices
  • System Requirements
      • Extension Engage Alarm Safety Platform v4.0
      • Demographics (ADT)
          • Laboratory Orders/EMRs (ORU, OBX)
          • Supported Wi-Fi Communications Handsets
      • HL7 Data Source
      • HL7 Data Types
      • Supported Smartphone/Tablets: iOS7 and Android v4.1

1R.W. Forsman. “Why is the Laboratory an Afterthought for Managed Care Organizations.” Clinical Chemistry Volume 42, No. 5:813-6.

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