Paul Fu Jr, MD, MPH, City of Hope National Medical Center, spoke with the Journal of Clinical Pathways at National Comprehensive Cancer Network (NCCN) Annual Conference regarding health care team communication technology.

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

My name is Paul Fu. I am a pediatric hospitalist and the chief medical information officer at City of Hope National Medical Center.

What were your key takeaways from the session “Best Practices in Care Team Communication Technology” at the Nation Comprehensive Cancer Network (NCCN) Annual Conference?

My takeaways from the session were that the technologies are outstripping our ability to manage the volume of messages that are coming in. We have so many different ways to communicate with each other, including many different apps. For example, the electronic health record (EHR) from Microsoft Teams for our nurses requires that they carry Vocera badges, which makes it difficult to determine the right way to contact a person.

There is a concept called sender-message-channel-receiver (SMCR) model in communications theory. When you have a one-to-one relationship, it's easy to apply. For example, if I'm a parent and I have one child, I can talk directly to them. But once you start adding children, or in our case adding more parents and more children, then it becomes more complex. And then when you start adding different ways to communicate with children, it becomes even more complex. In a health care environment, instead of two parents, you have entire health care teams, and instead of one receiver, you have entire groups of physicians or pools of people who need to know a single message. This becomes very difficult to manage. One of our challenges is, how do we gate these messages into the fewest number of platforms that make it easy for our staff and physicians and patients to be able to send, receive, and process information?

What are some of the latest technology innovations in health care communication in use or in development at City of Hope?

We don't do a lot of technology development ourselves. But, we do a good job of using the different tools that we have available to us—whether they are embedded in our EHR or based in our productivity software like Microsoft Teams—and identifying the right workflows where it's most appropriate to use those different types of messages. It's a complicated problem because everybody likes to be communicated with in a certain way.

However, once people understand that we are trying to decrease the burden of managing these workflows and decrease burnout from having to answer patient messages in three different places (eg, email, Microsoft Teams, or our EHR instant messaging platform), they become more empathetic about the challenge and are willing to adjust their processes a little, so we can start standardizing.

How can providers use these or other technological innovations to improve their practices and help them to provide value-based care?

One of the most significant developments has been in the use of patient-reported outcomes (PROs) to positively affect how we take care of patients. This poses both benefits and challenges as well. The benefits have been written about fairly extensively. Whereas the challenges are typically in workflow. We want to be able to address a patient's concerns or what they've reported is an outcome to us in the timeliest fashion. But coming up with the right support system to address those coming in—which can be sporadic—is sometimes more time consuming. We have to figure out for the right care team—what does this mean? Because it may be different for our transplant doctors as opposed to our benign urology patients. We still want to give the patients a good follow up. We still want to monitor how they're doing, but the workflow processes that support those two very different use cases are in fact very different. And so we have to figure out how to staff them from a common staffing model.

Do you have any final thoughts?

I think that artificial intelligence (AI) really represents an opportunity for us to help simplify this equation. One of the challenges right now is that we're relying upon people to understand the matrix of who to call, when to call, and how to call—whether that's burdening our inpatient nurses with knowing that Dr Fu wants to be called one way when he's on call at night, but to reach him on another mechanism when he's in his office doing administrative work. AI tools represent an ability for us to make those processes smarter. There can be a sort of silicon or system where I can say, "How do I contact Dr Fu?” and it will tell me based on my schedule, “Why don't you reach out to him through teams?”