New system eases clinical communication at Michael Garron

TORONTO – Michael Garron Hospital – formerly the Toronto East General – has deployed Hypercare, an enterprise-wide messaging system that allows clinicians to communicate with each other through an instant messaging app installed on their phones. Hypercare enables users to securely share clinical information and manage medical on-call schedules.

The Hypercare system runs on a cloud-based network that is independent of the hospital’s existing communication networks. In this way, it acts as a messaging back-up, in case of outages.

This scenario actually occurred about year ago, in September 2019. The hospital experienced a ransomware virus that disrupted its email service and paging systems. The Hypercare system, however, which had been deployed in a pilot to a limited number of users, still worked and enabled the enrolled clinicians to communicate.

“Hypercare really showed its value through the code grey time,” said Dr. Patrick Darragh, chief medical information officer at Michael Garron Hospital. The pilot project of 20 users quickly scaled up to 300 users by February 2020. And with the impetus of COVID-19 in March 2020, nearly all of the hospital’s clinicians have joined – about 700 users in total.

“We’ve had such good feedback about [Hypercare] that it’s become an essential way for clinicians to communicate with each other in the hospital,” said Dr. Darragh.

It’s not just the quick communication that’s appealing to clinicians. The hospital and Hypercare have together created a directory function that has transformed managing medical on-call schedules from a paper-based task to an automated, electronic one.

Dr. Darragh noted that creating the on-call schedules used to be done by collating the various departmental schedules into a paper-based master list – a painstaking and time-consuming task. Instead, Hypercare allows departments to create their on-call schedule electronically.

On-call schedules are consolidated automatically and posted immediately to the Hypercare messaging app on users’ phones. Clinicians can instantly find and contact the on-call specialists they need.

“You used to have to look up phone numbers or contact the call centre, find the right person, and wait for a call-back,” said Dr. Darragh. “Now, I just open my phone and it’s all right there.”

“It’s a better use of hospital resources, and it leads to better communications,” he added.

Albert Tai, CEO and co-founder of Hypercare, said the application easily supports even last-minute changes – something that was difficult to do in the previous way, using paper lists and requiring manual preparation of a master list the day before.

Moreover, clinicians can trade shifts online, and the changes show up in the system in real-time.

“The scheduling piece adds a lot of value to the system,” said Tai.

Dr. Darragh noted that of late, Hypercare has also been used as an effective COVID-19 alerting system. When patients were tested for the coronavirus, adding the final result of the swab to the electronic record was inefficient. Dr. Darragh said there could be hundreds of these patients with pending results in the system at any time.

Now, using Hypercare, “when the swab goes positive, [Hypercare] sends an alert to the most responsible clinicians.” Then, appropriate next steps can be taken by the infectious disease and infection control teams.

As well, a Hypercare alert goes out to the hospital’s infection control team when an inpatient COVID-19 swab result is negative. By reducing the time that patients are in isolation, the hospital can conserve personal protective equipment.

He noted that this alerting system has the potential to be extended to other areas, such as positive blood cultures for a number of conditions, and for deteriorating patients.

Many hospitals have early warning algorithms, but it’s sometimes a problem to get the word out to the right personnel. Hypercare can be used to trigger alerts and send messages to the smartphones of the appropriate caregivers.

Tai noted that Hypercare can be programmed to escalate – if one person doesn’t respond in a given period of time, the message will be sent to the next person in line, ensuring that nothing falls through the cracks.

Messages can go not just to individuals, but to “roles” – such as the attending nurse, resident or physician. “The individual may change from day to day,” said Dr. Darragh. “Hypercare makes sure the alert goes to the right person who needs to know the information.”

Alerts can also be sent to entire groups or teams.

As well, being adopted throughout Michael Garron Hospital, the Hypercare solution is now being extended to clinicians in the community. Family physicians and other clinicians who work with the hospital are using the application – making it one of the first cross-organizational communication systems to be used in the province’s new Ontario Health Teams (OHTs). Hypercare is already being used by East Toronto Health Partners, an OHT in East Toronto.

“Since April 1, we’ve opened it up to all of our groups,” said Dr. Meera Shah, a family physician and co-leader, Digital Health, East Toronto Family Practice Network. “We’re using it for urgent communication, from physician to physician, nurse practitioner to physician, physician to dietician, specialist to family doctor.”

Dr. Shah said that she has made good use of Hypercare to reach specialists at Michael Garron Hospital when questions come up that can be quickly resolved. The Hypercare messaging system allows physicians to communicate with specialists, often enabling their patients to avoid trips to the ER.

During the current COVID-19 crisis, keeping patients away from the hospital when possible has been a big plus for infection control.

She mentioned the case of a patient with very poor kidney function and no urologist. Normally, the patient would be sent to the emergency department for further tests and treatment. However, Dr. Shah contacted a urologist at the hospital using Hypercare and arranged an office appointment for the patient the next day.

She said the application has also been useful for patients with post-operative complications. Instead of sending them immediately to the ER, she has messaged surgeons using the Hypercare directory and app, getting fast responses to clinical questions.

The East Toronto Family Practice Network has opened up the Hypercare application to its 200 family physicians. Not all are using it yet, but many have started, said Dr. Shah. As well, an initiative is in the works to extend the application to allied healthcare professionals in home care, including wound care, so that visiting nurses and PSWs could send questions to clinicians when needed.

“It’s so much better than the phone,” said Dr. Shah. “The phone just isn’t the way people function today. As a doctor, I don’t have time to put in a call and to be put on hold – not with four or five patients in my office waiting for me.”