2014 Sautter Award Submission
Project title: Careweb Messenger
Submitter:
Ed Martin, Director, School of Medicine - Dean’s Office Information Services Unit
[email protected]
415-476-5400
Project Leader
Raman Khanna, MD, MAS, Assistant Clinical Professor, UCSF
Team Members
Raman Khanna, MD
Ed Martin, Director, ISU
Rodanni Pugeda, Salesforce Developer
Swarnim Ranjitkar, Mule ESB Developer
Dheeraj Kaveti, Mobile Developer
Victor Galvez, Data Integration Manager
Summary
The current state of informal electronic communication at UCSF Medical Center occurs on a
massive scale. Approximately 60,000 messages are sent to UCSF pagers every month. These
communications represent a critical component of hospital care but are largely irretrievable
by providers after they are first read. Furthermore, the current preferred paging portal,
Pagerbox.com, is run by an external vendor and is a cost to UCSFMC. Finally, and most
importantly, given their limited functionality, pagers themselves are becoming increasingly
archaic and obsolete.
Careweb Messenger, a new collaboration technology built on the Salesforce force.com
platform, combines the best features of paging, texting, Facebook, and Twitter. Careweb
Messenger carries, transmits, records, and makes searchable online (using a secure web
portal) all non-EMR (Electronic Medical Record) electronic messages at UCSFMC. Careweb
Messenger also delivers these messages to a variety of individually specified platforms
(including pager, iOS device, and website) per provider preference.
Project Description
The UCSF Medical Center still makes heavy use of pagers to quickly contact physicians and
nurses. Currently approximately 60,000 messages are sent to various UCSF pagers every
month. These fast, informal communications represent a critical aspect of hospital care, but
there are problems with its use.
First, messages often disappear soon after receipt and cannot be searched in any way.
Second, the paging systems are poorly integrated with one another and the EMR and
directory systems. Third, physicians are sometimes expected to carry multiple devices:
personal cel phone, primary pager, and on-call pager. For nurses, they have personal cel
phones, Ascom phones, and now a Voalte phone for the bed alert system.
Most important to address is expediting determination of who to page for a given patient.
The sender must know who is caring for the patient, and that information is not always
quickly available. This causes delays in patient treatment. In addition, patient care is a
team effort, and it can be difficult to know which providers, i.e. physicians, nurses,
dieticians, etc., are on the patient’s care team.
Careweb Messenger addresses these problems and ultimately improves patient care.
As an added benefit, Careweb Messenger is a collaboration enabler for interconnected
patient care processes. We are currently piloting Careweb to allow communications from
providers to patients and their families, which can be used to disseminate information
about condition changes, discharge, or education, just to name a few examples. In summer
of 2014, we are including radiology systems integration that allows physicians to be
immediately notified of relevant status changes of imaging ordered for patients they’d like
monitored. The same approach can be utilized for lab orders.
Careweb Messenger:
 Records and tags all text messages/pages to individual patients
 Places all text messages/pages online as searchable patient “conversations”
 Identifies patients, locations, and patient care team members in real time
 Available as mobile (iOS) and web application versions
 Ability to securely message patients and families
 HIPAA compliant
Goals:
 Increase speed in contacting patient’s care providers
 Improve collaboration of patient care through threaded messaging and participation
of entire patient care team
 Automated integration across 4 inter-related, disparate systems needed to make
system function:
o Electronic Medical Record System (via Epic ADT interface for patient and
care team information)
o Paging through the AMCOM paging gateway
o User-updated Directory
o Single sign-on with both Campus and Medical Center authentication
systems.
 Secure patient message privacy
 Index all clinical messages/pages to a patient.
 Collect data on how messaging affects patient care, and provide insights on how
patient care can be improved as a result
 Reduce the number of devices carried by Medical Center providers and replace
current, simplistic, paging application (Pagerbox).
Web Client Screen Shot
Mobile Client Screen Shot
Technology
Careweb Messenger relies on the following technologies:
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Salesforce.com – The web interface and underlying data structures are built on the
force.com custom application platform.
Mulesoft Enterprise Service Bus – Mule integrates HL7 data from EMR’s into
Salesforce. It also is responsible for sending data out to mobile and paging devices.
Paging Gateways – UCSF utilizes AMCOM and ASCOM for paging communications.
Apple Push Notification Services – to send notifications to iOS devices
Lion Labs Encryption Services – technology that allows encryption of messages to
Gmail and Facebook
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EMR – UCSF uses Epic Systems
LDAP – for the user directory
Sentillion & Shibboleth for Single Sign On
Implementation Timeframe
Careweb Messenger was first implemented as a pilot, called ZipRounds, in 2012.
It was originally implemented via an all-volunteer effort project, led by Dr. Raman Khanna.
Resources were donated by various teams across UCSF, UC Berkeley, Salesforce, Ideo, and
Mulesoft. The pilot took approximately 4 months to implement, from January 2012 to April
2012. Careweb Messenger was implemented as a pilot at the UCSF Mt. Zion Hospital in late
April, 2012.
In 2013, Dr. Khanna received funding support to improve upon the pilot and roll out to 3
floors at the Moffitt Hospital at the UCSF Parnassus campus. The effort took approximately
4 months, utilizing roundCorner, a Salesforce consulting partner, and the School of
Medicine, Dean’s Office Information Services Unit. This included an updated web
application interface and the mobile iOS application. This has been in production since
September, 2013, and the usage was been expanded to include the Cardiology ICU in April,
2014.
Portability to Other Academic Medical Centers
The Careweb Messenger solution can be adapted to other medical centers. Since a
substantial portion of the solution resides on Salesforce.com, no hardware is required to
support the web application. Within the UC system, Salesforce has a business associate
agreement with UCSF that is applicable to all other campuses. Salesforce also provides a
steeply discounted license through the Salesforce Foundation.
There are a few integration requirements:
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EMR ADT Data - Data integration with the hospital Electronic Medical Records
(EMR) to retrieve patient Admissions/Discharge/Transfer (ADT) information.
Communications Integration: SMTP or HTTP enabled Pager Gateway(s) and Apple
Notifications Services for the iOS client application
Single Sign On to streamline access for physicians and nurses
There is also a reliance on the Mulesoft Enterprise Service Bus. This can be installed on
premise or as a cloud version.
Objective customer satisfaction
Dr. Khanna surveyed pilot users in 2012 after a 2 week usage period. Here is a condensed
summary of the preliminary survey responses:
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Most preferred Careweb Messenger (to alternative, PagerBox), especially the
following features
o provider search feature by name
o ability to send a quick page
o ability to page many providers
o ability to send longer pages
Nurses appreciated the opportunity to receive pages
For the current 1.0 version deployed to production in September, 2013, there have ~20K
messages sent between October, 2013 – May, 2014. 80% of the messages are patient
related. 67% of the messages are threaded, meaning that a majority of the messages are
conversations. There have been many requests to make available to other parts of the
hospital, and a Medical Center wide rollout is scheduled for summer 2014.