Secure Chat (Instant Messaging)
Secure Chat is Connect Care’s secure messaging hub. It allows prescribers to send encrypted text messages to colleagues in real-time from a mobile device or a mobile computer. It can facilitate quick communication and collaboration but does not replace telecommunications for urgent matters, or In Basket for communications that belong in the record of care.
Prescribers should use Chat with care until the clinical information system (CIS) has fully deployed within a clinical area and new communication norms are widely understood. Early on, staff may forget that many matters still require face-to-face, pager or telephone communication. A couple key things to remember when using Secure Chat:
Secure Chat should not be used to convey urgent information or to ask for urgent intervention from a colleague without person-to-person communication.
Messages sent via Secure Chat are purged after 30 days, and so messages are not archived.
Initially, Secure Chat will be most useful for consenting clinical groups that commit to use it responsibly.
Functions
Whereas In Basket supports a wide range of communication types, Chat is uni-dimensional. It supports simple person-to-person or person-to-group text messages. There is no support for advanced text editing, SmartTools or word processing.
Images: Individual messages can contain a photo if sent from a mobile app (Haiku or Canto).
Attachments: If a message or conversation is anchored to a specific patient, then an option appears for attaching files or documents to the message.
Conversations: Chat "conversations" are groups of messages focused on a specific topic that go back and forth between individuals or groups.
Chart Links: The start of a conversation can include a link to a specific patient chart, indicating that the conversation relates to that patient.
Presence: Responsible chat participants will set their availability status and keep it current. This indicates whether one is able to receive and review incoming chat messages.
Forwarding: Recipients can configure Chat to forward all of their messages to someone else responsible for a clinical service while the recipient is away or indisposed.
Persistence: Chat messages persist for 30 days and then are purged from the system. They are not part of a patient's permanent record.
Uses
Secure Chat works like "iMessage" or "WhatsApp" but is approved for use by clinical teams.
Chat messages are especially effective for quick communications with colleagues using Connect Care mobility. Haiku (smartphones for physicians), Limerick (physician Apple Watches), Rover (nursing and allied health smartphones), Canto (physician iPads) and Hyperspace (desktop computers) all support visual and/or audible alerts to incoming chat messages.
Alerts to incoming chat messages are only received if the recipient is using a Connect Care information service configured to provide alerts to incoming messages; such as a SmartPhone configured to use the "Haiku" application, an iPad configured for "Canto," or a desktop device logged in to "Hyperspace". Even so, a break in network connectivity can delay message delivery. In this way, Secure Chat does not have the immediacy or reliability that a page or telephone call might have.
It is particularly important to be aware of and follow communication norms when devising a secure messaging compact for a user group.
Availability
The Secure Chat activity in Connect Care has a status selector prominently displayed at the top of the user interface. This allows users to indicate whether they are currently "Available", "Busy" or "Unavailable". This is important if, for example, a clinician will be in surgery and unable to attend to messages. A settings tool can additionally be used to indicate the duration of any availability status and to identify individual(s) to whom messages should be forwarded instead.
Appropriate Use
Teams: Chat is best suited to situations where all in a conversation are likely to be available and compliant. One can set up a chat group for an on-call team and then facilitate check-ins and work coordination. Students can send quick queries to residents.
Consensus: The members of a conversation should have a shared understanding about frequency of checking chat messages and expectations for speed of response. Examples include members of a clinical consult team currently on service for a defined shift or members of a critical care unit working together at the same time in related locations.
Mobility: Chat works well if all members of a conversation are using a mobile device. This improves the likelihood that alerts will be received. Each user needs to personalize their device to give audible, tactile or visual (badge) cues to new messages. Best to ensure that everyone is able before expecting everyone to participate.
Images: Chat can be used to confer about an image captured with a mobile device. The recipient can help decide if the captured finding is significant and whether it should be transferred to the chart.
Process: Chat conversations should be limited to matters of team coordination. Indeed, they must not be used for clinical documentation or content that belongs in the legal record of care. Discussion about where to start rounds, for example, is a good use of chat. Requests for consultation, however, should be handled through chart orders and notes.
Inappropriate Use
Urgent: Chat should not be used instead of a pager or telephone. The pager works even where cell or wireless signals may be weak. And the pager alerts the user even if not connected to the CIS. Urgent communications should be completed via pager, cell phone or a hospital locating service.
Record: Chat should not be used for any form of clinical documentation.