Leveraging Technology to Improve Healthcare Efficiency

Healthcare technology has brought along high hopes for more patient-centric workflows; process efficiencies; and improved job satisfaction for staff. So why does it seem that instead of more time focused on patient care we are spending more and more time with a computer screen?

Leveraging Technology to Improve Healthcare Efficiency

Technology is everywhere these days. It has changed our lives in ways that few of us could have imagined just 20-25 years ago. It has allowed us to be more effective when completing tasks, both at work and in our personal lives. It’s now possible to host virtual video calls with the click of a button. We can have our vehicle assist us with directions and driving tasks. We have access to more information than we can possibly consume - at our fingertips.

Unfortunately, the path to change hasn’t been without some bumps.

Many industries continue to struggle with the adoption of technology enabled workflows. Healthcare is no exception. With all the changes and improvements to process efficiency and outcomes, we should be embracing all things tech ... But are we?

When electronic health records (EHRs) first started to take off the benefits were promising. They were going to make our lives easier and would improve the way we would care for patients. Many organizations and individual practices have demonstrated notable improvements in patient outcomes. They also show reductions in various risk areas and reduced cost expenditures once technology is in place.

Common reported results from an EHR implementation include:

  • Care team members are able to access patient information in a more timely manner. They no longer have to wait for paper charts to come up from health records.
  • Diagnostic results have a faster turnaround time than they did in a paper world.
  • Notes and medication information are more legible. Resulting in a significant drop in interpretation errors.
  • Administrative processes, such as billing and scheduling, have seen accuracy and efficiency improvements. (Including fiscal improvements for many organizations/practices.)
  • Clinical decision support has led to increased patient safety measures.

There is no doubt the addition of technology is a key driver in transforming the industry. We have aspirations for more patient-centric workflows. (More time spent interacting with patients.) Beliefs that process improvements and efficiencies will improve health outcomes for the population. And hopes of improved job satisfaction as staff focus on the things that drove them to healthcare in the first place.

Why are we still struggling with adoption?

Does it seem that instead of more time focused on patient care clinicians are spending more and more time with a computer screen?

Over the past few years, several studies have found just that.

Looking back, the first EHR systems were developed back in the 1960s, and while they were nowhere near as capable as the systems we have today, one would think that we wouldn’t still be struggling with paper vs computer discussions some 5 decades later …

On top of that, staff is feeling frustrated, overwhelmed and burned out. Attributing some of those feelings to the use of technology. In the 2019 Medscape National Physician Burnout & Depression survey done in the US, 44% of respondents reported feeling burned out at work. Of that, 59% indicated that too many bureaucratic tasks, such as charting and paperwork, were a factor. More alarming is the fact that 32% identified increasing computerization as a factor - that’s 1 in 3!  (That number is only applicable to those that reported feeling burned out. But, I suspect a similar number would result if the survey broadly asked what contributes to your stress levels at work.)

Throughout my years in health informatics, some of the most common complaints that I’ve heard clinicians articulate are:

  • "It’s harder to find things that it used to be and even if you know where it is, there are too many clicks involved to get there." Paper charts only had one location that a piece of paper could live in. With the current EHRs, you can find the same data in multiple different places. Sometimes in many formats (e.g. written and graphical results).
  • "The application isn’t user-friendly and it doesn’t align with our workflow." Users feel forced into a sequence of activities. If they stray from the sequence, the risk facing some form of ‘hard stop’. With paper, you could do things in any order you wanted and there were no ‘hard stops’. (Note:  many of the legacy systems were customized for a particular specialty/practice. Whereas the systems we see today are more generalized.)
  • "There are way too many alerts." While most recognize that there is value to some alerts - there seems to be far too many of them that are not helpful at all. Alert fatigue is a well-known issue in informatics.  If you have never experienced it - imagine this .... You are trying to focus on watching your favorite show or sports team .... and .... Someone is constantly hitting the live TV pause button and popping in front of you with their arms in the air. Now, sometimes you can just hit mute and they go away. But other times, you must answer a skill-testing question before you are allowed to refocus. Either way - you've broken your train of thought and precious time has gone by.
  • "Users have to fill in more fields than ever before." Many organizations started with existing paper forms when determining their EHR content. While this, in theory, is a good thing, there often wasn't a review of field use on those forms. On top of that, there were also instances where multiple forms were combined into a single one in the EHR. By incorporating everything - the end product can be overwhelming. That's before mandatory and suggested icons come into play ....

So how do we make it better? Since waiting around for vendors and regulatory bodies to magically fix things doesn’t seem to be working out ….

We can start by providing meaningful feedback. Many of the government and regulatory bodies will seek input from industry representatives before they commit new requirements to law or a licensure rule. (I recognize this may not be the case in all areas.) Also, the majority of the large EHR vendors have user groups and/or forums where they regularly seek input from their client base. We can, and should, use these paths to articulate frustrations and suggestions for improvement. Silence is unlikely to result in a perfect solution on its own.

What are some of the things that each of us can do now in our own practice/clinic/health system?

Each practice and each organization is different.  There will be varying paths and opportunities available to make improvements. Now, I don't want to imply that any of the current initiatives or organizational practices are insufficient. Or that they are not going to lead to improvements as I believe that most with good intentions will. If you are struggling with where to start - you may want to consider the following:

1)  Ongoing Education

Make application training an ongoing activity for all end users. There is often a significant focus on training during initial implementation. However, with the amount of change occurring during that time. Along with the sheer volume of information, it is common to retain only a portion of the material. Ongoing education doesn’t need to be formalized classroom or online learning. It may be simple tips and tricks documents, lunch and learns, short presentations, or in-service events for staff.

2)  Transparent/Open Communication

When talking to leadership and IT staff, be open and honest about the frustrations and workarounds that have been put in place. (It is important to also keep an open mind when a response is given or a dialogue begins.) The overarching goals of individuals in the healthcare industry are the same.  To improve patient outcomes, and to deliver effective and efficient care. It is possible that those who can assist, are unaware of the struggles. Or that they do not have enough information and cooperation from stakeholders to make the desired improvements. Keeping the lines of communication open is a key step forward.

3)  Think ‘Outside the Box

Many organizations designed IT application(s) with paper-based or previous processes in mind. Or perhaps, workflows were developed without meaningful input from all key stakeholders. (For various reasons.) Instead of trying to force and old workflow to comply with a new system - consider making changes. There may be minor adjustments that will allow for tasks to occur at a better time or in a better place. Now that users are more familiar with the application(s) re-engage to consider options.

4)  Re-evaluate Roles

Identify roles that are currently performing tasks that are frustrating, duplicative, or redundant. Clinical applications usually have role-based security in place. This ensures that only those who hold required licensure or have the scope of practice can perform tasks. With this in mind, there may be actions that are being done, not based on role, but based on timing. Consider adjusting workflows so these tasks can be appropriately completed at a different time. Perhaps by a different clinician/team member.

5)  Collaborate with Colleagues

Communicate with colleagues to see if they have any ideas for ways to improve the process. As users get more used to IT applications, many will develop habits or rhythms for looking at and entering information.  Some of these may not be  known to others on the team. Try not to limit these collaborations to only those individuals that share the same role. You may learn the best navigation trick ever from someone who accesses the same information as you but for a different purpose.  (Think clerical staff, billing admin, other clinicians.)

There is little doubt that technology has come into our lives with the full intention of staying. As we move forward, we will continue to see an increase in the use of computers throughout all aspects of our lives.  Learning to incorporate applications into our work processes is important. Change won’t occur overnight, and it won’t occur without effort.  But it can start with some simple actions and some key concepts and over time grow into something great.

"Technology should improve your life ... not become your life."     Billy Cox.