After all that transpired in 2020, it’s understandable if people are reluctant to make predictions about what will happen in 2021. I suspect some prognosticators retired their crystal balls, or at least are finding the view a bit hazy right now.
And yet, in the healthcare IT domain, I’d argue that the major trends entering 2020 continued – some even accelerated – during the unpredicted chaos of last year. The movements in health IT toward greater mobility, interoperability, and remote care capabilities all manifested themselves in profound ways during the pandemic. Each will remain a priority for provider organizations in 2021, and I predict (warily) will see progress in the coming year.
Even as mobile devices have become more commonplace in healthcare settings, provider organizations still face challenges in realizing the full potential of these platforms. While there is utility in the ability to view clinical results or send messages (hopefully HIPAA-compliant ones) to colleagues, the real value is to integrate these features into a larger bundle of capabilities central to common provider workflows. Doing so places the entire technological ecosystem in the palm of a clinician’s hand. I predict we will see continued feature growth in the mobile space to better facilitate a provider’s ability to deliver care in the moment, wherever and whenever that moment may be.
To highlight where this evolution of mobility is leading us, consider this scenario. A provider reviews a concerning test or lab result on their phone. Without waiting to address this on a desktop station, they can utilize CPOE on their mobile device to order a follow-up study, and request a notification be “pushed” to them when the study is completed (or there is no result in timely fashion). They can query their fully-integrated messaging feature to identify the appropriate specialist on call and immediately send a secure text, which automatically incorporates a link to the patient’s full chart and all relevant data, and offers the user the ability to add a few lines of text to clarify the reason for consultation. The attending can confirm consult receipt and may further discuss the care plan. The consultant in turn may enter preliminary orders while the attending can message the larger care team (nurse, case manager, etc.) with an update before dictating a quick note.
With the continued advances in NLP and note automation, I anticipate the provider component of note generation will once again focus on pertinent positives/negatives, thought process and the plan, leaving the more administrative documentation to the system. Taken together, these advances will help free the provider from the constraints of the desktop terminal and facilitate the advancement of care. I don’t expect all of this to come to fruition in 2021, but we will take initial steps along the path.
Finally, on the mobile front, I would expect to see continued development of virtual assistants, which will one day move us from simple screen navigation to CPOE and touch-free engagement.
With all that the healthcare system has to worry about these days, perhaps it’s time to hit the “Pause” button on health IT deployment.
While it’s certainly true that provider organizations can ill afford any disruption or downtime in their health IT infrastructure right now – one could argue a massive EHR replacement project might not be advisable at this moment – it’s equally true that effective, practical health IT is needed now more than ever. Clinicians on the front lines of the COVID-19 response need accurate and relevant patient data from the EHR system, instantly (meaning with one click, not dozens); and they need to be able to collaborate with their colleagues on urgent patient care issues at a moment’s notice, anytime, anywhere.
To that end, nothing could be more practical or timely amidst the COVID-19 patient surge than patient data access and care team collaboration capabilities on mobile devices. Smartphones and tablets are the information access and communication tools of choice for most clinicians, wherever they may be – within the hospital, in a triage tent, quarantined at home, or anywhere in between.
But for hospitals under the gun in the midst of this pandemic, is implementing such functionality really feasible?
Let’s back up, and consider a fundamental truth of healthcare IT: EHRs aren’t supporting doctors the way they were intended to, and are diverting valuable time that could be spent with patients.
Ironically, before the EHR, a physician’s biggest pain point was not having access to enough data. Patient information was siloed, typically in dusty paper charts buried in the basement or out of reach in off-site storage. Physicians didn’t have a comprehensive view of the patient. Now with EHRs, providers should have better access to patient information. Alas, that often is not the case, as vital information is buried in a sea of redundant or irrelevant data within electronic clinical notes.
It is crucial that the healthcare industry empowers physicians with tools that will make them better. Unfortunately, forcing physicians to wait their turn for one of too-few hospital workstations is not making them better. The inexplicable persistence of UIs that fail to effectively parse information in a manner consistent with a physician’s workflow or thought process isn’t helping. Obtrusive, non-emergent automated queries that foster alarm fatigue aren’t helping. System design predicated on a one-size-fits-all user experience strategy hinders delivery of care.
On the other hand, well-designed mobile apps, which afford ready and actionable access to relevant patient data, can accelerate care. And if such apps are (a) an extension of the existing EHR, and (b) as intuitive to use as any consumer app on your phone today, then training and adoption shouldn’t be a problem.
The value of “mobilizing” the hospital EHR goes far beyond effectively caring for patients under crisis conditions. It has become essential for provider collaboration on patient care generally, as physicians today are as “siloed” as patient records once were. We are not all in the same hospital at the same time. Remote access to records and the ability to easily communicate with each other within the context of a patient chart are key to the kind of collaboration that fosters better care.
The news on physician burnout lately has been mixed. A 2018 Massachusetts Medical Society/Harvard report received considerable attention – it proclaimed physician burnout has become a crisis, widespread in the medical profession, driven by rapid changes in health care and physicians’ professional environment. Yet last month a study published in Mayo Clinic Proceedings found that physician burnout actually declined more than 10 percentage points from 2014 to 2017, though the rate for doctors was still considerably higher than for U.S. workers at large. And just last week, an American Academy of Family Physicians survey reported that 71 percent of practicing physicians are happy, albeit frustrated by the extent to which administrative and clerical tasks have become part of their daily work.
What to make of all this seemingly contradictory data?
When I began practicing as a hospitalist in the 1990s, the administrative burden on physicians was much less than today, owing in part to the regulations and routine processes of the day and the typical patient caseload. Back then I saw 12 patients per day. With that caseload, you could break even on billing while still having plenty of time to interact with patients and colleagues. While it would not be feasible to return to that volume today, the point is that the hospital afforded a much more professionally rewarding environment. There was time to discuss interesting cases with colleagues. There was time to revisit patients and dig deeper into their records. You had time to sit at a patient’s bedside and hold their hand. The pace today does not afford this opportunity, much to the dissatisfaction of physicians. The resulting isolation from patients and peers is a contributing factor to the burnout seen among physicians.
Then there’s the technology component. EHRs are widely regarded as a significant cause of physician stress and a distraction from patient care. For example, when hospitals installed computerized order entry (CPOE), it eliminated the order clerk and created an additional job for the physician. The evolution of the clinical note is another example of unintended clinical burden, with roots in the evolution of medical practice and the emergence of EHRs.
Take a step back and consider what the original purpose of a physician’s note was: to advance patient care. The note would be updated on a visit-to-visit basis by the same physician or perhaps another physician in the same group covering a weekend. Then shift-based medicine came into play, and the note became a vital mechanism to facilitate care transitions. Then, as malpractice suits became more commonplace, lawyers began requiring physician documentation to support their legal case. From there, we saw the note transform from a clinical and legal document to a billing document and a check for RAC audits.
Given these trends, the pressure on provider organizations (and physicians individually) to document extensively and bill correctly for every service performed has grown over time. Concurrently, the practice of regularly reconciling clinical notes and charges also has grown in importance, both to identify missing charges (for revenue enhancement) and to identify missing notes (for compliance). In order that this process doesn’t become another straw on a physician’s administrative back, many organizations prefer to automate charge-note reconciliation within the revenue cycle management workflow.
For a variety of compelling business reasons, not limited to concerns about physician burnout, healthcare systems must attend to their physician experience with the same level of care and intention as their patient experience. Here are three ways that improving physician experience can help to bolster a hospital’s bottom line: