By Subha Airan-Javia, MD, MedCity News | December 11, 2018
A clinician and associate chief medical informatics officer shares her perspective of what’s needed to improve the relationship between clinicians and technology in the development of end-user focused clinical tools.
In recent years, healthcare has been significantly influenced and shaped by a well-intentioned push towards the digital age. Unfortunately, in practice, policies, incentives, and IT systems have often been counterproductive to their goal — to enable connected, operationally efficient hospital systems. While the digitization of patient records through EHR platforms is a step forward for an industry marked as a laggard in technology adoption, poor design in an effort to meet strict regulatory requirements has frustrated end-users and caused a tumultuous relationship between clinicians and technology.
In my last 11 years of practicing medicine, as a front-line clinician, clinical informaticist and as an associate chief medical informatics officer, I have seen first hand the disconnect caused by poorly designed technology in the hospital system.
Significantly lacking in usability and mobile access, EHRs tether physicians to a desktop computer, causing them to spend more time on documentation and administrative tasks rather than high-touch patient care. This has led to an increase in physician burnout without realizing the promised benefits of interoperability and increased efficiency.
Take the recent situation at Central Maine Healthcare system, for example. Physicians have resigned and openly resisted a top-level, financially driven decision to switch their EHR system. Clinical professionals are at war with their own executive leadership, in a battle between profit margins and quality of care.
To those outside the clinical field, it may seem puzzling that clinicians aren’t embracing technology at the rate of other industries. However, when you look at the process to purchase technology within a health system, the problem is strikingly clear.
Internally, there are layers of bureaucracy slowing the pace of innovation. As a resident, there were many times I was frustrated by the state of available clinical tools or hoops I had to jump through to meet EHR requirements. The exhaustive lack of integration and dependence on paper-based tools led me to seek out, and ultimately design, a better solution. After building a mobile tool that clinicians actually enjoy using, I realized that technology – when designed well – could improve care and clinical workflow. This experience compelled me to co-found a health tech company and create mobile technology that optimizes clinician experience and clinical workflow.
The fact is, EHR platforms weren’t built to streamline clinical workflows. They were built to help improve the bottom line of health systems and doctor’s offices, by streamlining their ability to code and ultimately bill for services, and later to meet regulatory requirements. Along the way, care delivery and clinician tools have been tacked on in an effort to create a comprehensive solution. Unfortunately, there is yet to be one program that can “do it all.” Instead, clinicians adopt clinical workflows to systems optimized for finances instead of patient care, which leads to more frustration, errors, and inefficiency — a disservice to both my colleagues and patients.
A recent survey conducted by Stanford Med and the Harris Poll demonstrates the large gap between clinicians’ expectations for EHRs and the reality of their limitations. When asked about the value of their EHR, only 8 percent of responding primary care physicians (PCPs) saw EHRs as a clinical tool, with the most popular use-case being data storage. Additionally, 97 percent of those surveyed said that a responsive user-experience is a crucial feature of the EHR, but only 54 percent said they are satisfied with the current state of the platforms. Perhaps most telling is that almost half (40 percent) of PCPs see more challenges with the EHR than benefits.
So where do we go from here?
In an effort to improve the relationship between clinicians and technology, I’ve shared some lessons I’ve learned while building end-user focused clinical tools.
Clinicians must demand better and administrators should listen
The first step in changing the state of things is for those using these tools to make their voices heard. Rather than adapting our workflows to technology, we must instead insist on technology that fits to and enhances our workflows. Healthcare organizations need to create consistent feedback processes between clinicians and administrators, allowing end-user recommendations to be heard and acted on.
Adopt problem-based, user-centered design methods
This point may seem obvious, but it’s a key component to repairing the relationship between clinicians and technology. With the average physician burnout rate hovering around 50 percent, and the cost of replacing a lost physician being about $500,000 per physician, clinician well-being has a profound impact on the bottom line and on patient care. One way to reduce burnout and improve efficiency is to provide better clinical tools that do not just settle for being functional but are also enjoyable and easy to use. It’s simple: Well designed technology can lead to happier clinicians, and happier clinicians can lead to higher quality care.
Multidisciplinary design teams are paramount
As is true in most industries, teams consisted of different skill sets can achieve more than teams working in silos. With the creation of the field of clinical informatics, we now have experts in the area of designing and implementing effective health technology solutions. By bringing clinical informatics specialists together with internal technologists, and of course end users, organizations benefit from experts who both understand the challenges faced by front-line clinicians and are also focused on bringing better technology to the field. These collaborations will result in digital tools better designed to meet end-user needs, while still working seamlessly within the existing technology infrastructure of a hospital system. To build an application that is quickly adopted and enthusiastically integrated into daily workflows, it is important that end-user feedback is solicited often and implemented quickly, which can only be achieved if clinicians, IT team members and end-users work in harmony.
Fortunately, the tide is turning for clinical workflow and the way technology is designed and deployed. New solutions are re-imagining how technology is designed and enhanced clinical workflows, co-developed by end users, are finding their way into the right hands. This model for user-centered, “usable” and intuitive digital health tools have the potential to deliver the promise of EHRs from so long ago — increased efficiency, safety, and satisfaction for both clinicians and patients. Perhaps we can have our cake and eat it too?
Photo: Getty Images
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Subha Airan-Javia, MD, TrekIT Health’s chief medical officer, championed the early-stage development and evolution of Carelign. Dr. Airan-Javia is a by-the-book physician by day, but a technologist by night. Her goal is to improve the delivery of care at hospitals by integrating applications that harmonize every phase of the healthcare ecosystem. Dr. Airan-Javia spent 11 years as a healthcare information technology physician liaison and associate chief medical informatics officer at Penn Medicine, of the University of Pennsylvania Health System network. She completed her doctorate of medicine at the University of Maryland and earned a BS in biology at the University of North Carolina at Chapel Hill.
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