About 15 years ago, in the early days of the implementation of electronic health records in hospitals, I remember an intensive care specialist at the CCU warned that the EHR system was a disaster.
reason? The inherent order in the app prevents the doctor from prescribing the medicine in the dosage he needs. Technology has its own glitches, and all those who participated in the implementation of EHR during those years will remember the challenges they had to face.
Fast forward 15 years, and today, electronic health records have become the central hub for all digital developments in healthcare. As the EHR system stabilizes, the need to make healthcare more humane will only increase.
The introduction of the FHIR API and the interoperability ruling further opened the market for a series of consumer-friendly healthcare services that compete with Uber and Amazon. Due to COVID-19, the digital transformation of the past two years has accelerated for two decades, which has made change management easier than before.
Facts have proven that technology is a boon for consumers today who have a large number of care options and improved access to care. This is not the case for frontline nurses, who continue to suffer from clinician burnout and fatigue.
This article explores the impact and impact of digital transformation on front-line caregivers (clinicians, doctors, nurses, therapists, and other healthcare practitioners), and what they hope to gain from digital healthcare to change their lives as caregivers.
How will changes in digital workflow affect the ability of frontline nurses to perform their jobs? Does the pandemic’s dramatic shift in digital transformation meet the needs of healthcare providers?
Digital transformation of frontline caregivers-workflow and their needs
Digital health improves patient access to care, patient participation, and care provision, but it has little effect on frontline caregivers. Frontline nurses are responsible for administrative tasks such as order entry, browsing screens to view previous reports and prescriptions, and filling out clinical document forms.
They must use different solutions for face-to-face consultation, video consultation, and then take notes in the EHR. Although this may not sound like much, please note that the best use of software involves a learning curve and time frame. Not to mention that management may suddenly decide to change some or all of it after a few years. All of this leaves us with a question-is it worth the trouble?
The main digital touchpoints at different stages of the clinician’s workflow include:
Clinical consultation. A good diagnosis requires careful listening and careful physical examination during face-to-face or virtual meetings. Doctors are often distracted when they need to record notes and findings into systems that are not intuitive to use.
According to Dr. Yaa Kumah-Crystal, assistant professor of biomedical informatics at Vanderbilt University Medical Center, the new era of using voice technology can help with queries and commands in the EHR to retrieve information during in-person visits.
This improves patient engagement and providers are not distracted by having to leave and go to their computer screen to enter orders or take notes. However, there are some limitations, such as the inability to understand differences in language and speech, and privacy issues. Although Google transcription solutions and similar technologies are gaining more and more attention, they have not yet established themselves as reliable documentation tools.
During the virtual consultation, the physical examination is assisted by temperature sensors, pulse oximeters, etc. The remote patient monitoring equipment and the platform company cooperate to create a continuous experience of virtual examinations and entry of notes directly in the EHR.
This is an area where clinical user acceptance and implementation rates are relatively high. Therefore, expanding RPM and telemedicine programs to meet consumer needs by integrating devices, telemedicine platforms, and EHR is an area of concern.
Orders and clinical documents. After the consultation is completed, the next stage is to enter the order and complete the documents. Doctors, nurses, or clinicians interact with clinical content, such as an order entry form from a computerized provider within the EHR.
This involves going through order entry, process and clinical document screens. Forms for order entry and documentation are often poorly structured. Their design does not take into account the working methods, records, and prescription styles or specifications of frontline clinicians.
This unplanned or general form of design can trigger unnecessary drug interactions or drug dosage warnings, leading to confusion and distraction. There have been cases where the doctor placed the dosage and route of administration of the drug in the special instructions field of the order due to insufficient text space or the lack of the required dosage and route in the order itself.
Integrating voice technology into EHR screens and AI to understand what the clinician is saying can help eliminate additional post-work documentation time.
View reports from auxiliary systems and the importance of interoperability. An important part of diagnosis usually involves prescribing and reviewing patient reports. According to a poll in 2019, approximately 90% of outpatient clinics and medium-sized health organizations still send reports by fax.
Even today, the diagnostic center still faxes or sends a pdf copy of the report to the clinic. The clinic hires additional staff to extract key observations and values from the fax report and place them in the relevant area of the EHR for reporting purposes, simply because the system is not integrated.
This is a waste of time, energy, and resources, and it can be error-prone. This also delays the diagnosis, because the doctor must wait for the report to be sent by fax or email, and then someone can extract relevant insights from it.
By ensuring that radiology and laboratory information systems can interoperate with EHR systems and have two-way communication, first-line clinicians can focus on their primary care tasks.
Terminology in clinical documents
The exchange of information between two different systems is meaningful only when both systems can understand the information contained in the document. Clinical terminology encompasses a wide range of topics, and various professions record them in different ways. PID can refer to a gynecologist’s pelvic inflammatory disease or an orthopedic doctor’s prolapsed intervertebral disc.
The core of the information will be lost until it is correctly coded with the correct terminology on the backend. The doctor’s words and text are coded in computer-readable terms to improve communication within the system.
For many types of clinical data, USCDI has established data category standards for different types of clinical data. By complying with these data standards, the system must ensure data interoperability to achieve a seamless workflow for clinicians.
Significantly implement digital healthcare for frontline caregivers
Due to the many shortcomings of technology deployment in healthcare, clinicians are cautious about adopting any technology unless they are convinced of its ease of use and reliability. The concept of “first, no harm” is deeply ingrained among first-line clinicians.
Clinicians do not approve of technological innovations that challenge the way they usually operate. Technology is available and must be implemented correctly. According to Jim Beinlich, the former chief data and information officer of Penn Medicine, now it has nothing to do with engineering, but more about correct execution.
A gradual strategy that builds end user confidence by addressing deliberate implementation during consultation, ordering, recording, and reviewing reports can help doctors embrace digital transformation and align with their organization’s digital vision.
Digitize existing processes without changing the way clinicians or frontline nurses work. Digitization makes their lives easier, even if it means changing one process at a time, no matter how small or short the process is.
Dr. Joyoti Goswami is the chief consultant of Dharma Consulting.