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Technology should empower teams, not burden them

By Dr. Dennis Schmuland, Chief Health Strategy Officer, U.S. Health and Life Sciences, Microsoft on October 19, 2016

Filed under Health

Unless you’ve been living under a rock, you’ve come to accept the reality that we’re now operating in a consumer-centric, outcome economy.  To add value in this new outcome economy, clinicians are being called to show how their practice is achieving the triple aim – improving the health and experience of care of the populations they serve and doing both at a lower cost per capita.   Improving quality, safety, or reducing resource use alone are no longer enough.  Achieving the triple aim is the prerequisite to bending the cost curve.

But achieving the triple aim will require a new generation of digital transformation technologies that empower clinicians to improve the safety, speed, outcomes and coordination of care—without burdening them.  Here’s what I mean when I say, “without burdening them.”  The only technologies that most clinicians have experienced in the past decade are the EHRs they’ve bet their futures on.  These EHRs get the job done, but do so by exacting an immense burden on users’ productivity and time in the process of getting the job done.  Most clinicians tell me that many or most of the touted benefits of their EHRs are effectively erased by the additional burden imposed on them in terms of additional data entry and retrieval time.   I’m convinced that it’s this low benefit to burden ratio that’s behind the EHR backlash that’s compelled creative clinicians like Dr. Zubin Damania to create EHR parody protest videos like EHR State of Mind.   Unlike EHRs, the benefit to burden ratio of these new transformational technologies must be high enough to empower clinicians, along with their teams, to get the right things done and coordinate getting the right things done anywhere, in less time, and with less effort.

In the last post I sat down with Boise-based St Luke’s Medical Director of Care Management, Alejandro Necochea MD to hear his story of how St Luke’s was empowering clinicians to be more productive at work, home, and on the go.  In this blog post, I asked Alejandro to offer a few examples of how Skype for Business was empowering clinical teams to get the right things done anywhere—without burdening them–in less time, and with less effort than the usual phone, fax, in-person meetings and clinical messaging.  Here’s the transcript of that conversation.

Schmuland. At the heart of every great team is great communication.  Yet every Chief Medical Informatics Officer I talk with admits to struggling with care team communication and performance because they over rely on traditional modalities– phone, fax, in-person meetings and clinical messaging.  How are your teams at St Luke’s using Skype for Business to improve the communication, coordination, and performance of your care teams?

Necochea: We’ve made major gains in the area of care team communication and collaboration, yet there’s so much further to go.   For example, our hospitalist MDs use Skype for Business for content-sharing meetings–which allows them to attend those meetings from home or on the go.  Our hospitalists work hard when they are in the hospital, so when they are off, the last thing they want to do is go backinsert to the hospital for a meeting.  We also now use Skype for Business for all of our staff meetings where we share screens and presentations.  This works out well because we all cover two hospitals that are about 10 miles apart, so those at the other hospital or at home can easily webconference in to the meeting from wherever they are.  Sometimes we have 10 people in the room, and twice that number webconferencing in.  For some of our administrative meetings, we use the video option, which is much more engaging than the phone.

I’ve found that Skype for Business works particularly well for curbside consults with my care team colleagues.  At any given time, I’m usually able to find several of my colleagues online—so rather than interrupting them by paging or calling them, I can instant message them and when they see the toast pop up on their screen, they can see the level of urgency and decide when and how to respond in a way that’s minimally disruptive for them.  If it’s urgent, I can always call or page them, but if it isn’t urgent, the message will stay on their screen until they are ready to respond at a more convenient time.  If it’s an urgent matter, I’ll just send a message like “Please call me right away” or “I’ll be in my office, please call me when you get a chance.”   With paging, it’s usually one response: “must call ASAP.”  So Skype for Business is giving our doctors more control of their workday back to them, which means patient care time and “thinking time” is better protected from interruptions, right?

Schmuland: What technology innovations would you say are still needed to empower your patient-centered care teams to improve the quality, safety, speed and or outcomes of care?

Necochea: I think the inter-disciplinary team is still too rigid.  It’s a great concept, but it’s just not dynamic enough for the value based care model of today.  The current model is based on the old school “rounds” routine where everyone on the same shift makes the rounds in unison, moving en masse from room to room, each time taking their place around the bed of the patient and providing their updates, concerns, and care plans.  But outside that hour of rounds each day, things come up that require the team to collaborate and make decisions, collectively as a team, in real time.  For example, a patient may be reaching medical stability, but the team is still not sure of their needs at home because they may be weak or deconditioned–so the discharge plan really depends on the result of a physical therapy assessment.  But what often happens is the results of the PT assessment are entered in the chart early in the day but not discovered until much later, and so as a result, the discharge time is needlessly delayed and length of stay is extended.  If the team would instead use Skype for Business to virtually huddle and act on the PT assessment the instant it was filed, disposition planning, discharge time, and patient throughput could all be accelerated.

If every one of our team members had Skype for Business on their mobile device we could conduct team huddles ad hoc, whenever patients’ needs change, rather than waiting until the next scheduled rounds.  This dynamic model would make the inter-disciplinary team more efficient, effective, and patient centered, in contrast to the current approach which is more time-boxed.   I’m looking forward to that day.

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