Digital Technology as Force Multiplier for Health Care Workers … – nejm.org

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When designed well, technology can harmonize with clinicians to improve human-centered care delivery and bring joy back to the practice of medicine.
The Senior Vice President and Deputy Chief Medical Officer of Clinical Systems in the Office of Medical Affairs at UnitedHealth Group and NEJM Catalyst Editorial Director discuss the role of technology, specifically virtual care, digital workflow automation, and clinical decision support, in both contributing to the health care workforce crisis and as a source of solutions to burnout and leaving practice. When designed well, these technologies can be a force multiplier, augmenting care teams, reducing “pajama time” spent on electronic medical records, closing skills gaps, and enabling clinicians to deliver care at the top of their licenses, from anywhere, in a more human-centered way. Buy-in and financial investment from health care leaders is critical in choosing which technologies to implement, along with training in these technologies, such as “webside manner.”
From the NEJM Catalyst event The Health Care Workforce Crisis, sponsored by Optum, December 8, 2022.
Garry Choy, MD, MBA, Senior Vice President and Deputy Chief Medical Officer of Clinical Systems in the Office of Medical Affairs for UnitedHealth Group, speaks with Edward Prewitt, MPP, Editorial Director for NEJM Catalyst, about the role of technology automation and clinical decision support in both contributing to the health care workforce crisis and as a source of solutions.
As everyone knows, health care is in a time of extraordinary upheaval with its workforce. 2022 was a challenging year for health care workers, with increases in demand, complexity, and costs — including training and recruitment costs — skill gaps, and turnover. Burnout is at an all-time high, and significantly more people are quitting. “To make the situation more sustainable, we have to design and use technology to make things better for our workforce,” says Choy. “Technology can often be attributed to being a cause of some of this, but technology can be a solution as well.” Sustainability is one way to look at better applying technology to help the workforce, to have humans harmonize with technology to improve care over the long term.
Prewitt asks how technology can help address workforce challenges. “In medicine, there’s art and science. We’ve always tried to balance being human and also using technology,” Choy says. “How can we bring technology into the clinic room in a more human-centered way? How can this AI algorithm or clinical decision–support system be an additional team member?” Technology can be a critical member of the team, helping workers to practice at the top of their license by providing information at their fingertips.
Choy mentions how technology has helped outside of health care, such as ordering food online from anywhere with a single click. What about in health care? “How could we allow health care workers to have more choices, more autonomy, work from anywhere, deliver care from anywhere to anyone who’s anywhere else in the world?” Choy asks. “Technology can be a force multiplier.” It allows for automation, which, when at its best, allows for more human-centered care, more eye contact with patients. “We can be more human, the part that can’t be automated, the art of delivering medicine,” he says.
How can we bring technology into the clinic room in a more human-centered way? How can this AI algorithm or clinical decision–support system be an additional team member?
Physicians spend hours of “pajama time” when they go home working on their patients’ charts, their electronic medical records (EMRs), and when in clinic, much of their day is focused on administrative tasks. “We need to design better tech interfaces that don’t slow people down, that don’t create more burnout or frustration,” Choy says.
Where should we start? Which workforce issues are the most crucial to address right now? It starts from the beginning with training, Choy says, when we learn bedside manner and how to measure vital signs at the bedside. “How do we train our workforce to use the most modern technology to deliver the best care?” Choy points to a lack of skilled talent among health care workers and says technology can close skill gaps when it allows the workforce to operate with more capacity. If you hire someone who’s well trained in a particular technology, or if your workforce trains in the latest technologies, you create a more modern, more effective workforce. Training costs are a potential barrier, but, says Choy, “You have to invest in training the right workers with the right tools, with the right skill sets to operate these tools.”
Choy describes a virtual care example, which skyrocketed during the Covid-19 pandemic. In medical school, students learn in-person bedside manner. Now, we have “webside manner,” virtual bedside manner that must be taught in the classroom and on the job. Clinicians had to quickly learn how to conduct video calls with patients during the pandemic; many may never have received training in video calls with patients, webside manner, or how to conduct physical exams without physical touch.
Earlier in 2022, a family member of Choy’s fell down the stairs — a critical emergency. At 5 a.m., Choy received an unexpected video call from a neurosurgeon in the intensive care unit, who concisely explained the accident and his recommendations. “This surgeon clearly had done before,” Choy explains. “I felt at ease. I was very informed, felt that it was an appropriate webside manner. This surgeon must have gotten training, but also done it many times experientially. There was a lot of value there in a unique situation.” This virtual care allowed multiple parties to come together to make critical decisions in an effective, efficient way, which resulted in as optimal an outcome as possible in that situation.
We need to design better tech interfaces that don’t slow people down, that don’t create more burnout or frustration.
“This neurosurgeon had a command of technology and command of the bedside manner, the human side, the art side, as well as the science side of the equation,” Choy adds. He shared a CT scan on the screen while making eye contact with multiple people on the call, conveyed his expertise, and engaged everyone to ask questions so that there was true shared decision-making.
“You could see what we’ve talked about for years, how do you deliver good medicine in virtual visits? Could we have more of [examples like] this across the health care system?” Choy asks. Training in virtual care, and investing in the right resources for that training, is very important.
Virtual health care technology can help with workforce shortages, too. In the example, that neurosurgeon was in Maryland while Choy was in California. Other specialties or types of health care can be delivered regardless of patient and provider location, addressing workforce shortages in certain physical locations. Other technologies such as task automation and clinical decision support can also be force multipliers for the health care workforce.
Prewitt notes how distracting and frustrating EMRs can be and how much they have contributed to pajama time. How can digital workflows be changed to satisfy health care workers and make their jobs easier?
“The joy of practicing is part of being a health care worker,” Choy says. “If technology can make the workflow better, you’re making the job better, and you’re making that job satisfaction real.” Identifying what can be automated and improved through intelligent technologies allows for better retention and sustainability of the workforce — fewer people quitting out of frustration with the system, and increased likelihood of feeling like you are making a difference in patients’ lives. A majority of health care leaders say digital workflows are a priority for building a sustainable workforce, according to Choy.
The joy of practicing is part of being a health care worker. If technology can make the workflow better, you’re making the job better, and you’re making that job satisfaction real.
Choy provides an example of when he practiced radiology in Massachusetts. “As a radiologist, we’re like machines. We’re reading films all day. But you have to take into consideration that behind the chest X-ray there’s a person, and you want to know as much about that person as possible,” he says. He explains that they had multiple EMR systems and had to open multiple windows to understand the patient and be able to give a good diagnostic interpretation of the X-ray. The administrative burden of opening multiple windows took time and could cause the radiologist to miss something. To resolve this, his organization implemented a search engine that “made being a radiologist much more enjoyable and also better,” he says, speeding up interpretation and improving care delivery.
This type of workflow technology can come in many forms. Choy’s organization built search queries for orthopedics, obstetrics, and primary care, for example. “This is an example of clinical decision–support technology that can improve workflow so that you’re simply happier as a clinician delivering care. And, ultimately, better care translates into that,” he says.
Systems talking to each other and interoperability are other areas to consider as digital workflow solutions that improve the practice of medicine. To even have a search engine, multiple systems need to be searched. “Imagine doing this across state lines or across borders, and being able to do telemedicine,” Choy says. “Could you have remote access? Could you start to connect different systems that typically require another log-in, EMR integration with the different applications that you want to use as a specialist?”
There is no shortage of barriers, but we have no choice. We have to do better for our workforce.
“We talked about a lot of possibilities and opportunities, but what are the barriers?” Prewitt asks.
“There is no shortage of barriers, but we have no choice. We have to do better for our workforce,” Choy says. Major barriers to overcome include determining which specific technologies to invest in and getting leadership buy-in to invest. “Advocate with leadership to think of the best investments we can make for our workforce,” Choy says. This may involve finding and hiring people to equip the workforce with data analytics and workflow tools. Health care leaders may want to invest in technology, but what are those specific technologies, when there is no shortage of point solutions?
“How do you figure out, what are the tools that you put into your first-aid kit, one of the multiple Band-Aids that you have? You can’t just have one Band-Aid,” Choy says. “How do you piece together the portfolio that you have for your workforce and ultimately convince people to invest in that? You have to look at the whole, big picture.”
What’s ahead for 2023? Choy’s outlook is bright for what technology, whether automation or decision support, can do for the health care workforce in increasing workforce capacity, improving satisfaction and the joy of practicing, improving care delivery, and sustaining and scaling the health care system. “In the future, we can have an orchestra where technology interplays with humans, and we can deliver the best care possible in a way where fewer people leave the workforce, and they can deliver better care,” he says. “This will translate to better patient satisfaction, stakeholder satisfaction. A positive, virtuous, cycle where technology can start to augment our workforce.”
Garry Choy is Senior Vice President and Deputy Chief Medical Officer of Clinical Systems at the Office of Medical Affairs for UnitedHealth Group, which Optum is part of. Optum sponsored the NEJM Catalyst event “The Health Care Workforce Crisis.” Edward Prewitt is Editorial Director for NEJM Catalyst.
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