MedCity Influencers, Health IT

Defeating doctor burnout: It’s the systems, silly!

The various stakeholders need to collaborate to design and configure technology that not only meets regulatory, payer, and organizational needs but also satisfies the needs of clinicians, patients, and the general community.

A recent National Academy of Medicine report uncovered a disturbing link between the burnout rate among clinicians and the use – or misuse – of technology.

Excuse me for not being shocked by the conclusions.

Technology can either contribute to clinician burnout or be a boon for clinicians serving patients. It all depends on the quality of the technologies that doctors are required to use.

The finding puts added urgency on the need for payers to start treating healthcare providers more like members or true customers. Today, payers focus largely on large insurance brokers rather than providers or patients, who increasingly want to handle insurance needs directly with payers. The technology that payers implement should be designed around the needs of the provider — to help providers do their jobs.

As of 2017, almost all hospitals and nearly 80 percent of private practices were using certified Electronic Health Records (EHRs.) But as the NAM report makes clear, these systems all too often are responsible for hindering rather than helping the very people they were designed to serve.

Poor Design and its Discontents
When payers build out their technology processes, the approach should be to start with an eye on helping providers with their specific “job to be done” (a framework developed by Harvard Business School’s Clayton Christensen). Modern, purpose-built technology systems are supposed to make it easy and fast for doctors (and patients) to get what they need from payers. But putting those principles into practice is anything but straightforward.

The NAM report highlights the widespread use of legacy and poorly designed software systems that are not adequately integrated into clinical workflow. These systems are the very opposite of user-friendly and often lack the flexibility, functionality and connectivity that clinicians need.

These issues do not just frustrate doctors but also patients. With Medicare’s expansion and people living longer and requiring more care later in life, increasing demands are being put on the system. And the situation will be under even greater strain in the years ahead as we face a growing shortage of primary care physicians.

We need to change the status quo if the healthcare industry wants to make good on providing a better experience, quality care and lower cost – the so-called Triple Aim. That means a fundamental rethinking of how it approaches the design of its software

Lessons Learned from the Tech Industry
Many organizations assume they can upscale simply by creating electronic forms that move the same paper documentation doctors and patients previously used to fill out into digital formats. Back-office employees are tasked with the responsibility for coming up with designs.

The results were predictable: generally poor designs with burdensome documentation requirements that fail to align with clinical workflows. The upshot is additional busy work that forces doctors to enter redundant information into cumbersome systems that add unnecessary hassle to their daily routines.

Scale poses an additional challenge with more people than ever needing to see fewer and fewer care providers. We can talk all we like about technology being a lever. But the notion that we could scale up care simply by creating EHRs or EMRs and move paper into digital format was a bit far-fetched.

None of this is irreversible and it’s possible to course-correct to avoid making the same mistakes in the future. A good start is to look for guidance from the experience of technology companies who have found ways to provide great customer-focused engagement.

We live in an era where companies like Amazon and Google have set elevated customer expectations for clean and efficient user experience. They’ve helped set the new benchmark that every industry must now meet in the digital era.

When I order a product from Amazon, for example, I don’t need to contact customer service to check the status of my orders. Their system proactively keeps me informed with email updates that track the progress of a purchase as the package makes its journey from Amazon’s warehouse to my home.

When it comes to designing health IT systems, organizations should embrace a similar philosophy and strive to make it as easy to use as possible for clinicians to do their jobs effectively – whether that’s delivering quality care or streamlining pre-authorization for a tonsillectomy. A well-designed health IT system can be a boon for all stakeholders – including the care delivery team, patients and their caregivers. So, why should a patient be forced to waste time filling out long forms just to see the same doctor they’ve used for the last decade?

Patients should be able to answer a brief number of questions (and not repeat information that is already known) on a self-guided system that gets them into their physician’s office with minimum delay. In fact, members could handle this long before they ever get to the doctor’s office. If someone can order and wait for their coffee at Starbucks, why not also fill out a medical form in their spare time?

Physician staff should be able to see and augment this data with other information they have about the patient to further prepare the MD before any visit (and doctors should NOT be staring at the computer during their face time with patients.) Lastly, the patient should receive a digital readout of their visit along with instructions about follow-up measures to protect their health – something like the order summary a customer receives from Amazon. When done right, doctors should be able to use electronic health records to review a patient’s medical history and then quickly document any treatment plans and diagnoses.

An Approach to Friction-Free Systems
Part of the challenge is structural. Doctors don’t always have the last word when it comes to the deployment of complex IT systems. In fact, their authority may be limited as it must be balanced against input from other stakeholders involved in any technology implementation of a health care delivery system. While the EHR serves to document clinical information, it also needs to house documents used for regulatory compliance, revenue cycle management and billing, and materials management.

Let’s start by putting clinicians’ needs front and center.

Unfortunately, you’re more likely to see the financial and administrative teams with ultimate responsibility for capital spending on health IT. That means the folks in charge of those departments are also going to be the ones making the judgment calls if any trade-offs among user interests are required.

That must change if the overarching goal is to remove unnecessary friction from the process for doctors and patients. It also means starting any review of current processes with the customer in mind so that systems don’t get in the way of doctors doing their jobs.

We should start by dumping poorly designed interfaces and look for opportunities to impart intuitive functionality and self-guidance features. Well-functioning EHRs should ensure the delivery of quality care with patient-centered technology, such as portals that let patients interact with their clinicians outside of the office setting via secure messaging.

As per the NAM report, the general characteristics of a well-functioning system ought to feature the following attributes:

  • Easy retrieval of accurate, timely, and reliable native and imported data
  • Simple and intuitive data presentation
  • Easy navigation
  • Provide evidence at the point of care to aid decision making
  • Enhance workflow, automates mundane tasks, and streamlines work, without increasing physical or cognitive workload
  • Easy transfer of information to and from other organizations and clinicians
  • No unanticipated downtime

The various stakeholders need to collaborate to design and configure technology that not only meets regulatory, payer, and organizational needs but also satisfies the needs of clinicians, patients, and the general community.

But it ought not to be a tough sell. It’s actually in their enlightened self-interest to upgrade antiquated processes with more modern solutions with cloud-based, seamlessly-connected systems built for the individual needs of each user or customer. Think of the benefits that will accrue to the companies that do it right and develop more agile and responsive systems.

The companies with the foresight to pick up this gauntlet will be rewarded in the coin of greater customer loyalty and even higher revenues.

Photo: PeopleImages, Getty Images

As SVP and GM of Vlocity, Kevin Riley leads the health business in its effort to help healthcare companies modernize their customer-facing capabilities using Vlocity and the Salesforce Cloud platform. With two decades of CRM experience, Riley created the methodology for designing healthcare business decisions into CRM platforms. He has designed and delivered CRM solutions for some of the largest health companies in the world including. Previously, Riley held executive leadership positions for health companies ranging from convenient care to health insurance. He served as the first Chief Innovation Officer (CINO) at Blue Cross and Blue Shield of Florida Inc. (Florida Blue). As such, Riley was one of the first CINO’s in the American health insurance industry. While at Florida Blue, he was also the President and CEO of GuideWell Inc. Kevin Riley is an entrepreneur and executive with diverse experience engineering innovative healthcare business models and delivering them to market. Through an evolving application of design-thinking, he constructed a methodology for building healthcare businesses (called modelH), which has won numerous awards. Riley has applied this approach to solving healthcare problems for companies ranging from startups to over $10 billion in revenue. In each case, Riley has combined the discipline of innovation with sound business fundamentals to help transform healthcare concepts into companies with clear customer value. Riley also introduced agile delivery methodologies, customer experience (CX), and design-thinking into many of the organizations with which he has worked. Kevin can be reached at [email protected].

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.