Digital transformation — the use of digital tools to improve the quality and efficiency of care delivery — is a top priority for health systems. Indeed, 99% of U.S. health system leaders responding to a HIMSS survey in late 2021 said investing in digital transformation is “very important” or “somewhat important.”
The physicians and other clinicians working in those systems, however, may have a limited view of what digital transformation entails and how it will affect their work, says Darryl Gibbings-Isaac, MD, a clinical innovation subject-matter expert with Accenture, a member of the HIMSS Trust partnership.
Many clinicians responding to the survey considered their organization’s digital efforts to be at an advanced level; 16% said digital transformation has been completed. In reality, Gibbings-Isaac says, the digital transformation of healthcare is just getting started.
Nearly 80% of health systems are in the process of digital transformation, according to system-level executives who submitted survey responses. And their work will never be done, Gibbings-Isaac says: “The transformation is not an end destination — it is an ongoing journey.”
Gibbings-Isaac, an internist by training, attributes the disconnect to the fact that most clinicians are using some digital tools, but they are not seeing the big picture. He points to a likely explanation: 32% of clinicians cited a lack of clear communication of what digital transformation means within their organization.
There were other worrisome results from clinician respondents as well:
Almost half said digital tools were a burden or wasted their time.
A majority (69%) said that digital transformation contributed to greater work-related stress.
Still, Gibbings-Isaac and other physician executives interviewed by Physician Leadership Journal say the digital transformation of healthcare does not have to follow the torturous path of electronic health record (EHR) adoption. Rather, there are lessons learned from the EHR adoption that should inform health systems’ plans as they embrace new ways of delivering care, courtesy of digital technology.
“This is an organization-wide endeavor, and it requires the same change management practices that we need for any other major change,” says Stephanie Lahr, MD, chief information officer and chief medical information officer at Monument Health, a six-hospital system based in Rapid City, S.D. “Just because something is better doesn’t mean adopting it won’t be hard work and disruptive at times.”
Chief digital officer Nick Patel, MD, is in charge of transforming care delivery in Prisma Health, an 18-hospital system based in Columbia, S.C. “I don’t start with technology,” he says. “That is the last thing that should be on your mind when you think about digital transformation.”
He views transformation through three domains: patient access/experience, operational efficiency, and population health. “You have to look at all the issues and almost do a SWOT (strengths/weaknesses/opportunities/threats) analysis of the organization in each area,” Patel says.
That assessment, along with a review of current workflows, is used to identify where technology can move an organization toward its strategic goals.
For example, Prisma Health wants to enhance primary care, which means making it easy for patients to find the doctor who is right for them. To do so, the health system created a robust provider directory that allows patients to compare physicians online. “We have very detailed videos so the provider talks in layman’s terms not just about healthcare, but about themselves,” he says.
To help patients access the right care at the right time, Patel’s team created a digital health continuum of services. “I started off looking at a journey map for a patient: What does it look like for a person to be seen?” he says. “I wanted to align technology that made sense for that journey.”
Depending on a patient’s situation, the right care might be asynchronous care delivered electronically, a synchronous video visit, an enhanced video visit in which a wearable device or an at-home digital kit provides diagnostic information for the provider, a hospital-at-home admission, or monitor-at-home care that supports early discharge from a hospital stay.
Prisma Health is working to deploy customer relationship management technology so that everyone in the organization knows which patients need, for example, a chatbot nudge to schedule a mammogram or a telephone call to check on their status.
To support population health management, Prisma Health uses technology to identify patients’ care gaps and remind them to schedule colonoscopies, vaccinations, and other routine care at the appropriate time. The system also uses technology to identify patients who need help with chronic care management.
“You look at your clinical data to find your patients with diabetes, hypertension, or congestive heart failure that is uncontrolled and give them a kit that allows the care team to monitor them remotely and do real-time management so they get to their goals faster,” Patel says. “It’s very important for chief medial officers to partner with their chief digital officers to try to meet those benchmarks.”
Focus on the Benefits
MyMichigan Health, based in Midland, Mich., operates 10 medical centers in 25 counties, serving a large rural population. Adopting a single electronic medical record system for the entire system in 2017 set the foundation needed to be an early adopter of technology that moves care delivery closer to patients where they live says Pankaj Jandwani, MD, regional vice president for medical affairs and chief innovation officer.
The single electronic medical record allows the information sharing among nurses, physicians, and patients needed to support virtual visits and remote monitoring, he says.
Having started telemedicine pilots in 2015, MyMichigan was well-positioned to expand its virtual care in all settings when the COVID-19 pandemic hit. It soon adopted the technology for new uses.
Capacity shortages at larger hospitals forced MyMichigan hospitalists working at a critical access hospital to manage COVID patients who needed intensive care, including ventilator management.
“During the stressful times of COVID surge and ICU bed shortages, our hospitalists and emergency teams felt immensely supported by our intensivists in Midland, who provided teleconsultations to help manage critically ill patients in our rural locations,” Jandwani says.
Because of that experience, MidMichigan is currently working to implement a systemwide tele-ICU model to serve its smaller hospitals.
“Now they look back and say ‘Yes, we can do this,’ ” Jandwani says. “The tele-ICU will reduce the need to transfer patients to our bustling tertiary care center while offering advanced ICU care closer to home at our rural sites.”
MyMichigan is also using technology to help patients stay in their own homes through a tiered Hospital at Home program.
In early 2022, the Centers for Medicare & Medicaid Services (CMS) certified that MyMichigan’s Hospital at Home program met its stringent requirement for treating a specific subset of patients for an acute illness in their homes. Within MyMichigan, that CMS program is called Level 1 Hospital at Home. “However, our program includes many more patients,” Jandwani says.
MyMichigan Level 2 Hospital at Home patients are those who would otherwise qualify for a hospital observation stay. Remote monitoring technology and other support allow them to get discharged early, avoiding the often expensive and frustrating experience associated with observation status.
MyMichigan identifies Level 3 as those admitted, clinically stable patients who anticipate being discharged in the next 24–48 hours, but who need monitoring of their comorbidities like COPD or CHF.
“The goal for Level 3 patients is to get discharged from the hospital a little sooner, but with a comprehensive array of services like remote monitoring, nurse visits, virtual visits with our hospitalists, and close follow-up and coordination through our care managers,” Jandwani says.
Level 4 patients are those who were recently hospitalized and will benefit from care management for a chronic condition such as heart failure, COPD, and diabetes for up to 90 days after their hospital discharge.
Early results show that all levels of the Hospital at Home program are reducing readmissions in a high-risk population of patients and proving to be a big patient-pleaser. “We’ve had nothing but rave reviews,” Jandwani says. “The patient experience reports as we have delivered this care have been just heartwarming to see.”
Make Physicians’ Lives Easier
“My two main goals are to reduce friction points and to bring the joy back to the medicine,” says Lahr, of Monument. “This ambient-listening technology is one of those things that does both of those. This is the kind of technology that makes me as a physician excited to live in this space.”
She is referring to ambient clinical intelligence technology that captures clinician-patient conversations in both virtual and in-person visits and updates the electronic health record accordingly.
“We have a number of physicians across different specialties who are leveraging that note-writing technology,” she says. “They can focus their attention on interacting with their patients instead of looking at the computer screen to do their documentation or spending hours at the end of clinic working on it.”
Lahr sees the voice-recognition technology evolving so that keyboards can be eliminated in exam rooms. Instead of clicking into a patient’s record in search of the last CT scan, for example, the physician can ask the technology for its details. If the system recognizes that a clinician needs a data element that exists in the EHR, it will make it known.
For now, however, the technology is still developing — and it is most appropriate for early adopters who are frustrated with the burden of EHR documentation. “We go through a selection process to make sure that the physician–technology matchup is there,” she says. “We will roll that tool out basically to any physician across the health system in any specialty that has a need for the tool and interest in the tool.”
Monument introduced the listening technology in late 2020, and Lahr is pleased with the results so far. In most cases, physicians using it are adding more patient visits to their day, which offsets the clinic’s expense for using the system.
“Even more than that, the joy and experience that both the clinician and the patient are getting out of being able to sit across from each other and have a conversation and not be trying to type or look around the computer at the same time has been so valuable,” she says.
She expects that, within a couple of years, every clinic in the health system will have some physicians using the technology. She emphasizes the word “some.”
“I don’t know that we’ll ever be at a point where everyone is using it because that’s really not the point,” she says. “I’m trying to make sure that the right tools are available for the right person at the right time in the right setting so that whatever and however that’s defined for that provider, we can accommodate.”
Avoid Avoidable Problems
As organizations move forward with their digital transformation initiatives, Gibbings-Isaac warns against two common pitfalls: “Either involving clinicians too late or not having them involved enough. You’re almost guaranteeing that you’re going to have some friction later if you do that.”
Before asking physicians to be trained on new technology, make sure they understand how it will benefit them and their patients. “Training is adding an extra task and amount of time into an already stretched workforce, so you need to be able to justify that to make sure the training is received in the right way,” he says.
Position technology training not as a “one and done” task, but as an ongoing collaboration between clinicians and the digital team. “It needs to be a two-way effort,” Gibbings-Isaac says. “The training to get someone started with a set of tools is not the endpoint. Once someone is comfortable with these tools, how do we improve the technology, the processes around it, or the training?”
Getting quick feedback about users’ experience is important, but that’s only one step. Respond to complaints and critiques by promptly addressing them.
Clinicians like evidence, and they want to see the use of technology improve their patients’ health or their own workflow. Measure the results of new technology so you can communicate that success to clinicians or adapt if it is not meeting its intended goal.