Improved IT Usability is about Better Physician Work Flows

Feb 17, 2017

The chief innovation officer at UPMC says that improved usability in IT systems isn't about interfaces - it's about fitting into a doctor's work flow.

No one would deny that physician burnout is becoming a prominent issue in healthcare.

Many blame healthcare IT systems for this rising trend. In a recent study from the Mayo Clinic that polled physicians who say they are burned out, EHRs were listed as one of the top reasons. The words "not usable" get thrown around a lot when it comes to how physicians describe their EHRs and the lack of usable health IT systems has frustrated physicians to no end. Naturally, burnout derived from a lack of intuitive IT systems can have a negative impact on patient care and safety.

At this year's Healthcare Information and Management Systems Society (HIMSS) conference, held in Orlando at the Orange County Convention Center, Rasu Shrestha, a radiologist and the chief innovation officer at the University of Pittsburgh Medical Center (UPMC), will host a session that tackles this issue. The session, "Demanding a Delightful Care Team" will cover how the lack of usability - in IT and clinician work flow - are burning out physicians and affecting patient safety. It will also look at how organizations can create care team-centered user experiences.

Shrestha, who will be joined in the session by Santosh Mohan, digital solution management fellow at Stanford Healthcare, spoke to Physicians Practice about this session, scheduled for Monday, February, 20 at 12 p.m. Esatern. Below are excerpts from this interview.

Q. Describe the impact physician fatigue and burnout can have on patient safety?

If you look at where we are as a healthcare industry today, we're data rich and information poor. We've managed to move in the last decade from a culture of analog, paper, and film to one that's digital, paperless, and filmless. While that's been fairly positive when it comes to rolling out clinical information systems, the reality on the ground is that tech has been less of an enabler and more of an impediment. Consequently that has led to burnout. Clinical burnout is a really big issue today.

It's a big challenge in the industry. We've been in a rush to embrace the digital form factor. That's been fine to get the go-live up and running. Getting to go-live in a clinical information system is not the end goal. ….The end goal is better care experiences and better outcomes. That's still an aspirational goal unfortunately. [My HIMSS17 Session] is more of a discussion on  the role of user experience and design thinking in really reinventing the future of work flow and care team experiences.

Q. How can health IT be more user friendly and what impact can that have on burnout?

At UPMC, we're using the principles of design thinking to make an impact on the way we look at not just how software should be built, but also how we address specific clinical and operational pain points; how we address bottlenecks in work flow. Clinicians are good at coming up with workarounds.

What we believe in is, if we're able to leverage some of these disciplines and principles well in healthcare – which hasn't been done before - technology done right essentially becomes invisible. Technology shouldn't be this thing you struggle with or use or find shortcuts to do the thing you want to do.

Q. UPMC is a large health system with a ton of resources. How can smaller practice physicians find the money and invest to improve the usability of their EHR and other health IT systems?

The beautiful thing about design thinking and the discussion we're having around user experience, this isn't necessarily a product that you have to purchase. This is a mindset. What we're talking about here is how we make sure we iterate through and understand the bottlenecks we have as a large healthcare institution or small practices might have. How can we address specific things that we need to do, to break them down into sizable chunks that can lead itself to rethinking the care flow paradise?

As an example, the principles of design thinking dictate you need to start with empathy. Then you define the actual focus. Then you ideate it, when you brainstorm and come up with creative solutions to the pain points you've identified. Then you prototype. You build a representation of one of more of your ideas. You go to this iterative process, where you're going in and identifying those critical pain points so you're able to get to what needs to be done. Lastly, you test it.

This design thinking loop, in many ways, pushes for us to think about user experience more than just the user interface or color pallets or the size of icons. Think about this more in the context of enabling efficient work flows … that's a mindset. This is not just to the privy of large organizations.

Q. Do you have a real-world example of this thinking?

We're working on a real world example at UPMC in imaging. When we're talking about the old world, the old world vs. the new world, old world is where we've had film and we've made this transition from film to filmless. Now we have digital solutions we have access to, but they are silos of information that are not talking to each other. In the old world, we designed these solutions for regulations, for documentation and billing. In the new world, we're striving to build these not just for regulations, but for joy. That's a remarkable statement onto itself ... How many solutions are designed for joy? That's mind shift change. More of this needs to happen in healthcare. We're not just creating another set of imaging silos, we're looking through and through at the work flow of the clinicians, in terms of the studies and the communication and collaboration needs to happen care providers … How do these work flows seamlessly integrate? How do we do what is in the best interest of the patient, who may be at the brunt of the solutions we're rethinking?

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