Issues related to clinical workflow are best understood by physicians for an obvious reason. They participate in the delivery of clinical care on a daily basis. When it comes to workflow, they know what works and what doesn’t. This is one of the most persuasive reasons why empowered physician innovators are well-positioned to make meaningful changes in healthcare.
However, physicians are often left out of the process side of the healthcare system. Instead, these important tasks have fallen to administrators, private industry, and the government.
Advancements in medical process improvement have been meek at best, significantly trailing behind other industries. Remember, medical practices still use fax machines. Software platforms are dated and it is rare for solutions to communicate with each other. Most practicing doctors feel that the current information technology systems are not meeting their needs, or simply do not understand their world.
Kick the Can Forward
Many of the workflows used in hospitals and offices today were around when I was in medical school (I graduated from medical school in 1995). Back in my day, we knew that some of the processes were ill-designed. However, we went along with it since that was what doctors-in-training were expected to do. Some of the ridiculousness went away on its own, without the need for a full-on revolt.
For example, as a medical student, one of my jobs was to call the lab every morning and write down all of the lab results for the patients on our census list (some of you are shaking your heads in agreement right now). This was, of course, an outrageous waste of resources, even for the lab staff.
Soon lab sheets were faxed to the wards, and now they sit in databases waiting to be accessed via the hospital EMR. This problem corrected itself over time, as technologies became available. Yet many processes today remain in the dark ages despite the abundance of potential modern solutions.
There seems to be a reluctance to change, to pivot, to evolve. With the enforcement of stricter patient information privacy regulations, the ability to function in archaic yet established systems is getting harder and harder. Some of the physician burn-out seen today is a direct result of this process stalemate.
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Change Means More Work for Me
Information technology in medicine was supposed to fix everything. I remember my excitement at the thought of an electronic medical record. Given my experience in coding and system design, I was imagining the endless possibilities.
I wish you could have seen my face when I sat through a demonstration of a very reputable EMR solution that we were going to implement in our office. I could see where they tried to replicate our delicate complex world. But, in the end, this was going to mean way more work for me to get through a patient visit. Yes, some tasks, like calling in prescriptions, became easier. And, I was getting sick of writing out scripts and signing them all by hand.
However, despite minor gains, there were huge losses in my precious time. Day after day I could feel my bitterness growing. Just when I managed to redesign my workday to accommodate poorly designed software (wait, wasn’t this software supposed to accommodate me?), the hospital would roll out its new monster solution. One that required 14 hours of mandatory training.
It felt like these terrible solutions were simply thrust upon me, with no consideration for the disruptive impact on my efficiency or my ability to care for patients. These have been pretty frustrating times, which have left most practicing physicians hesitant to try new innovative solutions.
Corporate Force Feeding
Eager to introduce modern IT solutions into the healthcare space, larger companies sold good concepts to hospitals and large practices. Selling the hope of efficiency, analytics and overall process improvement made a lot of sense. The products they were selling had some physician input in the design phase and were beta-tested to a degree.
Yet when rolled out to real environments, they were met with resistance and user non-acceptance. Despite their displeasure, most doctors were not able to reject these solutions outright. In the end, bitter acceptance was the extent of the unified response.
There was a lot of complaining, foot-stomping, and even the occasional hissy-fit, but to no avail. It seemed like no one was listening. No one cared. The assumption was that eventually the complaining would settle down and people would simply go back to work.
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Maybe I Can Fix This Myself?
Frustrated by the complexity of rounding at multiple facilities, I decided to design my own solution, HybridChart. My software incorporated the nuances of the medical workflow and was instantly intuitive to the doctors who started using it.
While my initial motivation was to improve my own world, my little solution began to expand to other doctors at my hospital and ultimately to practices across the country.
The satisfaction of solving the issue of hospital workflow for rounds extended beyond improvements in my own quality of life. There was something about solving this problem for others that brought me great joy.
Interestingly, it was also an immediate cure for my physician burn-out. I was actually able to bring about process improvement with my dual personality as a practicing physician and a software developer.
Physician Innovators: Software and Beyond
As I looked for other examples of physician innovators, I came across countless examples of software solutions created by practicing doctors. Using their field-specific knowledge, they were able to identify gaps and propose solutions. They did this with the goal of gaining adoption by the hard-to-please doctors on the front lines of clinical medicine. Medical devices, surgical techniques, wearables with IoT are amongst the endless examples of physician innovation trying to disrupt healthcare.
Many of these approaches aim to improve patient outcomes, while others attempt to modernize the business of practicing medicine. These physician pioneers are taking on the challenge of repairing their own worlds.
I believe this bottom-up approach of problem-solving – starting with the users, perfecting the solution, gaining acceptance from real-world practices, and then commercializing the solution – has the greatest chance to succeed in the long run.
Physician innovators empowered to solve problems are the key to meaningful change in healthcare the years to come.
We’d love to know what you think about physicians leading innovation. Please leave a comment below.
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