Happy Solstice! It's time for my non-AI generated December article!

Yeah, I’m a little late, what do the kids say now? hashtag sorrynotsorry?

AI will be revolutionary! Meh...

My original article was going to talk about AI since ChatGPT was making the rounds. I deleted it, there’s a lot of articles out there about how transformative it will be, and others about how transformative it won’t be. There are a lot of use cases for AI that is able to extract, summarize, re-write, or generate content. If you want an idea of a couple of useful tools:

Abridge

Connective

Diagnoss

These are a lot of opportunities to utilize tools like ChatGPT that can help clinical work flows even beyond these examples. Check out this blog post from Tido Inc about how AI will revolutionize nursing.

An amazing survey!

Earlier this month I sent out a survey for health care workers that take care of patients asking what they wanted from technology to help them do their jobs better. Check it out here, if you’re taking care of patients or have direct contact with patients, please fill it out!

I’m curious for a number of reasons, primarily because of the conversations I have with friends who are nurses or doctors. I hear their thoughts, but I thought it would be interesting to get the perspective of a wider audience.

A Revolution in Health Care is coming!

Eventually...

For all the exuberance about tech start-ups and new solutions in health care, I thought this article from Forbes was good. What won’t change in health care in 2023? It’s a pretty good summary, and one quote that stuck out to me was “In 2023 we will see a continuation of this ‘failure to launch’ across big tech because of a lack of specialized, insider knowledge involving the many facets of healthcare delivery.” This was Dave Wessinger, CEO of PointClickCare.

Which begs the question, how are you going to disrupt the current health care environment without knowing what you are disrupting? It may seem obvious, especially to those who have worked in health care, but how many start-ups run virtual clinics or develop “solutions” with people who have no experience in health care? The answer is, a lot of them. Look through job postings, there are many that require start-up experience but list health care experience as a ‘nice to have.’ People designing clinical solutions and workflows that have never worked in a health care environment?

A lot mistakes will be made, and have been made, this has been evident by the questionable prescribing practices of some start-ups, and there will likely be more revelations as time moves on. Health systems, whether you love them or hate them, already have well developed clinical workflows, quality systems and operations. It’s evident in their job descriptions, health systems have a clear understanding of the different roles of clinical professionals. The questions for these new companies, What are they improving? How are they doing it better? What are they offering that is different from what current health systems already have?

Check out this video from the Careops team, gives a pretty summary of the challenges those in virtual care have faced. If you’ve worked in health care, you’ll probably listen to it and think… Yeah, that tracks. Innovation is hard in health care because of all the stakeholders, innovation is hard in health care because we involve so many stakeholders too. If you’ve ever asked for an improvement to an EHR, you know the hoops you have to jump through and the myriad of audiences you need to convince. By the time it gets back around to the clinical team, it often doesn’t resemble what was asked for. If you’re care team isn’t convinced it can be helpful or has trouble with it, it will fail, they’ll work around it.

The Careops site is a good summary of the process care teams go through to develop care plans and pathways. New methods of delivering care require validation, and clinical validation doesn’t happen with a quick user experience, it’s validated by clinical results that take time to become evident. That doesn’t mean that there isn’t room for fast innovation and iterations.

Can innovation happen quickly?

In large part, it already has. Practices and health systems quickly set up virtual clinics, clinicians adapted to delivering a mix of in-person and virtual care in record time. From March 2020 to May 2020 we witnessed a complete transformation of health care operations, everything from the physical environment to the virtual environment. For those that were working in health care it was a scary time, but also a time of great innovation and change led by those working directly with patients. Ideas, by and large, did not come from outside the industry, they came from within. Doctors, nurses and techs adapted current technologies and created new tools to take care of patients.

If anyone thinks the care teams are responsible for the slow pace of innovation, you’re wrong. Care teams want tools to enable better patient care and outcomes. We want to ensure our patients are taking their medications, making their appointments, having great experiences, and living their best lives. There is resistance to new technology in the health care area because we are skeptical of someone coming in and telling us they have a solution, without having knowledge of the problem.

Why is it so hard to change health care?

Unless there is wholesale change in the way health care is funded, there isn’t likely going to be a great change in the way it is delivered. Sounds a little pessimistic, I know. Please keep in mind, this is not a knock against any individual, it’s a function of the way bureaucratic systems make decisions in response to rewards/penalties.

Who is the customer?

Employers pay for insurance, there is no incentive to provide great service to the user (employee) unless the customer (employer) demands it. Do people like their health insurance? Polls often show the majority of people do, but let’s reframe the question, how many people that use their health insurance are happy with their service? The results will likely be very different from the first question. I’ve never heard praise from a patient about their health insurance, unsolicited complaining I have heard from almost every patient.

Health insurance pays for care, not patients. Treating patients as customers is great, but the fact remains that patients are not customers. Health insurance companies are the customers of health systems, patients are the product. Cold and heartless? Well, yes. But working in health care, we know that decisions and tasks are skewed toward satisfying the payor. I’m not saying insurance companies don’t want a healthy population, but the corporate solution often imposes onerous controls.

Care teams do not buy software/systems to provide care. The people using the software and systems are not often the customer. In fact, they are often the last consulted when it comes to utilizing technologies in the space. The vast majority of doctors and nurses work within a health system or insurance company, purchasing begins with evaluating the administrative tasks, not the clinical tasks. Clinical teams are usually the last people to evaluate options.

There are opportunities in the current health system.

Clinical teams want better tools, they adapt quickly to changing circumstances, and listening to them can lead to great innovations in care delivery. We’ve already seen it happen.

Better workforce engagement and refocusing resources on the care teams will go a long way toward retaining the current work force. Workers are frustrated with the current environment, the focus on doing more with less has led to more and more tasks being pushed up. The highest paid care team members are doing more administrative tasks than ever, if those FTEs are freed up to provide more patient care and treatment, the cost savings is real. It does require a higher look than the individual cost center, and looking at at the whole operation.

Health systems have extensive experience providing care and treatments, better utilization of existing staff can improve retention. Virtual and in-person work offer opportunities to retain employees and keep them engaged. Again, this requires looking at all resources in an organization (all human resources one might say?), flexibility in scheduling, assigning labor costs, and work locations are all opportunities for health systems.

Better patient engagement can come from existing tools and technologies available within EHRs. How are we engaging patients? Sometimes the low tech option is the best, a simple text message can go a long way. I was involved in the Moderna study for the Covid vaccine, they used text messaging to remind me about appointments, checking in on the app, and checking on symptoms. I was able to engage with the NP via text, and the text reminder was helpful to remember filling out the weekly questionnaire on the app. The app itself was really simple, just a survey about symptoms and side effects. While participating in the study was interesting, if I had to engage with a separate app exclusively, I would’ve been a “lost to follow-up” person. Many patients in health care want simpler solutions, not new technology or interfaces, just existing tools they are familiar with. These tools can work really well.

Better collaboration tools. Even within health systems on the same EHRs and systems, collaboration is difficult. Tools that allow different teams to collaborate will be a huge leap in improving the patient care environment, whether it is the physical and/or the virtual space. As care is becoming more dispersed, then we need solutions for collaboration to provide coordinated care, ones that move beyond texting, faxing, and CD-RW.

One solution to rule them all?

Probably not. We’ve already seen products in health care that try and be everything to everyone, they never are. Solutions will not come from a single source, an organization that can successfully integrate different tools and is built around supporting clinical teams and encouraging collaboration will have the best chance of making a meaningful difference in the lives of the population they serve. But can it be done with better outcomes and more efficiently than what’s already out there? Yes. Will it be done so much more efficiently that it can have a financial return that is far better than what’s already out there? Probably not. The current health care delivery system is designed the way it is for a reason.

We’ll see what the future holds. There are plenty of predictions, hopes and dreams abounding.

My only prediction for the coming year...

One prediction I will make for 2023, I think these virtual care companies will come under some form of regulation. There has already been controversy surrounding questionable prescribing practices, I’m sure there will be new controversies surrounding other types of virtual care. Will JCAHO move into virtual care? One thing is for certain, with the proliferation of third party health care delivery, there will likely be an organization seeking to capitalize on that and offer an accreditation that they will then convince CMS and insurers to require for reimbursement.

If you’re a nurse delivering virtual care, can you have an uncovered water bottle on your desk?

Will virtual care companies send cold pizza slices to their virtual care team when they successfully pass an audit?

There’s a lot of questions about this in the future. Are they ready for the regulations if they’ve never been through a regulatory audit before? Someone has to teach them the JCAHO shuffle.

Thank you!

Thanks to everyone who has read my writing and taken a trip through my brain these past months, it’s can be a wild ride, so I appreciate the company! It is fun for me to write down thoughts and interact with others through LinkedIn or Health Tech Nerds and learn more about what’s out there. I am always interested in what others are thinking, fill out my survey and connect with me on one of the venues!

Have a happy and healthy holiday season, and all the best in the New Year!