As the population ages, the imbalance between the demand for care and providers of care will continue to fuel the need for innovative solutions in our healthcare system. Digital technologies continue to be developed and applying these solutions across the continuum of care is increasingly popular. Surgeons, such as myself, who are directly involved in patient care have witnessed firsthand the evolution of technology from an electronic health record (EHR) to today’s AI-based clinical decision support (CDS) tools. However, their success is not solely determined by technological advancements and unique problem-solving; rather, effective change management plays a pivotal role in ensuring seamless integration into clinical practice. I will discuss the significance of change management in driving the adoption and success of digital health solutions.

The Promise of Digital Health

Digital health technologies impact patient care, offering unprecedented opportunities for enhanced diagnosis, treatment, and patient engagement. From EHRs to telemedicine platforms and CDS systems, these innovations have the potential to streamline workflows, expand access and improve outcomes.

Nevertheless, none of the current digital health and CDS tools we use today would be successful in health care practice if they had not been solutions to pressing challenges facing clinicians and hospital teams. At Houston Methodist, as with other healthcare systems, we had been using telemedicine programs prior to the COVID-19 pandemic.  Nonetheless, when COVID cases first hit our hospital system, our ability to scale our virtual platform and learn its most effective role was our first encounter using many digitally based innovations in direct patient care. This would not have been successful without aligning and synchronously engaging our formal change management strategy and the telemedicine integration.

The successful implementation of digital health tools requires more than just technological prowess; they demand a strategic approach to change management.

Change Management

The successful implementation of digital health tools requires more than just technological prowess; they demand a strategic approach to change management. Digital technologies are not commodities; they look to enhance real-time decision-making based on historical data. In other words, the digital tool tells you something, but it is up to the user to execute the information. The successful adoption of technologies tends to follow these three critical steps:

1) How big is the problem that the technology attempts to solve,

2) Ease in the first step of the change process, and

3) Positive feedback after the first step. 

If any of these steps faces significant challenges, then the likelihood of adoption tends to be less successful. This strategy encompasses a series of structured processes aimed at training and supporting clinical teams, administrative staff, and hospital operations personnel to navigate change successfully. Effective change management ensures that these individuals are capable of using new technologies and embracing them as integral components of their practice.

Resistance to change, workflow disruptions, and concerns about data security are just a few of the hurdles that must be addressed. Moreover, the fast-paced nature of health care delivery leaves little room for extensive training or experimentation with unfamiliar technologies. An analogy for implementing change in health care is like trying to change a tire on a moving car.  Thus, it becomes imperative to implement change management strategies that minimize disruptions while maximizing user acceptance and proficiency.

At Houston Methodist, we begin with a small pilot program to determine quickly whether an innovation can expand throughout our hospital system, building upon our “succeed fast, fail fast” agile model. With a recent pilot project, we co-developed an innovation to use ambient technology in the operating room (OR) to improve accuracy in our OR data analytics and reduce the reliance on nurse-driven data entry into the EHR. The objective was to focus on maximizing case duration accuracy to improve scheduling and staffing and reduce the data entry demands of the clinical staff. Educating clinical teams about the new ambient intelligence cameras in their ORs was and continues to be a delicate process for change management within our organization. Strategies around its application and engagement are iteratively evolving and are integral to evaluating the success of an executed technology.   

Disruptive Innovation

Startups that challenge the status quo and introduce groundbreaking solutions often find success in reshaping the health care landscape, but the iterative process is essential for new technologies to develop and integrate in an impactful manner in health care. Without this collaboration, the technology would still be unrealized because just creating great technology is not enough. Startups which are amenable and flexible to co-develop their products with industry partners will be more successful in the long run.

The concept of disruptive innovation is no stranger to the health care sector. It is typically touted as a key component to innovation. However, at this institution, we recognize all change; therefore, all change management is disruptive. Therefore, our goal is to create strategies for adopting these digital innovations that are as small a disruption as possible to the end user in regards to their daily activities. Disruption is not our goal; technological adoption, execution of new workflows, and improved alignment with digital technologies are the focus. Developing an effective process in this regard is as critical as our innovation.

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We hear about digital health everywhere, from remote patient monitoring (RPM) to telehealth and everything in between. With promises to have technology improve overall outcomes throughout the healthcare system, where does surgery come into play? Digital surgery is a somewhat new term, defined for the first time by researchers in 2022, and our understanding of it and how it can help improve hospital surgery outcomes is still evolving. In an age where AI is growing rapidly and taking over many industries, the question remains of what digital surgery is and how can we trust and implement it going forward.

Digital health innovations can be used at various stages throughout the surgery process, such as preoperative planning, post-surgical analysis, and even AI-driven training. Although much is unknown about digital surgery, some impressive results have been evident from the plethora of new technological advancements. For example, using Johnson and Johnson’s MONARCH robotics platform in bronchoscopy, doctors had a 15% improvement in diagnostic yield. Surgical Process Institute, a digital system that can be integrated with any surgical theater to show visualizations of a procedure’s key steps, has been shown to reduce unwarranted variability by up to 45% and reduce surgical time. Augmented reality (AR) glasses used during surgery reduced the muscular fatigue of surgeons’ bodies and improved the accuracy of surgical instrument placement by 35%.

Investing in infrastructure improvements is necessary not only to enable digital surgery and other digital health initiatives, but to reduce cost and waste throughout the hospital system.

What are some of the potential benefits of digital surgery? Access to quality health care in rural America continues to be a concern. With technology such as a robotic platform allowing a surgeon in one location to provide surgery to a patient in another, digital surgery could potentially help close gaps in the rural healthcare system. Robotic surgery benefits both patients and providers alike. Patients can enjoy a faster recovery time and less pain, whereas surgeons can enjoy enhanced dexterity and greater precision. Machine learning (ML) in surgery can help better analyze data and predict outcomes such as surgical site incisions with increased precision. AI and ML can also help hospitals better analyze and learn from large sets of data to better predict outcomes and trends. New technologies can attract new patients as they show the hospital is at the forefront of design and innovation. We have already seen how much technology can be used to bolster in-person health care during the COVID-19 pandemic, as many surgical consults moved online. It is not hard to imagine how much more technology can move us forward in the movement to increase patient access and care.

These advances do not come without risks as well as legal and ethical concerns. No hospital is without concerns about cyber security, and digital surgery is no exception. Many tools such as surgical robots, require connectivity in order to work. In the world of ever-increasing cyber-attacks, the technology used in the operating room (OR) could put patients at increased risk for a targeted cyber-attack. Hospital staff may hesitate to use new technologies, as they fear losing their job to automation. The high costs of these solutions can further health disparities amongst hospitals, as public funded hospitals may not be able to afford the same solutions as better-funded, private ones. In addition, little research has been done on ethical concerns regarding digital surgery.

Overall, it seems that digital surgery is here to stay like other technological advancements. What can you do in your hospital to ensure that these technologies are successful and that you address any concerns? First, it is vital for more research to be put into this area, as it is important to understand the ethical impact on digital surgery and digital health as a whole as we continue to adapt to an increasingly digital age. Hospitals can create a digital health governance team to determine which technology will work best for their hospital and thoroughly evaluate all risks and benefits. When rolling out new surgical technology, less can be more. Hospitals should focus on where they can have the most impact and not try to make too many changes simultaneously to overwhelm an already stretched workforce. As hospitals begin to see the benefits of the surgical technology they have started to use, their concerns around automation and using new technology may be eased. Hospitals can also invest in cybersecurity to ensure minimal risks of cyberattacks. Many hospitals tend to be behind in terms of readiness for digital advances by having outdated data infrastructure. Investing in infrastructure improvements is necessary not only to enable digital surgery and other digital health initiatives, but to reduce cost and waste throughout the hospital system. Hospitals should lean into the unknown as well. While there are many clear benefits to digital surgery, there is still a need for more research and much of that can be learned. Hospital systems can set themselves up to be leaders in innovation in this area by continuing to find new ways to both use and measure the success of digital surgery tools and in developing new research. Providers can adopt new ways to talk about AI and other digital surgery tools with their patients to help ease any concerns. It is exciting to think about what the future holds for digital surgery and healthcare innovation as a whole- we are just beginning!

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While scheduling a flu shot appointment, I encountered a workflow issue highlighting several drawbacks and drop-offs. After receiving a text notification regarding my appointment, I found no options to confirm or reschedule the appointment. This lack of interactive features in the notification text made it inconvenient for recipients like me to take immediate action. Drawbacks include the potential for missed appointments due to oversight or a need for a user-friendly confirmation mechanism. Additionally, the absence of an option to reschedule in the same text message could lead to inefficiencies, as recipients may need to initiate a separate communication to adjust their appointment, resulting in a less streamlined and user-friendly experience. Such workflow limitations emphasize optimizing communication systems to enhance user engagement and appointment management.

This gap underscores the need for an integrated Enterprise Decision Management (EDM) system that seamlessly manages appointment scheduling, notifications, and user interactions. A well-implemented EDM system could automate these interactions, sending messages with options to confirm, reschedule, or even provide additional information about the appointment, enhancing user engagement and satisfaction.

Digital transformation with EDM involves leveraging technology and data to revolutionize decision-making processes within an organization

Furthermore, this experience points to a digital transformation gap in healthcare communication. A robust digital transformation strategy should encompass scheduling and incorporate user-friendly, interactive features within notifications to streamline the entire process. It emphasizes the need for organizations to digitize their operations and optimize these digital processes for user convenience and efficiency.

Without the support of an EDM system, hospitals face several challenges. Let’s take an example in their patient discharge processes:

1. These processes are often manual, involving a multitude of tasks like managing medication instructions, scheduling follow-up appointments, and providing home care instructions. This manual approach can lead to delays and introduce the potential for errors.
2. The absence of a centralized system creates communication gaps among healthcare professionals, including doctors, nurses, and pharmacists, involved in the patient’s care, resulting in inconsistent instructions and confusion for patients.
3. Patient information is frequently scattered across various systems, making it challenging to access and share critical data necessary for informed decision-making during the discharge process.
4. Post-discharge patients may find it challenging to adhere to their post-treatment care plans due to the absence of reminders or clear instructions, potentially resulting in readmissions and compromised patient outcomes.

These challenges underscore the importance of implementing EDM solutions to streamline and improve patient discharge processes.

Digital transformation with EDM involves leveraging technology and data to revolutionize decision-making processes within an organization. By integrating EDM principles into various aspects of an organization’s operations, from customer interactions to internal workflows, businesses can streamline decision-making, enhance efficiency, and improve outcomes. EDM facilitates the automation of routine decisions, incorporates data-driven insights, and ensures compliance with established rules and regulations. This transformation empowers organizations to adapt quickly to changing market conditions, achieve cost savings, reduce risks, and provide better customer and employee experiences. Ultimately, EDM-driven digital transformation enables organizations to thrive in today’s rapidly evolving business landscape.

An exemplary illustration of the transformative power of EDM in a digital context is evident in the overhaul of the patient discharge process within healthcare. Implementing an EDM system enables the creation of a centralized repository for critical patient discharge decisions, encompassing vital aspects such as medication instructions, follow-up plans, and home care recommendations. This transformative approach automates the discharge workflow, utilizing predefined criteria to trigger a cascade of automated tasks, including instruction generation, follow-up appointment scheduling, and caregiver notifications, streamlining the process significantly. Furthermore, the EDM system harmoniously integrates diverse patient data sources, providing a comprehensive view of their medical history, medications, allergies, and more, facilitating well-informed decision-making. The system’s capacity to craft personalized care plans tailored to each patient’s unique needs, encompassing instructions, medication schedules, and follow-up reminders, engenders heightened patient engagement and adherence to post-discharge care, ultimately fostering better health outcomes. Moreover, EDM’s analytics capabilities empower healthcare providers to collect and analyze data on patient outcomes, readmission rates, and care plan adherence, identifying trends and opportunities for continual process optimization, thereby elevating patient outcomes over time. 

Lastly, by facilitating enhanced communication among healthcare professionals involved in a patient’s care through real-time updates, alerts, and notifications, the EDM system ensures seamless coordination and collaboration, ultimately improving the overall quality of patient care.

Incorporating design thinking principles into EDM

Incorporating design thinking principles into EDM is a strategic approach to creating more user-centered, efficient, and innovative decision-making processes. Design thinking involves understanding user needs, ideating creative solutions, prototyping, testing, and iterative refinement. The ultimate goal is to enhance the decision-making experience and outcomes while fostering a culture of continuous improvement.

By applying design thinking in implementing an EDM system for patient discharge and follow-up, the hospital can achieve a digital transformation that improves patient care, reduces readmission rates, enhances communication, and optimizes the entire process. The system’s data-driven insights enable continuous improvement, improving patient outcomes and operational efficiency.

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The recent pandemic years have changed many aspects of healthcare, from how it is delivered to how it is paid for and subsidized. With limitations on in-person interaction and extreme staffing shortages, many aspects of the provision of care that were previously deemed secondary or had only limited use-cases, have now entered the mainstream. Chief among these is Telehealth which has finally become a more convenient option for care provision, instead of being regarded as unique or pioneering. Similarly, Remote Patient Monitoring (RPM) is seeing expanded use beyond specialized areas of hospitals, as the technical ability to remotely ingest device readings into the patient’s record over the web has matured. RPM has especially found import in long-term care where ongoing treatment plans are based on readings provided by devices such as blood pressure cuffs, glucometers, pulse oximeters, and others.

Many envision a not-so-distant future where healthcare delivery lives, for the most part, beyond the hospital walls. And it is this future-state of a distributed model of care that will have a profound effect on population health.

By 2030, 20% of the U.S. population will be over retirement age. This means that in about seven years’ time, there will be a tsunami of demand for geriatric care, one that would easily overwhelm our population health initiatives and resources, if it were to happen today. It seems prudent, then, to build for this future today.

Some provider organizations are seeing the writing on the wall and are beginning to invest in at-home hospital programs to prepare. The idea here is to be able to provide services, whether urgent care, skilled nursing, infusion, or even hospital-level acute care, right in a patient’s home. While this approach is not new, many facets of our recent societal and digital evolution have made the environment even more fertile for it today. For example, the success of an at-home program depends heavily on the social determinants of health (SDOH) for a given population, which includes whether the recipient of care lives alone or has a support system around them each day. With remote work now a reality, this has shifted that variable drastically – it is more common now for multiple generations to be together at home, while maintaining full-time remote jobs, and supporting each other’s daily needs, from child care to meal preparation. It is, therefore, not inconceivable to imagine that in 2030, more of the older population would have full-time family support at home, while their designated care providers would come to them, to check-in periodically with supplies, meds, clinical consultations, and education. This would have positive downstream effects on healthcare providers as well, with an easing of pressure on their emergency departments and in-patient units – areas that had previously been stretched to a breaking point at most hospitals at the onset of the Covid-19 pandemic.

With telehealth now mainstream, in combination with RPM, we are seeing meaningful strides towards large-scale care management, especially when there is an established relationship and the patients are enrolled in programs with their providers.

The distributed nature of population health has long been a challenge as well; when gauging the success of a population health program, a key factor is the care-provision sites’ ability, whether they are hospitals or clinics, to provide services in a dependable manner to the communities in their immediate vicinity. With telehealth now mainstream, in combination with RPM, we are seeing meaningful strides towards large-scale care management, especially when there is an established relationship and the patients are enrolled in programs with their providers. Unfortunately, there are still many scenarios that illustrate gaps in our care models – for example, if you require urgent in-person care, do not have access to an appropriate treatment site, or if you lack an ongoing provider relationship, it is likely that your only options are to either not seek care, complicating things further, or to opt for emergency care instead. It is scenarios like this that continue to pose challenges to a comprehensive population health approach. There is a budding solution in this arena, however. One that requires many pieces of infrastructure that we now already have today, thanks largely to the transformation spurred on by the pandemic – on-demand at-home urgent care through both, in-person (also known as “mobile”) and telehealth visits.

Again, while the idea of on-demand mobile urgent care is not new, it has not yet had its time in the limelight. There do exist some firms that provide such services as an out-of-pocket expense in very limited geographies. However, most, if not all, such programs are small mobile-nursing-based companies with limited offerings and minimal diagnostic capabilities. And much like how shifts in reimbursement during the pandemic allowed Telehealth to go mainstream, to allow the disparate pieces to fall into place for this, there would need to be a focus on it by both provider and payer organizations. The “mobile” aspect of such care offers an obstacle, since it requires purpose-fitted transportation, loaded with appropriate supplies through an established supply-chain, manned by care teams that deliver on-demand location-based care, akin to rideshare platforms with delivery services.

Historically, creating an entirely new program, especially one that radically changes the mode of delivery, has been a hard thing for providers to achieve quickly at scale. Fully-integrated provider organizations with their own insurance plans and ambulatory networks do have an edge; they are able to see benefits in their communities even today, when offering at-home and/or on-demand care, even when the policy aspect and outside reimbursement have not quite caught up. This leads one to infer that it will likely be these very same organizations – which choose to invest in this realm of care provision, using the latest in digital health to extend their clinical resources – that will likely find themselves being approached by other keen health systems looking for a population health partner in the near future.

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Interoperability sits behind the scenes making sure that different systems can talk to each other and exchange data. It makes sure all the data rather than sitting in different systems can be brought together and get meaningful data that is linked by the patient. 

Interoperability involves digital health applications that have the ability to communicate with one another by accessing, exchanging and making use of data in a coordinated manner that can actually help save time and lives. 

Multiple applications automatically exchange data and information with each other to enable communication. In order for this to be possible, standards are set. Standards are a set of rules that allow information to be shared in a uniform and consistent manner across any application. 

They are approved and published by an authoritative official organization as the common set of standards.

Interoperability leads to better health outcomes with more accurate information from different stakeholders. Different stakeholders involved in the care of the patient can seamlessly collaborate with each other as data sharing conserves the time and effort of staff.

To ensure interoperability at a large scale between all the systems in an organization, one needs to invest in a component called “Health Information Entity.” This connects multiple applications and allows them to move data between one another using standards bundled together to provide information. 

EHR Interoperability is important since medical devices and technologies are compatible to share, explain and showcase health data in an easily digestible form whenever and wherever a patient’s necessities come.

Therefore, participating in the care delivery of the patient for better decision-making.

Benefits of EHR Interoperability:

• Portability and accessibility: Allow health information to be accessed and shared by healthcare providers.
  
  
• Collaboration: Health records can be securely shared with patients and other clinicians and healthcare settings to enable coordinated patient care. It allows for better and more timely decision-making, particularly in critical situations.
  
  
• Efficiency and cost savings: Physicians and other medical staff require having the right information at the point of care. If they lack specific information, they will consume more time getting the information.

Sharing results that are coded differently within systems is challenging since translation is required to integrate. While modifying data to a format used by an external translation service, data becomes isolated and important insights can be missed putting patients and clinical facilities at risk.

Therefore, to avoid these problems, the “Integrated View” is applied to intelligently integrating all of a particular system application. Integration engine among different systems which is critical to successfully manage patient care and promote advancements in healthcare. 

To connect digital health applications through integration leads to significant cost scalability and management challenges. 

There is a standard that is used. The standard is an agreed-upon method for correcting systems together. It may pertain to security, data transport, data format or structure, meanings of codes or terms. It is analogous to learning a language. 

Ultimately, it is a product built on consensus to make sure that different systems can talk to each other and exchange data seamlessly.  

Overall, interoperability is about making sure technological processes all work together and come together along with isolated pockets of information coming together for better care.

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As a 16-hospital, an integrated health system serving 67 counties in Missouri and Kansas, Saint Luke’s Health System has faced challenges: increased demand for care, higher patient acuity, and critical staffing shortages.

Addressing these challenges was critical to helping us achieve our vision of becoming a digital health system. As part of this, we embarked on a strategic throughput initiative to improve operational efficiency and integrate care progression across the system. We believed that if we could unlock efficiency for patients in the inpatient setting, we would create downstream capacity and improve access for new patients coming in the door.

Extending the EHR with Enterprise-wide Predictive Capabilities

Over the past few years, we have invested significantly in our Epic EHR capabilities. Our teams now use many advanced features and functionality to maximize value from the system. And as a system of record, the EHR enables our teams to capture clinical data and equips them with dashboards and insights to understand the current situation.

As we embarked on our strategic throughput initiative, we first explored how to further leverage our EHR. But even after implementing recommended enhancements, our teams were still managing patient flow from the “rearview mirror.” We used EHR throughput dashboards to set discharge goals, but these only used population averages, such as GMLOS, rather than recommending targets specific to a patient’s condition and circumstances. We also tried using EHR checklists to track discharge plans, but these created ongoing, manual documentation for our teams that still required much back-and-forth communication.

Through these activities, we realized that we needed new predictive capabilities. This system had to meet several criteria: it had to integrate with the EHR and leverage real-time patient data; it needed to automate processes wherever possible or make it easy for frontline teams to take the right action at the right time; and ultimately it had to reduce the workload for physicians and staff. 

We quickly recognized that building these capabilities in-house would be too time-consuming and cost-intensive, so we decided to partner with a vendor who uses AI and ML to automate care operations. This gave us access to top data science, behavioral science, and clinical operations experts to help us operationalize AI models and maintain the technology.

We originally started working with our vendor in the early phase of the pandemic to help us with systemwide planning for COVID-19. Our work together quickly evolved to bring automation capabilities to our inpatient and perioperative settings, as well as to our systemwide command center, Central Patient Logistics.

Creating Inpatient Bed Capacity

We focused first on creating inpatient bed capacity. In the past, our teams managed care progression within the EHR, but there were so many moving pieces to discharge a patient that we experienced a lot of variabilities. To better manage throughput across the system, we needed to optimize discharge planning at the patient level. 

Working alongside our vendor’s clinical and process improvement experts, we set up new multidisciplinary discharge rounds (MDRs). To reinforce these process changes, the software makes it easier for our teams to consistently establish and update discharge plans. Integrating with the EHR, it ingests patient-specific clinical data and then uses AI and ML to auto-populate or recommend key elements such as the estimated date of discharge (EDD), disposition, and likely barriers to discharge for each patient.

With the discharge plan and barriers captured during MDRs, the system automatically coordinates with ancillary services to resolve those barriers. Instead of the first-in, first-out EHR worklist used in the past, our vendor helps our ancillary services teams prioritize patients based on discharge.

The system also helps our leaders be more proactive in addressing issues in real-time. For instance, it lets them know when a patient identified as a morning discharge is still in a bed at noon so they can help remove barriers to getting that patient safely discharged.

By shifting discharge planning upstream, we have reduced excess days by 0.3 to 0.6 days per patient at two of our largest facilities. This creates a significant amount of new bed capacity to care for patients.

Unleashing Perioperative Growth

Like many health systems, we rely on surgical cases to strengthen our margins and support other services. To accommodate growing surgical demand — while having fewer available staff due to staffing shortages — we needed to maximize value on our OR schedules. The challenge was that teams continued to rely on manual processes and tools that kept a significant amount of OR time locked up.

Our perioperative team partnered with our vendor to automate surgical scheduling processes so we could unlock OR time, increase case volume, and improve utilization. ML identifies blocks unlikely to be used and then encourages surgeons and schedulers to release the time — weeks in advance. AI then automatically offers newly-released time to the specific surgeons and schedulers predicted to be the best fit, so we can strategically grow our volume instead of just filling the time with any available case. There’s also a reservation interface that surgeons and schedulers can use to view and request time — without logging into the EHR.

In the first six months using the solution, we’ve unlocked more than 170 hours, which is increasing at an accelerating rate each month as we drive greater use of the system. Blocks that would have previously gone unused are now used more than 37% of the time. In the last month alone, we had 109 cases scheduled through this system.

Improving Operational Efficiency Systemwide

With improved operational performance in inpatient and perioperative settings, we needed to optimize resources across the health system and improve care coordination between sites. Previously, we had co-located core system functions and teams in our system command center, Central Patient Logistics. However, our centralized teams still operated in a manual, reactive manner, and when exploring new approaches, we found that traditional command center technologies only replicated EHR capabilities.

To optimize our systemwide resources and processes, we realized this was another opportunity to use predictive capabilities. Our teams now have real-time situational awareness across facilities, service lines, and units. ML predicts census hours in advance, giving our teams more time for planning and decision-making. Looking ahead, the system will also help balance demand across acute care and community hospital settings.

With this foundation of predictive capabilities in place, we are far ahead today. Already, these capabilities have provided us with a distinct advantage in the market. We also see a broad range of new opportunities for care operations automation on the horizon, including integrating care delivery across new settings, such as virtual care or hospital-at-home, and optimizing staffing and scheduling.

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The impact of technology has empowered individuals to expect a seamless, consumer-focused experience across every aspect of their lives. Being able to order something to your doorstep, or manage your finances with a few taps on your phone has instilled an expectation in us that all of our interactions should be just as intuitive. Increasingly, consumers, including our community of patients and families, expect that same level of convenience and transparency when it comes to how they manage their health care, as well.

The health care industry hasn’t always enjoyed a reputation for operating at the forefront of technological innovation. But the recent COVID-19 pandemic brought several opportunities for digital health advancements into clear focus, beginning with a quick pivot to virtual care. Seemingly overnight, health care providers across the globe rapidly expanded telehealth capabilities to effectively transition in-person health care appointments to a virtual setting. 

For many, the transition not only protected the health and safety of patients and providers alike, but also ensured that patients who utilized the service didn’t delay important preventive care, health care screenings and chronic care management. As a result, as in-person visits resumed, many are seeing positive outcomes from those patients who could stay on track with their care. 

Savvy health systems also need to account for the provider experience along the journey to digital transformation.

At EvergreenHealth, where I serve as our health system’s CIO, our goal is to continue expanding access to quality health care by developing technology solutions that offer a seamless and integrated experience for patients and families. While shifting the traditional health care experience to an online setting was a critical move in ensuring continuity of care at the onset of the pandemic, we also recognize the opportunity to develop new, more innovative models that mirror how we all interact with digital tools in our daily lives.  

One of the ways that we’ve invested in digital transformation at EvergreenHealth is by forming our Digital Health and Consumer Innovation Committee (DH&CI). Now in its fifth year, the DH&CI Committee provides a forum for advancing new innovative ideas that enhance the patient experience with technology solutions.  

The collaborative advisory group of community members – many of whom are leaders in our region’s thriving tech industry – and EvergreenHealth leaders, work together to identify and implement innovative digital solutions that create seamless, personalized clinical care experience for patients and providers through the use of technology.  

Among its priorities, the committee aims to foster discussion among members of the region’s high-tech community and EvergreenHealth medical staff to advance the health system’s ongoing vision to create an inclusive community health system that is the most trusted source for health care solutions. The committee meets regularly to provide feedback to the EvergreenHealth Board and senior management on the health system’s strategic and tactical plans for digital health innovations and solutions; offer insights into how consumer-driven and regulated businesses approach innovation and technology to advance staff and customer loyalty and engagement, and to differentiate themselves from competitors; and to advise the health system on potential partnerships and resources that will help accelerate health innovation and adoption of new technology within the organization. 

A recent key initiative championed by EvergreenHealth’s DH&CI committee is our upcoming migration to the Epic EMR platform. Certainly, upgrading our EMR is not a transformative digital health initiative at face value, but there are many ways the platform – which is one of the most widely used in the United States – helps health systems everywhere level up their capabilities in our shared digital transformation journey.

At EvergreenHealth, we are laying the foundation to leverage the tried-and-true solutions of Epic’s native technology, which will enhance continuity of care for patients and coordination between EvergreenHealth’s two hospitals, urgent and primary care clinics, home health, emergency departments and specialty practices. But perhaps more importantly, the shift represents the health system’s commitment to continually invest in new digital tools and platforms, which allow us to evaluate innovative technologies that work in concert to improve the patient and consumer experience.

Let’s return to the premise that patient consumers increasingly demand the same friction-less experience with their health care encounters that they enjoy in so many other aspects of daily life – booking a dinner reservation, managing their finances, ordering virtually anything to their doorstep, the list goes on.  

While we know that patients are holding the health care industry to high digital standards, we also know that we must meet patients where they are. Some patients demand convenience and a high technology experience, while others will need or desire a human touch at every interaction. Health systems invested in digital transformation will meet these demands with a range of technical and personal solutions.

For example, at EvergreenHealth, patient registration and check-in will not only be possible with a few taps in the new MyChart patient portal from the user’s phone, but patients will also have the option to check-in through interactive Epic Welcome kiosks or tablets in the clinic waiting room, or they can choose to check-in with the help of a friendly receptionist.

By anticipating and responding to patient-consumer expectations for an experience that reflects their desires for ease, choice and convenience, health systems can continue to earn trust while also increasing patient satisfaction. By embracing digital health tools that put patients in the driver’s seat – enabling them, for example, to message their provider securely between appointments and view and pay outstanding bills in the same platform – they become schedulers, registrars and collectors, empowered to take charge of their health and well-being.

Savvy health systems also need to account for the provider experience along the journey to digital transformation. It is incumbent upon leaders at every level to design and implement solutions that maximize positive impacts to our patients and community of health care consumers, while minimizing adverse effects to clinicians and staff. A consumer-only focus will ultimately fail, as we will lose engagement by those who provide care.

As the health care industry continues along its journey to digital transformation, taking smart risks to investing in new and proven technology will not only help the health care industry offer services in line with today’s consumer demands, but it will also allow us to serve our community more fully and efficiently where they are, when they need it, using modern technology that will help promote positive outcomes for all.

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Health Information Technology (HIT) became a lifeline during COVID by allowing health care organizations across the United States to utilize digital tools to engage patients and provide care. Historically, many health care providers have viewed technology as adding to their workload, contributing to job dissatisfaction and impeding the patient-provider relationship. The pivot to using more digital tools has inspired many to envision the endless possibilities of connected care. Furthermore, this experience allowed many health care professionals and patients to experience the value proposition of HIT. Capitalizing on this reconceptualization of HIT can enable healthcare to move beyond solving problems only for this pandemic but lay the groundwork for what’s next. 

Prior to the pandemic, the healthcare industry struggled to keep up with staffing demands and COVID has compounded this issue, particularly now that many are leaving the healthcare profession. The combination of staffing shortages, increased life expectancies and chronic conditions are creating a perilous course for the healthcare industry. As a result, there is an urgency to develop innovative solutions to address these challenges and HIT is well poised to meet all of these challenges by building new integrated, efficient, consumer-friendly, and cost-effective digital tools. 

Technology has transformed how we interact and created a ‘new normal’ for interactions. The increased use of HIT during the pandemic allowed many to experience how these tools can fit into their daily lives and the healthcare landscape. We are seeing a level of connectivity and conducting business from our devices that has never been seen before. Patients have come to expect similar accessibility in healthcare and are increasingly deciding where they get care based on their digital experience. Traditional methods of providing in-person care have struggled to meet population health needs, particularly for vulnerable and underserved populations. Moreover, the “one size fits all” approach to care delivery has led to many health inequities and disparities. Health care organizations that don’t address these patient needs will be challenged by bigger market players that seek to attract new business and impede existing patient-provider relationships. 

Bridging the digital divide requires involvement of a diverse representation of patients throughout the product development process.

The “No Wrong Door” approach enables consumers to engage in care through the route or program that best meets their needs. Digital platforms can support the “No Wrong Door” approach by meeting people where they are through increased engagement and retention in care. HIT’s nimbleness can address patient needs more quickly, remove barriers and foster patient engagement in ways that are not possible in manual processes. Despite these promising benefits, HIT has neglected to create products that are accessible across different demographic groups. Over the years, HIT developers evolved to be more inclusive of clinical care teams throughout the product development process which has increased satisfaction and widespread adoption. Unfortunately, this approach has not translated to patient-facing digital tools. Even though the marketplace is rife with patient digital tools, these are often developed with the organizational management of these tools at the forefront rather than the patient. Moreover, product developers have neglected to engage patients throughout the development process like they do clinicians. Bridging the digital divide requires involvement of a diverse representation of patients throughout the product development process. Engaging consumers in the process helps ensure the usability and accessibility of their products. Additionally, creating consumer-friendly tools will prevent care teams from becoming their patients’ tech support and instead, they can focus on providing vital care. 

Patients who see value in using these digital platforms are more likely to utilize these systems and remain loyal to their existing healthcare organization. Instead of HIT being an impediment to provider-patient relationship, reframing the use of digital tools such that these tools can be harnessed to support patient care allowing care teams to focus on tasks that cannot be automated or digitized. Oftentimes, care teams are the gatekeepers of health information for patients (e.g., referrals to resources) which can delay access to needed services or resources. Using digital tools to provide real-time information can create a more positive patient-centered experience while addressing patient needs more quickly.  As a result, competition is increasing and organizations that respond with these new automated and patient-friendly tools will be better positioned. 

Combining HIT and data analytics can create a precision-medicine like experience for patients and clinical care teams by combining complex algorithms and automation to make personalized recommendations and move beyond the ‘one size fits’ all approach of population-based medicine. Quality measures serve an important role by recommending services or procedures a patient is due for. While these recommendations provide the necessary guidance, these broad-based guidelines have led to disparities by ignoring individual health needs (e.g., anatomy) and not factoring in other health equity issues (e.g., social determinants of health). However, innovations like machine learning can develop algorithms to assess each individual’s care needs and tailor recommendations to close care gaps. Systems that automate reminders, recommendations and information sharing to patients based on their individual needs, particularly in real-time, are likely to see improved satisfaction from both the patient and care teams. Advanced algorithms and automation can replace manual tasks, often with more accuracy, speed and at lower costs. Furthermore, tailored messaging will more likely resonate with a patient and may increase compliance with care recommendations and support better engagement in care.  

The healthcare crisis is on a precipitous course and we must pull every lever to address these challenges. The pandemic previewed how HIT can fit into the healthcare landscape, but we need to meet both patients and clinical care teams where they are. The integration of more robust, automated digital tools can address inequities, bridge the digital divide, close care gaps and reduce strain on the healthcare workforce. While HIT cannot solve all the health care problems, digital tools have immense potential to both fill the voids and enhance the health care experience.

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The healthcare industry is at the forefront of digital innovation and evolution. Advancing digital technology adoption has the potential to improve the health care consumer and patient experience and also transform care delivery. While these advancements enable efficiencies that benefit both patient and provider, the methods in which these technologies are utilized can tip the scale on their impact.

Patient care journeys through the healthcare system vary widely. Therefore, there is no single approach in improving experience. Patients access the health system for different types of medical care. They have different communication preferences based on digital literacy and/or access to digital devices. While many patients who live on their computers day to day enjoy the speed and convenience of digital medicine, a large portion of patients find these tech-enabled interactions to be cold and emotionless. Without consideration of each individuals’ exclusive needs, blanket technological solutions are bound to further the digital divide experienced by wide swoth of healthcare consumers.

Despite the inherent challenges associated with infusing digital technology into current care operations, communicating the “why” can help with change management. One “why,” is that digital technology has the ability to improve the patient experience in a seamless, efficient manner.  For example, creating an experience that includes robotic process automation and artificial intelligence offers benefits like expedited completion of documentation, simplified coverage validation, streamlining bill payment, as well as automated prescription refills, to name a few.  These technologies have a two fold benefit of making the experience more simple for the patient, and more cost-efficient for the health system.

Digital technology can also improve provider experience and patient care. Simplified interactions through recording, automated patient outreach, and using artificial intelligence to detect disease more quickly in diagnostic testing are just a few tools helping to lighten the load and prevent burnout of our healthcare professionals.   

COVID-19 created an optimal case study that exemplified the opportunity technology brought to bare. Organizations saw the use of automation, chatbots, conversational AI and application program interfaces (API) leveraged on a coordinated, large scale for testing, vaccination, and communication processes. COVID-19 required massive scalability with limited human resources, which only technology could sustain across the world. Learnings were derived from each organizations’ approach and adaptability was required as demand ebbed and flowed. The ultimate challenge to maintaining a positive technology implementation experience was predicting and creating a sustainable patient journey through a rapidly changing environment. One of the greatest examples of this principle was the finding that virtual visits between patients and providers can be an efficient and effective way to render health care. Needless to say, out of necessity, technology was catalyzed in medicine through the COVID-19 pandemic.

In order to realize the benefits of digital technology in healthcare the design process is critical. It is necessary to engage patients and providers continually throughout the process.  Understanding critical aspects of our patient and provider needs will lead to successful solutions.  For patients, it is imperative to understand social health as well as physicial health. Access to devices, broadband and digital literacy will all impact the experience. It will be necessary to design digital strategies with these factors in mind. Not including these factors in the design will lead to a divide among our most vulnerable patients who need help accessing care. For providers, it is important to create solutions that actually improve their workflow and ability to produce better outcomes. Digital solutions that add more work or are difficult to use will ultimatily fail.

The manner in which we deploy digital technology will determine its utility. Technology is a part of a solution to a problem but is not the solution. In order to be successful, it will be necessary to keep the patient in the center of the design.  Understanding inherent complexities will allow us to truly transform patient and provider experience and redesign care delivery, all while lowering the total cost of care. All laudible goals that have been elusive, on a larger scale, until now.

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There is no shortage of investments being made to create, optimize and fortify the “digital front door” at healthcare organizations. Consumer expectations are increasing to a point that loyalty to a health provider might be measured by access, ease and excellence of digital experience over the quality of care provided (yep, hard to believe, but consumer feedback supports this theory). But, is the digital front door a panacea for healthcare, like it was for the airlines? Not exactly.

The airlines went through a consumer renaissance that transitioned the administrative work of booking a ticket onto the consumer, and we love it. Wait, what? Yes, remember when airline call centers, ticket counters or travel agents were the only way to book air tickets? Who enjoys calling an airline call center to book a ticket now? Enter the digital experience and new standard. Consumers do the work themselves, on their own equipment, with their own network to go online and find the best flight schedule, at the best time, at the best price, pick the best seat on a preferred airline and pay all of the fees online. Did you see what happened? We are doing all of the work and we prefer it! Are there still people that ring the airline call centers, travel agents or wait in line at ticket counters? Yes, but it is typically the exception and usually a personalized situation. Oh, there it is, a personalized situation. 

Personal care orchestration and low-friction experience must be a priority for patients. Let’s give patients what they deserve, the best experience!

The digital front door in healthcare is undoubtedly part of the ‘best experience’ eco-system, but it is not solely the panacea for the best patient experience. Why? Because healthcare is a personalized situation. We aren’t selling perishable airline seats traveling between Akron and Kansas City; we are in the business of healthcare. Our health situations are personal and occasionally complicated. Sometimes it is more reassuring to speak with a real person as opposed to a bot, even for digital natives! 

The telephone remains the primary contact point for patients and health organizations. Call centers, contact centers and telephone agents remain a staple in most health systems to manage day-to-day inquiries, complicated situations, health questions, care navigation and other items. Can some of this load shift from a call center to a digital platform (like the airlines)? Sure. But unlike the airlines, there is still a heavier load coming through a call center for healthcare. This may never change and perhaps it should not change to preserve human touch in a business that is so personal.

With that said, envision a ‘best experience’ eco-system as a hybrid of physical and digital pathways. The physical pathways transition to digital pathways in a patient’s journey (with some back and forth). For example, a patient is given a cancer diagnosis. She is scared, uncertain about the next steps and really wants to talk with someone that understands the oncology journey and can answer her questions. The patient places a call to the health organization where a real person answers the phone with empathy for the patient’s situation, and immediately connects her to an oncology specialist assigned to support patient navigation for her diagnosis. The specialist forms a relationship with the patient, answers her questions, provides online resources and assists her with setting up initial diagnostics and specialist visits. The oncology navigator sends a text to the patient’s cell phone (with permission) with a link to resources, appointment scheduling and a number to call back anytime for questions (enter the digital front door). The patient becomes comfortable with digital navigation and manages part of her journey online (appointments, health records, information sharing, prescription refills, provider Q&A, others).  When the patient receives a critical result that inspires questions (or fear), she calls the health provider and has a consistent experience getting connected to the oncology navigator to get questions answered and navigate through the next steps in her care journey. The patient finishes treatment and enters remission, but she needs annual diagnostics for monitoring and preventative health maintenance. She receives a text (checking in with her) with a link to set up her annual diagnostic appointment via the digital front door. In the following year, she receives the text again, but forgot to set up her appointments. The patient’s absence is noted by automation within the digital front door and following a few digital nudges, she is called by a real person (care navigator) to ensure her maintenance appointments and diagnostics are completed. 

The oncology scenario demonstrates how both physical and digital pathways can be combined to create an optimal experience (based on preference) for personal care orchestration. This should be easy, right? Not exactly. Health organizations that have developed similar processes haven’t done this overnight. The processes and design to make this work are curated over a term that ranges from months to years. The economics of the design can be difficult if automation and technology are suboptimal. On the other end of the spectrum, some health organizations maintain the status quo with a bare minimum call center (seen as a cost center, not an engagement or experience hub) staffed with minimally skilled agents that aren’t provided toolsets or training to be successful. Turnover is high and agent satisfaction and engagement is low. Imagine, you have been diagnosed with complex disease and your first interaction with a health organization is a call center agent that doesn’t have the skills, resources or training to help you. Patients (and agents) deserve better support from health organizations. Personal care orchestration and low-friction experience must be a priority for patients. Let’s give patients what they deserve, the best experience!

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