With Health Information Technology It’s all about the End User

Flying back from a business meeting recently, I had the privilege of sitting next to a young home health nurse who was going to her brother’s graduation from the Naval Academy. We got into a very interesting discussion about her job. Her clients are children with physical or mental challenges and she shared with me both the joys and frustrations of her work. On the positive side were her interactions with the patients and their families, and helping them work through their every day challenges. Her issues were related to coordination with the rest of the care team, workflow, and the impact of new technologies.
I showed her the new IBM-Apple health apps and also shared some information on Watson health. One of the apps is a Home Health RN app and fortunately for me (maybe not for her) I had a captive expert to get an instant review. She liked the app and felt it would be beneficial to people in her field because it provided a way to better manage some of the workflow, capture additional information about the setting, and made it easier to coordinate patient information with other care team members. It appears that her organization in rural Arizona is not using technology to the extent that many other parts of the country are today.
As IBM and others continue to provide exciting technology advances to support healthcare, we always need to ensure that we hear from the potential users, understand and map the workflow, and have a continuing dialogue with the users to ensure that the technology is an enabler and not an inhibitor or a barrier to patient care and workflow.
Two other data points on this topic. Robert Wachter, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco, has written a thoughtful book on the impact of electronic health record systems and other information technology innovations on the clinicians. His book, The Digital Doctor, discusses both the promise and pitfalls of the new digital world. In particular he notes that both workflow and patient-doctor interactions are often negatively affected by the new technologies. He describes the impact of alert fatigue, excessive checkboxes, more attention paid to the screens than the patient and other problems that have been created by technology. Another group that has extensively studied the issues around technology and healthcare workflow is Medstar’s National Center for Human Factors in healthcare. They have numerous examples based on their research where IT is not fully integrated into hospital workflows, mostly because the “solutions” were not fully vetted with the entire care team. This lack of integration causes the technology to be underutilized or even bypassed with manual workarounds.
The bottom line is that technology innovation is vastly changing today’s healthcare but too often technology is presented as the solution when it is really only a piece of the solution. Beneath the marketing hype, government mandates and incentive programs, and large implementations, are the users, both patients and clinicians, who have to deal with the impacts on the healthcare system. As an industry let’s make sure we continuously dialogue with end users like the home health nurse to make the technology infusion process better. That will help avoid or decrease implementation and post-implementation issues that can detract from the game-changing benefits that technology is bringing to healthcare.

Chief Health Information Officer, IBM Global Healthcare Industry

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