Clinical Workflows Must Support Real-World Care Delivery

clinical workflow

Exactly 10 years ago, federal regulators began revving up EHR incentive programs, and Medicare launched the first accountable care organizations. Ambitious collaborations began to shepherd the industry toward “interoperability,” which, as they saw it, was guaranteed to bring clinicians together around patient-centered care.

A decade on, stakeholders are reporting some success from these initiatives.

For example, almost every service provider has an EHR. That’s great. However, almost no one is truly satisfied with how the EHRs are being used. Interoperability is a goal for the industry, but the practical vision of seamless communication, as laid out in the early days of the health IT revolution, is still evolving even today.

It’s tempting to respond to this uneven progress with disappointment, but there is a more positive viewpoint to adopt. We can consider this milestone year an opportunity to reflect, re-evaluate, and reinvigorate our efforts to craft a frictionless digital universe that makes healthcare work for all.

To move forward, we must identify and address the key pain points that limit providers’ ability to document, access, and actively leverage patient data for informed decision-making.

Changing EHR workflows can contribute to cognitive gridlock for providers that lack training or simply don’t have the staff they need to use their systems as intended. By understanding the roots of the problem and realigning workflows to meet the complex demands of modern care delivery, we can make our next leap forward into a second decade of meaningful, effective health IT transformation.

Challenges of the existing health IT environment

Health IT experts often point out that EHRs were originally developed as systems of record for billing and coding — not for facilitating proactive, preventive patient care. Combined with a historic lack of clinical involvement in software design, too many care teams are left with an ecosystem that is ripe for workarounds and mistakes that lead to fragmented, inaccessible patient records.

This is particularly problematic for closing care gaps, securing prior authorizations, and managing referrals. Each of these tasks requires coordination with external partners that may or may not be using similar technology. We know from our own market research that payers in particular want their technology systems to smooth out the communication channels between themselves and their provider partners. And providers want to solve for prior authorizations and have the tools they need to deliver the best care possible.

Without a bridge of communication between disparate organizations, these requests and orders might get overlooked. And behind every overlooked care-related communication is a patient — a human being with health concerns and quality of life needs. If the healthcare system is focused on both health and care, these human aspects should never be out of sight or out of mind.

For example, with more than 100 million specialist referrals requested in the ambulatory setting each year, according to a recent report from the Institute for Healthcare Improvement (IHI) and National Patient Safety Foundation, the results of lost referrals can be devastating for patients. Currently, only half of referrals are ever completed, largely due to missing information and communication failures.

And with prior authorizations accounting for as much as 25 percent of spending for some populations, the need to manage them efficiently is as important to the satisfaction of providers as it is for patients.

Patients who don’t get the care they need — regardless of the reason why — too often experience worse outcomes. And the provider organizations involved may also be at risk of losing value-based incentive payments when follow-up care falls off the radar.

About 24 percent of filed medical malpractice claims relate to a missed or delayed diagnosis, the IHI report states. Around half of the claims that originate in the ambulatory setting involve failure to follow up with specialist referrals.

It’s easy to trace many of these issues back to documentation challenges, outdated platform experiences that require providers to switch in and out of multiple screens and applications, and information delivery delays that prevent the full complement of care teams from acknowledging each other’s work.

The future of healthcare information delivery calls for swift action to tame the chaos, remove the barriers, and proactively identify potential gaps in processes before they lead to harm. Consistent and coherent workflows and user-centered design principles built with empathy for the care teams’ daily reality will be only way to refocus on the human aspects of care.

Shifting perspective on developing workable EHR workflows

EHR vendors definitely deserve credit for the work they have done over the past decade to move away from their transactional origins. Many have made a concerted effort to involve clinicians more heavily in their design and have adopted modern interoperability solutions, such as APIs, to enhance communication and allow access to critical information at the point of care.

By working together, the entire healthcare ecosystem can build more bridges and increase the flow of information. For example, sensing technology can capture changes to patient information in real time, communicating what those changes are to the right people at any point of care. The key is that actionable intelligence — not a mountain of data — must be delivered directly within the EHR workflow so care teams can act quickly and serve the patient.

By displaying critical information to providers without excessive effort on their part, intelligent platforms can eliminate the hunt-and-peck of traditional workflows. That will reduce both the time and cognitive burdens involved in accessing information in order to make the best decisions for patients. This strategy can cleanly close the gulfs between providers, payers and healthcare networks, as well as other community partners who need to work together collaboratively on behalf of patients.

Re-engineering the way data flows through and between EHRs will allow innovators to create precise and intuitive workstreams. This can be accomplished without disrupting the established EHR environment or asking care teams to learn entirely new systems.

The result is the best of all possible outcomes: better experiences for providers, better care for patients, better communication across the care continuum, and an unrivaled opportunity to make the next 10 years of health IT evolution even more productive and successful than the first. This milestone is a call to action for the whole ecosystem. It’s time to refocus on the human elements of clinical workflows.

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