Technology in healthcare is a double-edged sword. While it has created medical advancement and greater availability of electronic patient information, it has also produced side effects that are now beginning to show, according to Rahul Parikh, M.D. at Kaiser Permanente.
Physicians can spend more time navigating their way through an EHR than interacting with patients during in-office exams, and that can contribute to physician burnout, Parikh said.
"The challenges were evident," Parikh said during his talk at the American Telemedicine Association's annual conference and expo. "The technology was getting in the way of taking care of our patients -- of forming the connection that gives us a sense of meaning, purpose and wellness in what we do."
Kaiser Permanente, based in Oakland, Calif., began taking steps to address physician burnout by fighting fire with fire. It developed digital health tools to make its physicians' lives easier and its patient experience better.
Implementing department technology leads
Kaiser Permanente, one of the largest managed care organizations in the U.S., took its first key step to address technology-related physician burnout about seven years ago. The healthcare organization decided to appoint technology leads at each clinical department in Kaiser Permanente's clinical medical centers.
The department technology leads are physicians who are given the time and support to teach their colleagues how best to use the technology in front of them, Parikh said.
They also serve as a conduit back to the Kaiser Permanente headquarters to provide insight into where technology may help improve how physicians deliver care.
"That was the foundation of trying to make our practices more meaningful again in light of all the technology we were using," Parikh said.
Using technology to simplify physician workflow
In the last seven years, Kaiser Permanente has developed three technologies to simplify the physician workflow and help mitigate physician burnout.
The first application is an EHR toolbar. One of Parikh's colleagues grew frustrated by the number of mouse clicks it took to close a patient's chart in the EHR, which can amount to five or six clicks.
All of these ideas are realistic, they're meant to address real problems, and they were developed in conjunction with or by people doing the work.
Rahul ParikhM.D., Kaiser Permanente
Parikh's colleague decided to address the problem and developed what Kaiser Permanente calls the toolbar, software that sits on top of the organization's Epic EHR and enables physicians to close a patient chart in three clicks.
"For a single patient and a single encounter, that's not a lot," Parikh said. "But in aggregate, over a day, a week, a month, a career, it's a lot."
The second application Kaiser Permanente developed is the Clinician Connect app. The healthcare organization wanted to better connect physicians in remote locations to specialists in other -- oftentimes larger -- Kaiser Permanente medical centers. In the past, physicians would have to call and talk to a hospital operator before being connected to the specialist, Parikh said.
Kaiser Permanente built and adopted a suite of apps to improve the collaboration and connection between Kaiser Permanente's medical groups, Parikh said. The Clinician Connect app, built in-house, enables a physician to bypass a hospital operator and instantly connect to any medical center or specialist within the Kaiser Permanente network.
"I can voice call, secure text or video call the colleague," Parikh said. "It's reduced an amazing amount of wait time for me and my patients."
The third technology Kaiser Permanente developed is a video remote interpreter to address language barriers that may exist with patients. Kaiser Permanente uses in-person medical interpreters, but Parikh said they are few and far between and can take time to connect to a physician who needs them.
To address the issue, Kaiser Permanente worked with vendors to develop an iPad-accessible platform for on-demand video interpretation of more than 27 languages, including American Sign Language.
"The idea was we can now connect more directly with our patients in a more comfortable and meaningful way," Parikh said. "All of these ideas are realistic, they're meant to address real problems, and they were developed in conjunction with or by people doing the work. They're synergistic with our patients and help our patients get the care they deserve."
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