Based on the hit-and-miss performance of many current EHRs and similar solutions on the market, it’s clear that many tech experts don’t quite understand how to make a truly useful digital health application.
It makes sense that, in order to help doctors, nurses, surgeons and the like do their jobs, you need a thorough understanding of how that job works every day. According to the providers we’ve spoken to over the course of 2013, many developers simply lack that knowledge.
Many providers still struggle to fit emerging digital solutions into their workflows.
The Tide Turns
What if providers and designers teamed up from the start and developed a digital solution together? Couldn’t that solve the problem? We may soon know the answer, as cross-specialty collaboration becomes more and more common.
We’ve heard from Dr. Chris Kuzniak, a surgeon, an associate medical director for Xerox’s healthcare provider solutions and an entrepreneur who merges the worlds of technical innovation and healthcare experience in his life and various startups, like eClinic Healthcare.
Omada Health, an evidence-based digital health startup in San Francisco, includes a Harvard and UCLA-trained “Medical Director” on their core team of 10 technologists and entrepreneurs.
And experts from diverse areas of study, including working health professionals in hospitals, put their heads together to develop Xerox’s Digital Nurse Assistant (DNA). Let’s take a closer look at DNA, as an example of ground-floor collaboration between providers and health IT specialists.
Bridging the Divide
The pre-pilot-stage DNA device looks like an iPad Mini, according to Rufus Howe, a Xerox chief innovation officer and one of four Registered Nurses involved in the product’s design.
“It has all of the pertinent information a nurse would need to do their job during the day,” he said. Individual patient files include conditions, treatments received, lab results, imaging and vital signs updated in real time through the data streams the hospital produces.
“Nurses have carried around this info for years, periodically stopping at the EMR workstation on their floor and jotting down shorthand notes on paper, in a binder or notebook,” he said.
Nurses call these handwritten notes their “paper brain.”
“That isn’t broken, because it works to a certain degree. But it doesn’t get updated,” Howe said. Nurses have to continually check the EMR for updates.
The DNA device transcends the paper brain. It updates in real time and sends alerts when a medication status or vital sign changes. Nurses don’t have to continually check in with the EMR workstation anymore.
“It seems like a small thing, but it’s huge for nurses,” Howe said. Nursing is a hellish job sometimes, and they can find themselves running around “like a chicken with its head cut off,” he said.
Taking that first step from existing process to digital innovation can be tough, even when the advance seems logical. It requires the collaboration of diverse experts.
“A number of nurses were involved in the initial research conducted by Palo Alto Research Center (PARC) researchers and ethnographers,” Deri Plummer, a Xerox product leader and another of the nurses collaborating with the design team, said.
“In addition, we donned our scrubs and pulled a few 12-hour shifts at a local hospital to shadow and interview several staff nurses and charge nurses throughout the design process to ensure we were on the right track,” she said.
PARC employs experts in intelligent workflow design, including one who designed the Mars Curiosity rover mission control software.
“You can imagine, when you bring together that expertise with nursing, it’s like a match made in heaven,” Howe said.
Initial research found that more than 30 percent of a nurse’s day is spent checking documentation and overcoming inefficiencies inherent in the system. Based on those findings, the research team decided to try to make something to smooth out the system.
The research scientists worked with nurses, like Howe and Plummer, and a team of ethnographers – specialist researchers who study the way people live and work. Based on their findings, it wasn’t hard to see why nurses need help.
“Most times, what people think they do isn’t what they actually do” Howe said. “Ethnographers painstakingly record all of your actions, categorize them and make sense of them.”
The ethnographers made “cognitive load” diagrams for the nurses.
“At any one time, a nurse is thinking of 15 to 20 things at once,” Howe said. “Often times the tasks that would be missed are comfort level,” like getting blankets or assisting in the bathroom, he said.
By detaching nurses from the EMR station, fewer comfort level tasks will be missed, he hopes.
Time Will Tell
“Once the initial pilot is launched, we will take validated learnings, make modifications and enhancements as necessary, and the product should hit the market soon afterward,” Plummer said.
Howe looks ahead at what will come post-launch: Specialized models for other providers, like respiratory therapists, physical therapists, lab and imaging technicians and hospitalists. All these specialists have similar workflows? in the hospital and could use a tool like the DNA device to access central databases.
“This is just the beginning,” Howe said.
Don’t undervalue business experts on a development team. Even if an innovation like DNA improves the days of patients and providers on the surface, there is still one hurdle to overcome: Why would a hospital administrator shell out scarce money for this new product?
“There are real business reasons why you would want this on your floor,” he said.
Innovations like the DNA device help reduce medication errors, complications, and reduce length of stay. That makes them an attractive investment for hospital buyers.
It might even reduce hospital readmissions, the “holy grail.” Streamlining the system helps keep discharged patients from re-admitting and hospitals from paying penalties. On an innovation team, the last piece of the puzzle is sound business sense.