Hospitals have been investing millions in digitization efforts to improve workflows and care outcomes over the past decade, but recent research shows nearly half of employees say too much digitalization hurts productivity.
Here, eight executives from hospitals and health systems across the country answer the questions: "How do you know when you've gone too digital? How do you strike the balance of making things more efficient without confusing staff?"
Note: Responses have been edited lightly for clarity and style.
Karen Murphy, PhD, RN. Chief Innovation Officer at Geisinger (Danville, Pa.): Successful digital transformation always begins with the end user. At Geisinger, we heavily invest in the design process, which includes engaging staff and patients as we develop technology solutions. We also identify key performance metrics as well as an evaluation strategy prior to launching. We have found that the greater the complexity in using the technology, the more frustrating it is for the end user. Low engagement rates are a signal that you’ve either gone too far digital or developed an ineffective tool, resulting in the need to go back to the design process.
Our rule regarding staff engagement is that the digital tool cannot add to the staff burden. Digital solutions have to take away the complexity of work. Again, engaging staff in the design process enhances the probability of success. Also, we do not want to "digitalize" current processes. The idea is to transform using digital tools as an enabling strategy. The goal is to improve staff experience.
Greg Till. Chief People Officer at Providence (Renton, Wash.): For the last several years, healthcare has been racing to catch up with the rapid acceleration of digital tools that consumers use in their everyday lives. That urgency has led to the proliferation of administrative applications, sites and other digital solutions that solve for discrete business needs but largely ignore the holistic employee experience. Caregivers from Providence and its family of organizations have made it clear that merely adding to the growing list of workplace tools without considering the entire digital footprint is a losing proposition. Instead, we must consider caregivers’ full experience and design digital support that provides fast, simple ways to get work done.
At Providence, we are investing more in upfront design that contemplates the full ecosystem of work tools from our caregivers’ experience. This means ensuring all of our functional teams are collaborating on a user-centered design experience, taking into account how caregivers access our administrative tools on a daily basis.
A recent success using user-centered design is the launch of OnboardMe, an app that helps newly hired caregivers and their leaders get real-time support from hire through the full onboarding experience. From access to providing updates all along the onboarding journey, OnboardMe is integrated into the workday, so it feels like a natural, value-add use of technology. We are looking forward to continuing our digital journey and offering even more integrated, digitally-enabled work experiences for caregivers, so they can focus on the important high touch work of caring for our patients.
Richard Zane, MD. Chief Innovation Officer at UCHealth (Aurora, Colo.): I lament the term "digital" or "virtual" health because there is nothing virtual about it; it’s really technology-enabled "actual" care. At the end of the day, healthcare boils down to people, process and tools. We must keep in mind that digital is just a tool for people to take care of other people and "digital" is not a destination in and of itself. Like any tool, it requires training and human adjudication on when and how to best use it.
Our guiding principles are simple: digital health must be easier and not harder, fewer clicks and not more, the path of least resistance, bulletproof, and must enhance human connectivity and not decrease it. The bottom line is that if a tool does not make providers' jobs better and easier and does not improve our patients' experience and lives, then it needs to stay on a shelf.
Kolaleh Eskandanian, PhD. Chief Innovation Officer at Children’s National Hospital (Washington, D.C.): The root cause of being too digital is often the absence of a well-integrated digital transformation strategy, one that would take into consideration all aspects of a hospital’s value chain. And, I always wonder: What happened to the notion of the good-old ERP (enterprise resource planning) introduced in the 1990s? Why are some health systems so consumed with enhancing and babysitting their EHRs that they put the equally important back-office digital transformation on the back burner?
This hurts the productivity and efficiency of the health system as a whole, contributing to staff burnout and confusion. So, I would say we can never go too digital in the presence of a well-integrated digital transformation agenda that takes into consideration integration and interoperability for all actors of the hospital’s ecosystem: 1) patients and their families, 2) clinicians, 3) scientists and 4) back-office operators.
Daniel Durand, MD. Chief Clinical Officer at LifeBridge Health (Baltimore): Many of us truly believe that digital health and virtual care can help us be both more efficient and more effective at delivering a wide range of healthcare services. But digital and virtual medicine must always remain a means to the end of helping people care for people. Trouble arises when digital transformation simply becomes about putting more contemporary tools in place or staying at the front of industry trends. We need to look for sustainable adoption rates, avoid overly abrupt transitions to digital, and protect against the "digital confusion" of having too many separate solutions in place simultaneously.
So, how can we balance our sense of urgency to improve care rapidly while protecting against "digital for digital’s sake"? We need to keep ourselves honest by relentlessly focusing on measuring each innovation across the full "quintuple aim" of improved population health outcomes, decreased total cost of care, enhanced patient and provider experience, and equity in all of these measures between populations. If, after a reasonable implementation period, a specific digital or virtual innovation fails to sustainably create more healthcare value than it consumes, then it’s likely an example of digital gone too far, or at least too far ahead of its time.
Thomas Graham, MD. Chief Innovation and Transformation Officer at Kettering Health (Dayton, Ohio): Few sophisticated healthcare delivery systems are experiencing a paucity of data. The relationship we have with our data, enabling us to be a decision-making organization, is the critical fulcrum of whether you are effective and agile or tending too digital. It’s incumbent on leaders to identify the people and processes who turn information into intelligence, then ultimately deliver insight from the "ones and zeros" in which we are awash.
Nick Patel, MD. Chief Digital Officer at Prisma Health (Columbia, S.C.): Balancing the need to be innovative and disruptive without disrupting provider or patient experience is a tough one. Some key signs that should alert you of a digital asset gone wrong, is if it causes segmentation of your patient or team member population. You have to consider the social determinates of health when deploying a new digital tool. You don't want to increase the digital divide of those populations that you are trying to reach. Access to hardware (mobile/desktop), tech literacy and access to broadband may make your tool inaccessible to some. Technology should augment the human interaction of healthcare delivery.
Some other common unintended consequences that should make you pause and rethink your strategy would be poor user adoption, more disgruntled team members, increasing costs or limiting access. The last twelve years have shown the negative disruption an EHR can make in provider productivity, satisfaction and accessibility for patients if you don’t deploy it correctly.
You have to be very prescriptive on the use of technology so that it adds efficiency and improves satisfaction instead of being another layer of nuisance. Proper understanding of the use cases and key performance indicators need to be fleshed out prior to introducing any new technology. As Steve Jobs said, "You've got to start with the customer experience and work backwards to the technology. You can't start with the technology and try to figure out where you're going to sell it."
Tom Andriola. Vice Chancellor of IT and Data at University of California Irvine: No one would describe Amazon, a digital company that can provide you with almost anything, as being too digital. What they have done is focus on meeting people‘s needs and using technology as an enabler to make things simple and efficient. That’s key: simple and efficient.
The place where sometimes organizations can get off track is when they lose sight that the purpose of technology is to be the enabler in solving problems in better ways than they have been addressed before. You can keep the definition that simple. When technology is implemented in such a way that it doesn’t respect the actors within the process, what the desired outcome is, and leverage user-centric design to make it simple, you can end up in the "complex and fragmented" category — which I would equate to the term "too digital." Most organizations are far too complex. Focusing on how to simplify work and how it connects into the way people work — that’s a repeatable formula for success.