Stop screwing around with my workflow

Ask doctors why they don't adopt some technology, and they will probably tell you, " Because it is not how I do things so stop screwing around with my workflow".

Doctors want you to make them a QWILT SET.

Quality: Something that delivers evidence-based improvements in quality of care. It should answer 3 basic questions: 1) Will it work? 2) Has it been clinically validated?, and 3) What is the evidence that it adds value or achieves the quintuple aim?

Workflow : Something that eliminates waste, improves throughput, takes advantage of the savings from business process outsourcing and, thus, reduces costs in their practice. Does your "solution" introduce yet another third party intermediary that second guesses decisions, removes control or contributes to technofatigue that stokes burnout? Do doctors have to use an app that is not integrated in an EMR? Doctors are already suffering from sick care software sprawl and its burnout impact factor.

eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow—the sequence and personnel needed to undertake a series of tasks for clinical care.

First, identify which components of the intervention are critical and when these components need to occur during a clinic visit. Second, choose from a variety of described methods to observe the existing clinical workflow relevant to the intervention. Third, confirm their findings using a second workflow assessment strategy. Finally, consult the clinic staff on the best ways to adapt the intervention compatibility with the confirmed clinical workflow.

Income: Something that will generate more money for the doctor, e.g. more time to spend with a patient, more time seeing new patients (although most are seeing too many patients as it is), using the platform to submit MIPS reports for chronic disease management or improving patient compliance, engagement and outcomes

Liability: Something that will reduce the risk of getting sued or having to pay more for malpractice insurance. Or, in the case of DaRonda Vought, the posssibility of being convicted of a felony and going to prison.

Here is a review of product liability and AI machine vision software.

These authors describe four ways to reform liability: 1) changing the standard of care, 2) insurance and indemnity, 3) special adjudication, and 4) regulation. These tools are neither static nor mutually exclusive: they will ebb and flow as AI/ML evolves in different parts of health care. They are also largely available to both federal and state policymakers—and in some instances, private parties.

Time: Something that will save time or allow them to spend more face time with patients or on themselves and their families

Trust: In “Preparing Clinicians for a Clinical World Influenced by Artificial Intelligence,” Cornelius A. James, M.D., Robert M. Wachter, M.D., and James O. Woolliscroft, M.D., look at the current state of affairs around AI and machine learning, and what AI development will require of physician leaders. The physicians believe that the advance of AI and machine learning is inevitable, and that, “Importantly, equipping clinicians with the skills, resources, and support necessary to use AI-based technologies is now recognized as essential to successful deployment of AI in health care. To do so, clinicians need to have a realistic understanding of the potential uses and limitations of medical AI applications. Overlooking this fact risks clinician cynicism and suboptimal patient outcomes.”

Set: Social, Emotional and Technical jobs that need to be done.

Even if you do that, there is no guarantee that they won't make technology adoption errors.

Process Mapping, a key lean tool in continuous improvement. Regardless of the industry you’re in having a clear understanding of your processes is important for efficiency and effectiveness. Process Mapping is a visualization of your operations, allowing you to see how tasks flow, who is responsible for what, and where bottlenecks or inefficiencies may exist.

Through simple symbols and lines, this tool highlights the sequence of actions from start to finish, making it easier for teams to communicate and collaborate.

eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow—the sequence and personnel needed to undertake a series of tasks for clinical care. The central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation.

The 4 steps needed to perform the clinical workflow analysis are: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation.

In other words, who is supposed to do what and when and hand it off to the next person? How are we doing it now? How can we make it better?

Fine-tuning healthcare workflow management to make improvements in efficiency, productivity, and profitability can be a difficult task, but when successful, resources can be used more effectively, stress can be reduced, and patient throughput, patient satisfaction, and clinical outcomes can be significantly improved.

Take the example of starting the OR in time. What does your workflow look like starting with the patient finding your location and a place to park and ending when they get back home after discharge.

UCHealth in Aurora, Colo., is transforming care coordination and scheduling between hospitals and anesthesia teams through innovative technology and standardized workflows. Their efforts have led to 78% use of staffed rooms and 40% fill rate for openings, among other achievements.

Here is an algorithm journey map.

In this work, the authors look to existing hospital quality assurance (QA) and quality improvement (QI) efforts as a template for designing similar initiatives for clinical AI algorithms, which they refer to as AI-QI.

To make the digital and AI transition, start with workflow mapping. LEAD it. You can do it using artificial intelligence to help you overcome the barriers to AI dissemination and implementation.

LIST YOUR WORKFLOW AND TIME MANAGEMENT PRIORITIES

ELIMINATE TASKS THAT ARE NOT URGENT AND IMPORTANT

AUTOMATE AS MANY PRIORITIZED TASKS AS POSSIBLE

DELEGATE THOSE AUTOMATED TASKS TO SOMEONE WHO DOES NOT NEED AN MD/DO TO DO THEM

Process and workflow mapping is an important initial step in your AI transition roadmap.

Creating a process map is simple and can be done on paper or using workflow management software and templates. These steps explain how to create a process map from scratch. 

This discussion paper details the role of content management systems in addressing nursing workflow by providing a mechanism for nurses to be developers themselves, and not just users or consumers of health innovative technologies. By using content management systems as platform for application development, nurses or other healthcare professionals, may be able to address problems with internal workflow without having to incur huge amounts in software development, or having to extensively learn programming languages.

Fix what's broken and don't screw around with what's not.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack