The Art of Medicine in a digital world

The Art of Medicine in a digital world

Table of contents 4 When redesigning healthcare, what really matters? By Amy Cueva, Chief Experience Officer and Paul Kahn, Experience Design Director Mad*Pow 7 From Rockwell to reality: the evolving role of the physician By William K. Kapp III, MD, MS, FAAOS CEO and Chairman, Landmark Hospitals and Technomad 10 A lost luxury: taking patients every step of the way By Steven M. Schiff, MD, FACC Medical Director, Cardiac Catheterization Laboratory CMIO, Orange Coast Memorial Medical Center 12 For physicians in the foxhole, fast and easy matters By Carl I. Schulman, MD, PhD, MSPH, FACS Director, William Lehman Injury Research Center Associate Professor of Clinical Surgery and Associate Director, Surgical Residency Training Program, University of Miami Miller School of Medicine 14 The collaborative system: transitioning to user-friendly healthcare By Jonathon Dreyer, Director of Cloud and Mobile Solutions Marketing Nuance Communications 2 The Art of Medicine in a digital world

The best lesson I can give to the medical students and residents I teach is: listen to the patient if you want to figure out what the problem is. Today, we are frequently driven by technology crowding out the listening part. The science of medicine goes nowhere if you leave the human element out of the equation. Curing our patients starts with listening to them. Myron Z. Falchuk, MD Chief, Clinical Gastroenterology Associate Professor of Clinical Medicine Beth Israel Deaconess Medical Center The Art of Medicine in a digital world 3

#artofmedicine When redesigning healthcare, what really matters? By Amy Cueva, Chief Experience Officer and Paul Kahn, Experience Design Director, Mad*Pow In order to redesign healthcare, we need to become new students of the problem erase the assumptions we have and approach the challenges with a fresh mind. We can achieve this by interacting with the people who will be affected by the solutions we create and observing the situations we are trying to improve. After all, it isn t about the specific tools or technology, it is about crafting an ecosystem focused on care, one that delivers real and meaningful value to people s lives. Humans are hardwired to seek out meaningful connections. It falls to us to design technology that helps fortify relationships, shares information, and facilitates communication between individuals and their care teams. If we send ourselves back to design 101, we would learn that before we can create impactful solutions, we need to gain a full understanding of the end-users their workflows, the obstacles and challenges they face, their frustrations, and their hopes. Just when you think you know and understand the latest in technology, it sneaks up and saturates another part of our world. In healthcare, what really matters right now is connecting patients to the people, information, and resources they need. The path to better outcomes and decreased costs will be paved with reliable interoperability and patient-centered systems. Patients, healthcare providers and payers are all immersed in the same continuously connected mobile world instant messages, email, applications recording, transmitting, and notifying. It is up to us to re-evaluate and harness the tremendous opportunities inherent within this technology and turn them into the most efficient and well-designed tools. 4 The Art of Medicine in a digital world

Technology translates. It turns typing, touching and speaking into digital information. It can interpret a stream of words into structured data that drives actionable systems. And it can translate medical-pharmacologicalinsurance terminology into something patients can understand. Technology connects. It sends data around the globe in seconds, immediately sharing images, impressions, and sensations. It obliterates the distance between any two points on the network, moving information from parent to child, laboratory to bedside, exam room to living room. Technology should be the wind at our backs, not in our faces. Technology tracks. It records, stores and plays back. It calls up events, x-rays and prescription orders. It can tell you how many steps you took and how fast you ran last week. It can tell you when to refill a prescription and congratulate you when you ve achieved a goal. Technology should be the wind at our backs, not in our faces. We need to take these powerful capabilities and artfully create healthcare technology that supports and empowers the way we live, not distracts from it. Innovations are plentiful, but cool tech alone will not solve our problems. We need to use human-centered design to improve the experience of technology and drive toward better health. It is time to redesign healthcare technology into a highly reliable point of support for the person who can do the most to improve the patient s health: the patient. Healthcare solutions can be redesigned to empower the patient to become his or her own best care provider. Every patient is in touch with his or her thoughts, sensations and feelings every minute of every day. We can t continue to let their health information, plan of care, and other valuable resources be locked up in a maze of systems. We can design technology that provides them with access to the right information in the right context at the right time, and effectively connect them with their own health information and care team. The Art of Medicine in a digital world 5

Making documentation easier carte blanche would enable physicians to focus on taking care of patients. If you could talk to the patient and have voice recognition record what you and the patient are saying, and put that voice-generated data into discrete fields, then you basically would have an automated scribe. That would help physicians get work done quickly, accurately, legibly, and help them focus on patients. Mary Veronica Daly, MD Chief Medical Information Officer Atlantic Health System 6 The Art of Medicine in a digital world

#artofmedicine From Rockwell to reality: the evolving role of the physician By William K. Kapp III, MD, MS, FAAOS, CEO and Chairman of Landmark Hospitals and Technomad In Norman Rockwell s, Doctor and Boy Looking at Thermometer, a white-haired man in a tailored gray suit sits on the edge of bed and is engaged attentively with his patient. That physician made house calls and had the time to teach a young patient how to take a temperature. But, that was then. The reality is that Rockwell s physician actually spent more time providing care than documenting it. He wasn t required to view patient data on a screen, document care on a keyboard in the hallway, or pointand-click his way through a checklist of symptoms. In today s digital era, getting physicians refocused on patients means finding ways to integrate technology directly into current clinical workflows. If it doesn t work like physicians, it doesn t work for physicians Physicians speak a unique language. We observe and assimilate a lot of seemingly unrelated data points about our patients to come up with a diagnosis. What works for us is intuitive technology. We need an electronic system that captures the unique conversational interaction between doctor and patient not drop down menus that miss the nuances of the patient s unique story. Put simply, our ability to capture the complete patient story while remaining focused on the human life at hand is what the art of medicine is all about. In order to get technology to truly work for physicians, it must drive productivity, be available on-the-go, and act as an enabler between physician and patient. For technology to do just that, there needs to be a layer of intelligence that rests between the user and the system something that mimics the ease of the paper chart and mirrors our workflow while also leveraging the advantages of a digitized system that can capture, analyze and derive insight, and connect dots between seemingly incongruous bits of information. Moreover, while technology needs to keep physicians focused on patients, it also needs to do so without sacrificing full utilization of the electronic health record (EHR) and related data capture. Such technology must automate processes as appropriate so that physicians can focus on high-priority efforts and less so on data-entry duties. This will allow physicians to capture data in a way that makes sense for us and the patients we serve, and also allows for the extraction of information for broader population health management initiatives. My organization is working diligently to bring such technology to life. We ve assembled an in-house team to develop a cloud-based hospital EHR called ChartPad. Utilizing robust mobile The Art of Medicine in a digital world 7

EHR accessibility and voice-driven technologies, ChartPad takes into account the needs of physicians while not losing sight of the critical importance of patient engagement. Simplicity and intelligence are disruptive for physicians and patients Simple, intelligent technology isn t just what clinicians want patients want that too. With the rise of the empowered patient, consumers are demanding better access to technology and personal health data in order to more effectively and efficiently manage their own care. As patients look to take charge of their own health and wellness, they will increasingly be in search of intuitive technology like mobile apps and patient portals that put the power of personal care into their own hands. Capturing the complete patient story while remaining focused on the human life at hand is what the art of medicine is all about. As these disruptive consumer health technologies come to market, the focus needs to be on instilling simplicity in how patients interact and engage with technology to achieve improved outcomes. After all, if technology is not easy for patients to use, we can t expect them to embrace this shift in personal health responsibility. For physicians and patients, truly disruptive technology must do three things increase engagement, maximize the efficiency of care, and be available anytime, anywhere. It s this type of intelligent technology that will allow us to once again embrace the Norman Rockwell vision of the doctor-patient relationship. In the end, Rockwell s image is not only what patients expect, but also what we as physicians understand is the key to positive patient outcomes. 8 The Art of Medicine in a digital world

A computer system is a tool, just like a scalpel is a tool. What if a surgeon s scalpel changed every few weeks? How is it possible to deliver good care if the primary tool you re using is changing on an irregular basis? It makes it hard for physicians and puts a barrier between them and their patients. Ben Kanter, MD, FCCP Chief Medical Information Officer Palomar Health The Art of Medicine in a digital world 9

EHR A lost luxury: taking patients every step of the way By Steven M. Schiff, MD, FACC, Medical Director, Cardiac Catheterization Laboratory CMIO, Orange Coast Memorial Medical Center As far back as I can remember, there was never a time when I didn t want to be a physician. It s a choice in which there is no equivocation: either you want to be a doctor or you don t. It encompasses your life there is no punching the clock, no walking away. Illness doesn t take vacations, disease doesn t go away for the holidays, and pain doesn t sleep. As physicians, we have accepted these truths as basic facts of our daily lives. While I realize that technology can be unwieldy at times, especially for those of us who grew up before computers and the internet, I also see the incredible potential it holds for positively changing how we, as doctors, are able to provide care to our patients. Clinical information used to be the exclusive province of the select few, and this knowledge was then trickled down to patients; but I believe the electronic revolution in healthcare has allowed a shared and more collaborative relationship to develop. The more patients understand, the better their ability to participate in their own care, and the better their personal choices and decisions will be. In this pursuit, I have been using EHRs as a tool to help explain and work through health issues with my patients. Sitting side-by-side in the exam room with my patient, and perhaps his or her family, I pull up the health record on my laptop and we review our notes from the last visit. We discuss how treatments are working, complete templated fields together and, using a section I have created called Instructions to the patient, I outline action items and next steps. I enlist their active participation in the creation of this take-home document, and the content of these clinical notes exceeds the basic information required by Meaningful Use clinical care documents (CCDs), which means I know my patients will leave my office with a thorough understanding of their current health status. This is a new era of patient-physician collaboration. We can leverage technology to enhance our partnership with our patients to create clinical notes that they can share with family members or use as a reminder of what they need to monitor and work on until our next visit. These take-away instructions are an important piece of extending the continuum of care beyond the doctor s office. I have been a physician for more than 35 years, and, to me, being able to escort my patients every step of the way whether it is through an illness or simply to the front desk at my office is a big part of what being a physician is about. 10 The Art of Medicine in a digital world #artofmedicine

There are 8,736 hours in a year, yet we expect a 60-minute annual wellness visit to keep our patients healthy for the remaining 8,735 hours of the year. That amount of white noise between visits doesn t work. Healthcare needs to modernize. And who has been there to help us? The consumer electronic market. They connected our patients in the cloud and in the home and taught them how to use sensors (FitBit). We connect to them using telemedicine, patient portals and leverage these for team-based care, and they love it. This is the new model of care where the patient is at the center. Andrew R. Watson, MD, MLitt, FACS CMIO and Medical Director Center for Connected Medicine University of Pittsburgh Medical Center The Art of Medicine in a digital world 11

#artofmedicine For physicians in the foxhole, fast and easy matters By Carl I. Schulman, MD, PhD, MSPH, FACS Director, William Lehman Injury Research Center, Associate Professor of Clinical Surgery and Associate Director, Surgical Residency Training Program, University of Miami Miller School of Medicine For physicians on the combat field, making technology easy to use is nothing short of critical. I am the director of the William Lehman Injury Research Center, where we developed MobileCare, a web-based software that integrates documentation, education and telemedicine. MobileCare was designed for Army physicians in the field. We are now applying these lessons to the civilian healthcare sector. One of the most important things we had to take under consideration when creating MobileCare, which was developed in partnership with the Department of Defense, was the actual design of the app and the related user experience. The biggest lesson I ve learned as a result of the experience is this: If a certain technology or app is not something physicians like, actually want to use and feel like they can easily integrate into their workflow, they simply won t use it. In my opinion, one of the main issues facing all physicians today is the fact that healthcare technology was not designed with ease of use and physician workflow in mind. Put simply, user experience was not a high-priority consideration. Instead, many companies put their eggs in one basket aimed at getting only half of the equation right when it came to health IT and that was collecting data, not enabling doctors to provide high-quality, efficient patient care. And to be fair, it s no easy feat to balance those two critical needs in a single system, especially when you re designing it for a highly regulated and risk adverse industry like healthcare. In the beginning Today s technology does not mirror the manner by which physicians go about their day-to-day duties. My main concern is that current technologies force physicians to take a before and after approach to patient care. Technology is an after-the-fact thought that physicians integrate post-visit, not at the point of care. In essence, technology forces us to breakup our workflow into chunks that don t fit seamlessly with each other. What s lost in this approach is the opportunity to engage patients in the complete care process which includes the capture of their note in the EHR and to also gather all of the patient s information in real-time so it s undeniably accurate and not subject to the degradation that happens when a physician has to engage with the EHR, or even worse, has to leave the patient room and make the trek down the hall to document that care. One of the other major losses when it comes to the advent of technology in healthcare is that systems were only designed to capture data, not make sense of it. An original promise of the EHR was transparency, 12 The Art of Medicine in a digital world

availability and accessibility of all information needed to inform real-time health decisions. And yet today we are merely storing much of this information. Unfortunately, since it s not organized or presented in a way that facilitates a physician s workflow, we must cobble together what we need from bits and pieces of data scattered across multiple systems. EHRs were designed to satisfy specific functions for distinct parts of the care process. Currently, EHRs are all about making sure all the warnings are heeded and all boxes are checked. It s not about bringing the information together to make physicians jobs easier so they can make faster, more informed patient care decisions. The problem isn t solely new regulations and requirements; it s the fact that we ve adopted systems optimal for collecting data, not improving care. All of this leaves us spending more time interacting with technology instead of focusing on patients. As a result, our days are longer, our administrative duties are continually on the rise, and our patients are less satisfied. Still, I m hopeful that through innovation we can start to address some of the patient engagement, physician workflow and data integration issues that have plagued the healthcare industry over the last decade. In the future The right EHR for physicians captures data without requiring extra physician time to do it, integrates data into a format that s compliant, synthesizes data for coding and billing, and is so easy to use that everyone involved in the patient care process including the patients themselves could look, understand and interact with all of the information created. The ideal EHR is also hands-free and shares information across various platforms and systems. More so, it allows physicians to make smarter decisions faster, and enables them to spend more time with patients and less time on technology. Let s consider a not too distant future. A physician enters an exam room, and the EHR immediately begins recording the ensuing patient encounter. Everything the doctor and patient say is captured and collated as needed unstructured notes for the care team and structured data to satisfy coding and compliance requirements. Based on the physician-patient conversation, the system suggests a diagnosis, recommends and orders appropriate tests, and prints out and emails any post-visit instructions the patient might need. Truly seamless and beyond intuitive, this is the vision for the smart patient encounter of the future. The Art of Medicine in a digital world 13

#artofmedicine The collaborative system: transitioning to user-friendly healthcare Jonathon Dreyer, Director of Cloud and Mobile Solutions Marketing, Nuance Communications People have come to expect and rely on the conveniences that technology brings to their everyday lives and this doesn t stop once they enter the healthcare system whether they are providers, patients or family members. All of these players in the healthcare realm expect the same efficiencies and ease of use in their healthcare experience as they do in their day-to-day lives. We are on the cusp of a revolution where technology is beginning to mold itself around humans instead of forcing us to conform to technology. A prime example? We no longer have to fumble with the television remote to find our favorite shows. Instead, we can simply speak to our TVs and request the show we d like to watch. Today, although technology has begun to actually understand us, and the ease of conversational and intelligent interaction between people and electronics has exploded, it has not yet fully made its way into our emerging, learning healthcare system. Why? Healthcare, one of the final frontiers when it comes to making the shift from a paper-based communication system to one that is digital, has been slow to adopt emerging technologies. Part of the reason for this is the complexity of the entire healthcare system at hand, and the risk involved in such change people s lives. Still, the rise of intelligent, user-friendly systems in healthcare is taking shape and both physicians and patients stand to benefit from this modernization. While physicians have found adoption and use of health IT painstaking at times, this is changing. Usability and design have begun to take center stage and the promise of innovative intelligent systems that can provide clinical decision support and cut through layers of complexity are emerging. Whether being integrated with EHRs, wearables, mhealth apps, virtual avatars or patient portals, intelligent systems will, in time, act as reliable assistants to physicians and patients, fostering decision making and communication, not hindering it. Imagine being able to speak to your mobile device in real-time and having a virtual assistant weed through vast amounts of information to determine an initial understanding of what your recent barrage of headaches and nausea might amount to prior to even visiting the doctor. Or, consider the benefits of not having to leave your home to access quality care from a doctor because you can speak to a personal avatar via your smartphone, tablet, TV or other connected device. In a new world where patients are empowered and physicians are tasked with balancing high patient volumes and both the art and science of medicine each and every day, well-designed technology that s intuitive is poised to be a game changer. These innovations can impact not only the quality of care, but also lessen the financial burdens of current inefficiencies in our healthcare system. The relationships we have with people are impacted by the relationships we have with technology. One only needs to visit a doctor s office and have him/her turn their back to type information into the EHR to understand just that. As the healthcare industry and the patients it serves evolve over the coming years, technology must act as an enabler for clinicians who want desperately to spend more time with their patients. It must also help consumers more easily and actively participate in the care process as they will, in short order, be tasked with taking a more active role in their own health and wellness. A future where people talk and technology listens is at our fingertips. As systems gather intelligence and understand our intentions and individual nuances, they will rapidly deliver the right information at the right time, to the right place unifying physicians, patients and the entire healthcare ecosystem, alike. 14 The Art of Medicine in a digital world

A core factor in the richness of a relationship is how good the raw communication itself is one person speaking and the other person hearing. But another factor in a collaborative or participatory environment which is what we re striving for is how well connected people feel in the dialogue, and this extends beyond just I speak and you hear e-patient Dave debronkart Patient Advocate and Activist The Art of Medicine in a digital world 15

#artofmedicine About the Art of Medicine The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding. Let s reimagine healthcare where physicians can get back to the art of medicine. Learn more at nuance.com/artofmedicine Nuance is the market leader in creating clinical understanding solutions that drive smart, efficient decisions across healthcare. More than 500,000 physicians and 10,000 healthcare facilities worldwide leverage Nuance s award-winning, voice-enabled clinical documentation and analytics solutions to support the physician in any clinical workflow and on any device. For more information on Nuance healthcare solutions, visit nuance.com/for-healthcare Copyright 2014 Nuance Communications, Inc. All rights reserved. Nuance, and the Nuance logo, are trademarks and/or registered trademarks, of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. All other brand and product names are trademarks or registered trademarks of their respective companies.