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Hospital-at-home workflows: Physicians’ pain points, in their own words

Healthcare organizations quickly scaled “hospital-at-home” programs during the pandemic. As a result, clinicians quickly adapted to new technologies and workflows. These changes raise the question: What pain points are physicians facing with remote care delivery?

The Allscripts Human-Centered Design (HCD) team set out to answer this with Sheba Medical Center’s ARC Innovation Center. As a member of the research team, I’d like to share a behind-the-scenes look at our work and highlights from the findings.

Longtime partners focused on the future of healthcare

ARC (an acronym for “accelerate, redesign and collaborate”) is the innovation arm of Sheba Medical Center in Israel, named one of the top ten hospitals in the world by Newsweek. Sheba Medical Center has leveraged the dbMotion™ Solution for more than 15 years, and the organization formed a partnership with Allscripts in August 2020 to accelerate the advancement of health IT. The hospital-at-home research is a product of this partnership.

Our study’s participants were six physicians from Israeli hospitals practicing remote telehealth for cardiac rehabilitation, oncology, internal hospitalization, gynecology and psychiatry services. Each physician participated in a retrospective, a meeting in which they reflected on their workflows and considered ways to improve those processes. The research team then grouped similar observations extracted from those interviews to find emerging patterns and common themes.

Here’s what we learned from those in-depth conversations and synthesis of the findings:

Simply simplify

The first theme from our research is the need to simplify physicians’ workflows. Participants shared that multiple tools are necessary to execute telehealth services because the systems they use are insufficient and/or do not integrate on their own. Physicians must work harder from a technical standpoint and perform manual, time-consuming steps to complete their documentation.

Additionally, physicians must evaluate patients to ensure they qualify for telehealth services from a clinical standpoint. Participants expressed that when they determine a patient is ineligible for telecare, they must find a different route of care for the patient, which compounds their administrative burdens.

Remote is the future of worldwide healthcare

While telehealth existed before the pandemic, adoption rates were relatively low. For example, a 2018 survey found that only 14% of physicians had implemented technology for virtual visits. From our study conducted just a few years later, though, it appears physician attitudes on virtual care have since evolved. Participants knew the effectiveness of remote care had been proven and established worldwide. Additionally, they noted there are no differences in care methodologies for telecare—simply that the means to deliver care are different.

Collaboration and communication are key for patients and team members

A third sentiment expressed by participants was the need for better organization of virtual encounters. Patients use a variety of ways to engage in virtual care, such as video conferencing and messaging through patient engagement platforms, but they lack a single point of entry to connect with providers. Participants also said they lack defined mechanisms to promote collaboration among care team members who are often engaging in both in-person and virtual encounters in their everyday routines. Further, participants said changes in personnel disrupt workflows as incumbent care team members must train new members on the different systems they use.

Focus on the patient

At the heart of these findings is a central theme: Focus on the patient. As virtual care continues to grow, the supporting technology should minimize distractions so clinicians can turn their attention to people, not processes. For Allscripts part, we will continue employing HCD principles to better understand provider workflows, iterate our solutions and support exceptional care—no matter how or where it is delivered.

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