PERFORMANCE EXCELLENCE - CareTech...can apply these advanced technologies, including artificial intelligence (AI), bots, voice technology and robotic process automation, to improve

Using Intelligent Process Automation to Reduce Clinician Burnout + Improve Patient Interactions

PERFORMANCE EXCELLENCE

S P O N S O R E D B Y :

Using Intelligent Process Automation to Reduce Clinician Burnout + Improve Patient Interactions


At its core, intelligent process automation is an emerging set of new technologies that combines fundamental process redesign with robotic process automation (RPA) and machine learning. It is a suite of organizational process improvements and next-generation tools that assists clinicians by removing repetitive, replicable and routine tasks. The AHA's Center for Health Innovation convened two executive dialogues to explore the ways hospitals and health systems can apply these advanced technologies, including artificial intelligence (AI), bots, voice technology and robotic process automation, to improve provider-patient interactions, engagement and outcomes. This summary of the discussions highlights how AI, machine learning and RPA can eliminate clinician burnout, reducing burdensome tasks, and how these technologies may enhance patient interactions post-discharge.


2EXECUTIVE DIALOGUE | Sponsored by CareTech | 2019

THE PANELISTS


▶ Suzanna HoppszallernSENIOR EDITOR, DATA AND RESEARCH

AHA CENTER FOR HEALTH INNOVATION

CHICAGO

PARTICIPANTS

▶ Kimberlee Bliek, R.N.DIRECTOR, WOMEN’S SERVICES

MULTICARE HEALTHSYSTEM

CARSON CITY, NEV.

▶ Regen Gallagher, D.O.CHIEF MEDICAL OFFICER

CARY MEDICAL CENTER

CARIBOU, MAINE

▶ Kelly DukeCEO

KIT CARSON COUNTY MEMORIAL

HOSPITAL

BURLINGTON, COLO.

▶ Chary MudumbyCHIEF TECHNOLOGY OFFICER

CARETECH SOLUTIONS

TROY, MICH.

▶ Susan Vaughan, R.N.CHIEF NURSING OFFICER

KIT CARSON COUNTY MEMORIAL

HOSPITAL

BURLINGTON, COLO.

▶ Tom Whalen, M.D.EXECUTIVE VICE PRESIDENT AND

CHIEF MEDICAL OFFICER

LEHIGH VALLEY HEALTH NETWORK

ALLENTOWN, PA.

▶ Rob Vissers, M.D.PRESIDENT AND CEO

BOULDER (COLO.) COMMUNITY

HEALTH

MODERATOR

P A R T I

4

PERFORMANCE EXCELLENCE | Using Intelligent Process Automation to Reduce Clinician Burnout + Improve Patient Interactions

EXECUTIVE DIALOGUE | Sponsored by CareTech | 2019

MODERATOR (Suzanna Hoppszallern, American Hospital Association) : Do your organizations use intelligent process automation or other tools to reduce the clinician workload? If so, do they help clinicians focus more on patient care by lessening burdensome administrative tasks?

KIMBERLEE BLIEK, R.N. (MultiCare Health Sys-tem) : We completed an electronic health record (EHR) conversion last year. There aren’t any innovative approaches yet that minimize the need to interact with the medical record all the time. It definitely takes away from clinicians’ ability to interact with the patient on both the inpatient and outpatient side. And, it takes considerable time to catch up with notes and documentation.

ROBERT VISSERS, M.D. (Boulder Community Health) : We aren’t doing anything particularly inno-vative with our physicians to reduce their workload at this time. The EHR is a significant driver of burn-out; yet, it can enhance workflow and experience. But it also requires lots of time for documentation and other administrative tasks. While we haven’t adopted a technological approach to reducing cli-nician burnout, we do have an innovative wellness program for all of our employees. Being in Boul-

der opens up some opportunities for us, such as holding sound baths for physicians, for example. Sound baths are group gatherings where people relax, often lying down, as various instruments are played. It reduces stress.

We recently opened a state-of-the-art fitness center on our campus that is available to all provid-ers. Every couple of weeks I hold a commensality breakfast. We bring various providers together to share a meal and develop a sense of community that we have lost over time. Also, our provider wellness committee has a high profile within the organization, and our providers know whom to go to for support.

THOMAS WHALEN, M.D. (Lehigh Valley Health Network) : We are also not doing much from a tech-nology perspective at this time. Similar to what Rob described, we are doing a lot in the wellness space. We have a chief wellness officer who is a part-time obstetrician and who reports to me. We hold monthly multidisciplinary dinners with 10 clinicians. Our ground rules are that no people can have the same position and no bosses are allowed. We want them to talk about anything other than work. We’ve adopted another idea from a New England Journal of Medicine article — having clinicians write a “This is Me” article. The article is personal and cannot be about their job. We select different clinicians to write these pieces and then distribute them to the medical staff. It helps build community. We are innovating, not automating.

We are starting a venture with a virtual scribing company based in India. Physicians can upload their patient encounters and they are written up by physicians and available the next day. It will help reduce the time physicians have to spend docu-menting the patient visit. When they get to work, they may have to spend about 25 minutes review-ing and signing off on the notes. We approached this as a 50-50 venture. We pay half and our phy-sicians pay half. We’re rolling it out to our primary care physicians first, and then, we’ll roll it out to our specialists. It will help save physician time and increase satisfaction.

The EHR is a significant driver of burnout; yet, it can enhance workflow and experience. — Robert Vissers, M.D.

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REGEN GALLAGHER, D.O. (Cary Medical Center) : We are discussing what’s available to alleviate the clinician workload. We are looking at a number of things. Even something like single sign-on can have a big impact, so clinicians do not have to enter their password multiple times throughout the day. However, we haven’t implemented any of them yet. Part of it has to do with being a small place with a small number of people with multiple priorities, and part of it is cost. We are just now at a point where we need to do something. There’s a lot to do in this space and a lot of things that we can do to make our providers’ lives and our nursing staff’s lives better.

BLIEK: Regen, do you have virtual health for special-ty consultations at this time? Do you utilize that?

GALLAGHER: We have a couple of physicians who do, including our medical geneticist. And our rheu-matologist is exploring it. We are in early discus-sions for providing telepsychiatry in the emergen-cy department (ED). One reason we aren’t using it more is because we have a specialty clinic that physicians are required to staff. It’s 2.5 hours south of our hospital and our specialists have developed relationships with our patients there. A lot of it is

trying to figure out reimbursement and cost and who’s going to get paid.

CHARY MUDUMBY (CareTech Solutions) : In addition to being chief technology officer, I’m also a trained meditation practitioner, specifically in Heartfulness Meditation. We put attention on the heart, synchronizing the mind and the heart, and we’ve effectively done this in various hospitals and health systems to address clinician burnout. Apart from that, when it comes to technology, the common complaint we hear from clinicians is around interoperability. That’s where intelligent au-tomation, such as robotic process automation, can definitely help. In many organizations, documenta-tion requires looking at information in one system and putting it into another because they are not talking to each other. That can be done by a robot. Organizations have successfully implemented RPA, synchronizing applications within the hospital or health system, be it different EHRs or other clinical applications.

BLIEK: How does that actually work?

MUDUMBY: In the example I mentioned, clinicians have to sign into a system and find the information

In many organizations, documentation requires looking at information in one system and putting it into another because they are not talking to each other. That can be done by a robot. — Chary Mudumby

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they need and then sign into a different system and plug in the information. With RPA, the robot signs on to the system on its own and takes a piece of information that it needs and places it in the other system. It’s essentially a tool set. We’re able to select which fields of information we want the robot to search for and direct it to the other system. They are automatically synchronized.

Other technologies, such as natural language processing and speech to text, which we all have on our phones now, can be effective with note creation. It also can help clinicians with documen-tation, for example. And then there’s object rec-ognition and image processing technologies. If a radiologist is looking at an image, he or she knows what to look at and what it is. But the software can actually make it a lot easier for them by selecting which images they need to look at and pay more attention to. It improves efficiency.

VISSERS: There’s a definite benefit to telehealth for patients, particularly those in rural areas. It can help patients see specialists in a timely manner, without having to travel. What are the benefits for the providers? In the primary care space, it’s been hard to demonstrate that it’s improved the well-be-ing of the providers. I was speaking with someone at Kaiser Permanente the other day about their e-visits. About 40% of their patient interactions are e-visits. But interestingly, they haven’t demon-strated a reduction in office visits. It’s almost as if the e-visits are an added burden for the providers. After completing patient visits, they have to work on their charts and respond to those patients who have reached out electronically. I’m not sure the providers see telehealth as a tool to wellness, at least right now.

MODERATOR: Rob, I want to circle back to your previous comments on your wellness program. How did you go about identifying areas of focus?

VISSERS: Our clinicians talk a lot about the docu-mentation burden. If you really drill down, you find they’re spending less time providing patient care

and more time in front of the computer. Another issue they often talk about is a loss of the sense of community. The hospital used to be the place where providers would gather, and now we facili-tate communication through the EHR. There used to be a physician’s lounge where people would sit down and talk about cases. Now, there is signifi-cantly increased fragmentation among our pro-viders. Most providers don’t come into a hospital space where they are solely in that space. Even if they’re all in the hospital, they mostly communi-cate through an EHR.

BLIEK: If they are in the lounge, they are often try-ing to catch up with their documentation, instead of interacting.

VISSERS: That’s correct. We created a meditation space for our providers just in the past year. It’s a wellness space with a beautiful view and it’s being used. It doesn’t replace that robust sense of community and interaction, but we are trying to create opportunities for that. A third complaint we frequently hear from clinicians is loss of control. Often, they feel as though what they’re doing has become a commodity. They’ve lost some of that sense of autonomy and self-direction. I’m not sure

Patients are monitoring their heart rate, blood glucose and sleep cycles. Can we harness these technologies so that the nurse doesn’t need to repeatedly check for vitals?— Kimberlee Bliek, R.N.

7


how to overcome that, except for trying to engage with them more in our improvement work and enhance engagement between clinicians and hos-pital leaders. Any technological solution we turn to cannot exacerbate those issues.

MUDUMBY: Absolutely. These technologies are sup-posed to help you, not give you more work to do.

BLIEK: There is an opportunity to take other technol-ogies we have in play to enhance workflow. Take wearables, for instance. Patients are monitoring their heart rate, blood glucose and sleep cycles. Can we harness these technologies so that the nurse doesn’t need to repeatedly check for vitals? That work adds up and takes nurses away from be-ing with the patient and interacting with each other.

MUDUMBY: These are known as “internet of things” technologies. These are interrelated tech-nologies that can gather information and share directly with the EHR. Most of the devices used by hospitals today are not internet-of -things devices, so it’s a matter of prioritization and determining need. We’ve worked with a children’s hospital in Michigan to help provide in-home monitoring for

cardiac patients. Cardiac patients are given an iPad at discharge that’s connected to the hospital sys-tem. They upload and share patient information, review data, and physicians may ask patients to come in if something doesn’t seem right.

BLIEK: Are you saying that you could have a device in a patient room that records everything in real time as the provider is interacting with that pa-tient? The provider doesn’t actually have to interact with the screen or a keyboard?

MUDUMBY: Yes, that’s correct.

WHALEN: I think the progress we’ve made with speech to text is truly remarkable, but we’re not there yet. We use speech recognition technology in our system, but it remains a source of frustration for many physicians because it isn’t 100% accurate.

MUDUMBY: It’s coming. I think we’ll soon have virtual scribe technology. The current technolo-gy is close, but there are misspellings and other problems that we cannot allow in the health care setting. Virtual scribes are probably going to be machine learning tools that will do the job. Getting back to the issue of clinician burnout, ideally, we will create a system in which physician documen-tation occurs automatically during the patient visit. There is research underway to develop accurate, secure speech-to-text technology. It would be a tremendous timesaver and would alleviate stress.

BLIEK: I’ve seen disclaimers at the bottom of clinical notes, along the lines of ‘This was done using voice recognition. Unfortunately, this may lead to typo-graphical errors, etc.’ Have any of you seen that?

KELLY DUKE (Kit Carson County Memorial Hospi-tal) : I haven’t seen that yet. Until the technology is improved, we have to be cautious. Consider your phone. My voicemails are transcribed with the latest technology. Here’s one message: ‘Hi Kelley, this is Aunt Sherry.’ I don’t have an Aunt Sherry. The message continues, ‘I’m from blank for blank.


I think the progress we’ve made with speech to text is truly remarkable, but we’re not there yet. — Tom Whalen, M.D.

8



Um. I want to be able to blank.” This is the latest in technology and it’s not close to being accurate. The technology has to catch up to what we really want to have. Imagine throwing in medical terminology. These are basic words; I can see where medical terminology would kill voice recognition.

MODERATOR: Susan, I’d like to find out more about what your nurses’ challenges are and how technology might help. What are your biggest pain points?

SUSAN VAUGHAN (Kit Carson County Memorial Hospital) : One of our biggest challenges is re-source-driven. We are a small, rural hospital and we are already stretched in terms of having the staff we need to provide high-quality patient care. We have the same regulatory challenges as every-one else, but a smaller staff to ensure that we meet our requirements. Our physicians have many time constraints and we have to step up and support the provider. We have one physician who is 72. He works seven days a week and rounds on patients twice a day. We do what we can to support him. We sit down with him to support electronic medication reconciliation, etc. It’s just something we have to

do. It’s hard to recruit and retain physicians, so we do our best to support them.

MUDUMBY: Many of these tasks will be automat-ed, freeing up both physicians’ and nurses’ time. There is fairly accurate voice-to-text transcription now. IBM, Google and Amazon are working to understand accents and languages with close to 99.9% accuracy.

DUKE: Just tell me where to buy it. That’s the de-mand. We have a relatively long-tenured medical staff, and technology transitions can be hard. We are upgrading a lot of our systems to be up to date. They are supportive, but it’s still a struggle. If we can shorten the dictation and notation, that’s what will make them happy. They want to do it right. We can’t have technology interfere with their work and take them away from their patients. And, at the end of the day, they want to go home and spend time with their families.

BLIEK: That’s true. How do you sell the ‘next best thing’ to help improve their work if what they’re finding is that it’s not helping or too often it’s add-ing more work?

DUKE: Exactly. They’re scared of it. They’ll be scared of the next best thing.

MODERATOR: How do you leverage technology to enhance patient interactions and engagement? Chary provided the example of the children’s hos-pital in Michigan. What are you doing to connect with patients in a timely fashion? Are you able to leverage the resources you have or outside resources in the community?

WHALEN: We have a relatively vibrant telehealth program. Our biggest success is probably in tele-burn. There are more than 100 sites in Pennsylva-nia, Delaware, New Jersey and New York partic-ipating in our teleburn program, which provides EDs 24/7 access to burn specialists. The EDs are equipped with the teleburn web app, which is used

Our physicians have many time constraints and we have to step up and support the provider. — Susan Vaughan, R.N.

9



to upload and share pictures of the patient’s burns. The photos are reviewed by advanced practice clinicians with burn expertise. They determine whether the patient can receive the right level of care in the ED, or whether he or she needs to be transported to the nearest burn center. We’ve actually decreased the number of burn transfers to our facility as a result. We also have telestroke and telepsychiatry. Our telepsych unit also has been successful because we, like others, struggle with placement of psych patients.

BLIEK: For us, telepsych is actually part of their treatment because the patients are there for so long, we actually end up discharging them home and they never get placed.

VISSERS: That’s what happens to half of our psych patients as well. They are able to go home after their telepsych visit and they are no longer deemed to be a harm to themselves or others.

DUKE: At Kit Carson, we are new to using telep-sych. At my previous organization, one challenge we encountered with telepsych is that patients were unable to establish a long-term relationship

with a provider. Every time a patient came in for a consult, they would speak to someone new. The patients were not happy with that.

MODERATOR: Has anybody used telepsych for more continuity of care? Have you used it beyond the immediate emergency?

DUKE: We aren’t using it at this time because we are new to telepsych. In Colorado, we are blessed with space. We are working with some nonprof-it community groups to build a center that will house about six nonprofit psych and rehabilita-tion programs. It will house both face-to-face and telepsych visits and when the patient returns for treatment, he or she will have an appointment with the same provider as during the telepsych visit. We think it’s going to be a pretty neat program.

MUDUMBY: Technology can certainly add value to patients after discharge. It can enable education and communication and reduce unnecessary read-missions. It’s important because patients will not be looking at generic information, but that which is specific to them. We can create packaged technolo-gy that is customized to the patient’s condition.

We have a relatively long-tenured medical staff, and technology transitions can be hard. — Kelly Duke

▶ Suzanna HoppszallernSENIOR EDITOR, DATA AND RESEARCH

AHA CENTER FOR HEALTH INNOVATION

CHICAGO, ILL.

THE PANELISTS


PARTICIPANTS

▶ Brandon Jones, R.N.SYSTEM PATIENT EXPERIENCE

MANAGER

CARILION CLINIC

ROANOKE, VA.

▶ Deepak Prabhakar, M.D., M.P.H.

MEDICAL DIRECTOR

SHEPPARD PRATT HEALTH SYSTEM

BALTIMORE, MD.

▶ Chary MudumbyCHIEF TECHNOLOGY OFFICER

CARETECH SOLUTIONS

TROY, MICH.

MODERATOR

P A R T I I

11



MODERATOR (Suzanna Hoppszallern, American Hospital Association) : How are your organizations using intelligent process automation, and is it meeting your expectations of bridging that gap between the clinician and the patient?

BRANDON JONES (Carilion Clinic) : We’re trying to ensure that we not only provide patient-cen-tered care, but caregiver-centered care. It is our firm belief that we can’t take care of the patients without first taking care of the caregivers. It’s a big transition. We’ve moved from patient satisfaction to patient experience, helping understand and mitigate patient stress and suffering. And we’re working to relieve regulatory burden, and other things, to allow our clinicians to spend more time with patients.

CHARY MUDUMBY (CareTech Solutions) : Clini-cian burnout is a big topic of conversation in most health care organizations. A question we need to ask is whether it’s due to having too much work or doing work clinicians don’t enjoy. I believe it’s mostly the latter. If clinicians can spend more time with patients, rather than on administrative tasks, they will be much happier. In health care, automa-

tion will be able to assist in reducing the unwanted tasks. We are looking at what can be delegated to machines? What can be done by robotic process automation (RPA), for example. Much of the work nurses do is not related to nursing but looking at utilization and staffing. Many of these repetitive, burdensome tasks can be removed and clinicians can focus more on caregiving.

MODERATOR: Are any of you using technology currently to reduce unnecessary tasks?

JONES: We continue to explore technology to add to our toolbox. One example is the use of technolo-gy to enhance leadership rounding. Leader round-ing is a best practice and technology removes some manual documentation and data collection to free up leaders to fully connect with patients. Additionally, one of the biggest challenge areas in healthcare is with the electronic health record. The documentation requirements add to the workload of our caregivers. One example is the automation of the documentation of vital signs. Vital signs can be automatically uploaded to the EHR and the caregivers just need to validate the results.

We’re trying to ensure that we not only provide patient-centered care, but caregiver-centered care.— Brandon Jones


12


DEEPAK PRABHAKAR (Sheppard Pratt Health System) : We are looking at if we can use technol-ogy to improve access and reduce burden on our clinicians. I see these solutions as enabling us to touch more lives, while not necessarily increasing our work. Any clinician will tell you they find joy in working with patients. Anything on top, that inhib-its patient interaction and may induce burnout. We really need to be future-oriented, working with our current workforce, as well as preparing the work-force for tomorrow. Technology provides us with the opportunity to improve access by allowing care episodes to occur in an individual’s home environ-ment. We can collect information from patients in a meaningful, actionable way. Technology can sort through this information and package it, so clini-cians do not have to go looking for the information they need. This can open up time for patient care, enhancing access. Sheppard Pratt is the largest non-profit provider of mental health, substance use, special education, and social support services in the country so this will help us reach patients who may not currently have access. Access to mental health services is a struggle across the country, so this could be a great relief.

MODERATOR: How do you see automation enhancing patient experience and communication at this time?

PRABHAKAR: Currently, it’s mostly EHR-depen-dent. All of the EHR companies have a patient portal where patients can ask questions or sched-ule an appointment. It helps alleviate some of the pressure on the front lines. In mental health, we are always concerned about emergent clinical needs, such as suicide. We always want to inter-vene way before somebody is actually thinking about, or taking steps, towards that. This is an area of opportunity for us. If we can engage with that patient and/or their family, we may intervene in a timely fashion. Currently, when a patient is dis-charged, we provide a thorough plan for follow-up. Automation may enable us to be more proactive, rather than reactive.

MODERATOR: Brandon, does that resonate with you?

JONES: Yes, it does. Our main connectivity with patients post-discharge is via the patient portal. On the inpatient side, we use the Interactive Patient Care Technology to help with patient education, etc. While the patient is in the hospital, we provide education about their condition, medications, what to expect, etc. The challenge is for our clinicians to not become too dependent on the technology. If a physician or nurse tells them that something is important, it will stick. That may not come across electronically.

PRABHAKAR: That’s right. There has to be a true bal-ance. We’re never going to fully automate the en-tire health care enterprise. We are learning to use technology in more effective ways, in ways that are actually helpful to patients. The human interaction is very important. How can we change the process to allow it to be more customer-friendly?

MODERATOR: Chary, do you want to add anything to that from your experience with the

We’re never going to fully automate the entire health care enterprise. We are learning to use technology in more effective ways, in ways that are actually helpful to patients.— Deepak Prabhakar


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optimization of patient portals or use of patient portals that you see?

MUDUMBY: AI can assist with portal access and usage. The ‘chat box’ feature can reduce calls to the hospital, for example. As many as 50% of patients can be assisted through the chat box without hav-ing to be assisted by a real person.

JONES: It’s important that we, as health care orga-nizations, remind ourselves why we have a patient portal. It’s really to engage and empower patients with their own information.

MODERATOR: What areas do you believe have the most potential to remove burden from clini-cians now? Where do you believe AI and machine learning will have the greatest impact?

JONES: We’ve had very early conversations with our nursing leaders to identify what tasks they feel are the most non-value added. Once we get a com-plete picture, we’ll look at how machine learning can help.

PRABHAKAR: The barriers are many, but the com-plaint we hear most from our clinicians is redun-dant processes due to regulatory requirements. We have to work through these requirements and automate as much as we can so clinicians can focus on patient care.

KEY F INDINGS

The electronic health

record is one of the key

drivers of clinician burnout due

to regulatory requirements for

documentation and notation.

RPA, and other technologies,

have the opportunity to reduce

this burden by reducing the time

clinicians need to interface with

the EHR.

Machine learning

and RPA can facilitate

greater communication with

patients post-discharge,

enabling clinicians to

continue to monitor

patients’ conditions,

eliminating unnecessary

emergency department and

inpatient visits.

In addition

to technical

solutions, wellness

programs and

networking

opportunities can

help ease clinician

burnout.

21 3

Clinician burnout is a big topic of conversation in most health care organizations. A question we need to ask is whether it’s due to having too much work or doing work clinicians don’t enjoy— Chary Mudumby

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PERFORMANCE EXCELLENCE - CareTech...can apply these advanced technologies, including artificial intelligence (AI), bots, voice technology and robotic process automation, to improve