Industry Voices—Achieving digital transformation without adding to digital fatigue

The COVID-19 pandemic has dramatically accelerated efforts to advance healthcare’s digital transformation. Months of stay-at-home orders and state public health ordinances forced more people than ever to take many of their face-to-face interactions online.

Over just a few months, millions of people and their doctors tried telehealth for the first time, aided by Centers for Medicare & Medicaid Services’ (CMS) loosening of restrictions and temporary waivers of cost-sharing by health plans. And most indications suggest that we will only solidify many of these rapid gains in the months and years ahead. As CMS Administrator Seema Verma put it, “the genie’s out of the bottle.”

As we seize upon this moment to unleash the full potential of digital care, however, we must do so without adding to digital fatigue among both consumers and clinicians. Even before the pandemic dramatically increased our time online, people were experiencing what neuroscientist Adam Gazzaley has described as a “cognition crisis.” 

Cognitive overload, brought on by our increased time with and dependence on information technology, has taken a toll on human attention, decision-making capacity, and emotional wellbeing—contributing to rising rates of depression, anxiety, and attention deficit disorder. Now, as months of isolation and economic upheaval contribute to a sharp national spike in mental health issues, digital fatigue has the potential to add to a looming behavioral health crisis.

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Clinicians are experiencing their own distinct flavor of cognitive overload, with 31 percent of primary care physicians in a recent survey reporting symptoms of burnout—most attributing their burnout to Electronic Health Records (EHR) and computer use and the rising burden of administrative work, which has been exacerbated by COVID-19. In a McKinsey study looking at impacts from COVID-19, more than half of physicians surveyed report an increase in feelings of burnout over these past months. With already exhausted clinicians adding screen time and extending work hours to accommodate virtual visits, we have to consider the compounding effects on burnout.

Gazzaley has suggested the answer to this predicament isn’t to retreat from the promise and benefits of exponential technologies and digital transformation. Rather, we must make these technologies work harder to ease our cognitive burden, so they can “play a positive role in enhancing what makes us human, rather than diminishing us.”

How do we do this? To help consumers, it means adopting best practices of human-centered design to create simple, seamless and stress-free health experiences for people.

Best practices for human-centered design

Personalize engagement. Today, what should be an easy task, such as finding a doctor and verifying the quality of care online, can be a daunting chore and is not tailored to the individual needs of each consumer. Healthcare is personal and one-size-fits-all experiences leave consumers feeling unrecognized and disengaged.

With more people engaging online than ever before—and the estimated volume of medical data doubling every 73 days—there’s an opportunity to leverage the rich insights to be proactive in predicting the needs of consumers and personalizing their individual health experience.

Make it easy on the consumer. More than ever, consumers need the ability to quickly find relevant content so they can make informed decisions and access the right care, at the right time. They shouldn’t have to search tirelessly to find what they need.

By predicting consumer interests and curating relevant content, we can make it easier for them to self-service and take control of their care. By utilizing data and implementing an insights-driven approach to designing and developing simple and easy-to-use experiences, we can create seamless and intuitive engagement that do not contribute to mental exhaustion.

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Integrate the best solutions. Digital health has spawned a plethora of new apps and services. But finding, vetting and integrating them shouldn’t be the consumer’s burden. We need to seamlessly integrate and curate these offerings to simplify and streamline every consumer interaction with the digital health ecosystem.

By reimagining interactions and partnerships to drive data and product interoperability we can create an uncomplicated way to increase access and engagement for consumers to verified health solutions.

Keep quality and affordability top of mind. Cost and quality transparency are critical in supporting consumers in making informed health decisions by creating visibility into the cost of health services and quality of providers. Additionally, ensuring the information available is tailored based on plan coverage and benefits for those with coverage (e.g. who is an in-network provider and the most skilled to treat a particular condition) is especially important for those with pre-existing conditions and comorbidities.

In the midst of an economic downturn, reassuring consumers by providing easily accessible insights is more important than ever for alleviating undue anxiety and stress often created in the effort to understand their cost of care.

Designing user-friendly technology for clinicians should follow many of the same principles. As they move between home and work, their digital experiences shouldn’t be substantially different or dissonant. And yet, many of the systems that dominate medical settings fail to meet basic standards for user-centered design. In a recently published study using eye pupil data to examine the link between EHR use, fatigue and efficiency, 80 percent of physicians in an ICU experienced fatigue within the first 22 minutes of EHR use—over a third in just the first minute.

The study further showed the damaging effects of digital fatigue on efficiency, with physicians who experienced EHR-related fatigue in one patient case taking longer with subsequent visits and tasks.

To counter this trend, we need to first learn from the mistakes of the past. As EHRs and other technologies are rolled out or evolved, change management and governance need to account for and prioritize the clinician experience. Every new app or feature added should not only serve the interests of improving patient care and reducing costs, but should also remove, automate or redirect clinician work and aid decision-making.

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AI- and voice-enabled technologies, which have seen explosive growth, should become the new standard for scribing and documentation, alleviating digital fatigue by focusing clinician attention on their patients.

AI can also make it easier on clinicians to find the right information in the moment of care. As Bret Shillingstad, MD, Chief Medical Information Officer at Nuance noted in a recent roundtable discussion, being able to ask your EHR to "show me the last MRI of the neck or show me the CT of the head" saves 10 or 15 clicks and the associated fatigue.

As healthcare becomes more digital, clinicians need better digital immersion training—both to use and integrate these new technologies most effectively into the flow of care and to do so in ways that won’t add to burnout. Driven by necessity, thousands of doctors turned to telehealth. But caring for patients through a screen is hardly the same as being physically by their bedside. As one first-time-using doctor expressed, telehealth is like a “new language,” one that needs to be taught and learned.

In these uncertain times, we are all reaching for predictions and prognoses about what life will look like in the “new normal.” But as the physicist Dennis Gabor once suggested, “the future cannot be predicted, but futures can be invented.”

While digital adoption in healthcare is clearly accelerating, what is it accelerating toward? And, more importantly, where do we want it to go? We’re at a pivotal juncture where we can steer the course of digital transformation toward a future where it will elevate, and not diminish, our humanity.

Ashwini Zenooz, M.D., is the chief medical officer at Salesforce. Rajeev Ronanki is the chief digital officer at Anthem.