Tech’s role for the health care workforce

Edward Prewitt:

Thanks Tom. We are here today to talk about the role of technology, automation, and clinical decision support in both contributing to the healthcare workforce crisis and also providing solutions. And joining me here is Dr. Garry Choy, who is Senior Vice President and Deputy Chief Medical Officer of Clinical Systems in the office of Medical Affairs at United Health Group.

Dr. Garry Choy:

Thanks Ed. Great to be here.

Edward Prewitt:

So Garry, let's start with acknowledging the obvious. Healthcare is in a time of extraordinary upheaval with the workforce. From your lens, how is 2022 different?

Dr. Garry Choy:

Yeah, 2022 has been a pretty challenging year. And so there's been a lot of increases in demand, complexity costs with regards to the workforce. It's not an easy year for healthcare workers in general. There are a lot of skill gaps, turnover, and so that's not making things easier. And so to make it even worse is the financial burden with regards to wage increases, training, recruitment costs. You really have to do something about this.

And so to make the situation more sustainable, we really have to design and really use technology to make things better for our workforce. Clinician burnout is at an all-time high. There's been a significant increase in people quitting the healthcare workforce. What do we need to do about this? And technology can be often attributed to be being a cause of some of this, but technology can be a solution as well. Sustainability is really one way we can look at this, is better applying technology to help our workforce. And how can we make the humans harmonize with the technology to really improve care and to really support it in the long term?

Edward Prewitt:

Very good. So talk about some of the strategic ways in which healthcare technology can help address the workforce challenges.

Dr. Garry Choy:

In medicine, there's an art and science. We've always tried to balance being human and also using technology. Just in medicine, in technology, there's also the art and science too. How can we bring technology into the clinic room in a more human-centered way? How can this AI algorithm or clinical decision support system be an additional team member? Technology can be a critical part of the team. How do we allow technology to help our workers to the best of their capacity?

And so for example, technology allows physicians, nurse practitioners, social workers to practice at the top of their license. It allows them to do more. It allows them to have at their fingertips information so that they can deliver the best care possible. Even when we think about how technology has helped us outside of healthcare, we can do more things. We can order food from anywhere during the pandemic. I'm sure many of us ordered food, a single click. What about in healthcare? How could we allow healthcare workers to have more choices, more autonomy, work from anywhere, deliver care from anywhere to anyone who's anywhere else in the world?

So technology really can be a force multiplier and a key member of the team. And as we start to think about how we apply technology, technology can allow for automation while also allowing for more human-centered care. We can have more eye contact with our patients. We can really be more human, the part that can't be automated, the art of delivering medicine.

And you hear statistics about primary care physicians or physicians in general spending a lot of time, the pajama time when they go home, they're still working on closing up the chart. And during the day when they're in the clinic room, over two thirds of their daily work time are typically focused on administrative tasks and not tasks that you would typically attribute to practicing at the top of their license. And so how could we enable technology to help our workforce? We need to design better interfaces, interfaces that don't slow people down, that don't create more burnout or frustration. Technology really has the capacity to make our lives better as we deliver care.

Edward Prewitt:

So that's a great overview of the opportunities. Where should our audience start? Which workforce issues are most crucial to address right now? And could you add an example please?

Dr. Garry Choy:

Yeah, I think it starts from the beginning. When we think about how we're training even as healthcare workers. As a physician, we learn bedside manner. We learn how to use a stethoscope, which is technology. We learn how to use pulse ox monitors, the vital signs monitors, tools that we need to have at the bedside and when we deliver care.

And so training is a big part of that. How do we train our workforce to use the most modern technology to deliver the best care? And if you think about training, you think about skill gaps. If you look at some of the statistics about a third of healthcare leaders site there's a lack of skilled talent, skilled healthcare workers. How do we close that gap?

And technology holds a potential solution in the sense that technology allows the workforce to operate with more capacity. So if you hire somebody who's well trained to use technology, well you get potentially a force multiplied workforce. Also, if you train this workforce to use the latest technology, you have a more modern workforce that's more effective too. They know how to use the latest tools that happen to be sitting in front of them in the practice environment.

And so training costs are something to keep in mind. Of course, you have to really invest in this. You have to invest in training the right worker with the right tools, with the right skill sets to operate to use these tools. An example that I think of often even during the pandemic is virtual care. And so when you're starting to see a physician through a video call, did that physician train with knowing how to do this? I got to say I didn't train with that. There was no Zoom, there was no Teams, no video conferencing, when I was in medical school. The bedside manner that we had was really in person.

And now we have webside manner. We have a virtual bedside manner that you have to teach any clinician. And a lot of clinicians had to learn this during the pandemic. Some might have never even gotten the training to do video conferencing and see a patient. How do you do a physical exam over video without laying hands on a patient to feel their abdomen? My wife's a physician. She had an iPad delivered to her physically so that she could do virtual visits. And so a lot of training happens on the job. A lot of training happens in the classroom.

One encounter where I happened to be a family member, but also wearing the hat of clinician occurred with a family member where a neurosurgeon gave us a call. Unfortunately, one of our family members fell down the stairs. And so a critical emergency at five o'clock in the morning, neurosurgeon calls us, FaceTimes us. Given the severity of the situation this call was unexpected, but it was a virtual call. It wasn't an in-person ICU. We weren't in the ICU, but he was calling from the ICU to explain in a very concise way what happened, what the recommendations were.

And this surgeon clearly has done it before. I felt at ease. I was very informed, felt that it was an appropriate bedside manner, webside manner. And this surgeon must have gotten to training but also done it many, many times experientially. And so there was a lot of value there in a very unique situation. But yet in this moment, in 2022, this happened in 2022, this allowed us to bring together multiple parties, including other family members in the same call to make critical decisions in a very effective way, in an efficient way that ultimately resulted in probably as optimal of an outcome as you can imagine, given the situation.

And this neurosurgeon had a command of technology, had command of the bedside manner, the human side, the art side, as well as the science side of the equation. He was able to command even showing a CT scan, scrolling through a CT scan while sharing the screen, while making eye contact with multiple family members on the call, and was able to really convey his expertise, get everyone to ask questions, and to really have shared decision making. You could even see what we've talked about for many years. How do you actually deliver good medicine, play out in virtual visits like this? Could we have more of this across the healthcare system?

And so training's very important. How do you get a workforce that's trained, and how do you invest the right resources to train that workforce? And this can address workforce shortages. Technology like this really allows workforce asymmetry to be solved potentially. For example, this neurosurgeon was in Baltimore and I was in California. But you can imagine other specialties, other types of healthcare being delivered where patient and provider can be anywhere really. So this can allow for workforce shortages to be addressed. Virtual technology, virtual healthcare and other sorts of technologies can be applied. Decision support, task automation, these are additional technologies that can even happen behind the scenes in other situations where really there's again, this force multiplier effect for the healthcare workforce.

Edward Prewitt:

Well, that is a fascinating example and I'm happy that it results in optimal care as you say.

Let's jump ahead to talking about digital workflows and how those can be changed and used to satisfy the workforce because as we know in certain cases they've been distracting and frustrating for workers. And of course the EMR has been a great factor in pajama time that you mentioned earlier. So please talk about the digital workflows.

Dr. Garry Choy:

Yeah, I think digital workflows can be really leveraged to help with workforce satisfaction instead of distracting the workforce. Could you actually start to make it easier for them? I enjoy practicing medicine still, and the joy of practicing is really part of being a healthcare worker. Many people intended to get into the workforce to really enjoy their career. And so if technology can make the workflow better, you're making the job better, and you're making that job satisfaction real. In a simple way, identifying what can be automated, what can be improved through intelligent technologies will allow for better retention and ultimately sustainability of the workforce. You'll have fewer people quitting because they're getting frustrated with the system. The technology can actually be part of improving the system and increase the likelihood that you really can feel the impact that you're delivering as a healthcare worker and that you're really making a difference.

The majority of healthcare leaders, some studies say 70 to 80% of workflows of digital workflows are very important to, and a priority for building a sustainable workforce. One example that I can think of comes from back when I was in Boston when we're practicing. I'm a radiologist. And as a radiologist we're like machines, we're reading films all day. But you really have to take into consideration that chest x-ray, behind the chest x-ray there's a person.

And you want to know as much about that person as possible. We had multiple EMR systems. We had to open multiple windows to really understand that person in order to give a good diagnostic interpretation of that chest x-ray. But we found that this administrative burden of opening multiple windows, for example, took time. We could miss something. Why not build a search engine that would serve up on a silver platter, is somebody smoking? Is somebody infected with an elevated white count while we're reading the chest x-ray?

So this search engine technology that we implemented, deployed really made being a radiologist much more enjoyable and also better. Smoking status would pop up when we saw that nodule. It made us worry more about a cancer. And it also improved how we delivered the interpretation. It sped it up though too. We didn't have to open 10 windows to figure out if somebody's a smoker or not, to give an interpretation we wanted to really be able to be confident about.

And so this type of workflow technology can come in many forms. And we ultimately built multiple search queries for the orthopedic surgeon, for the OBGYN, and the primary care doc. And this is an example of clinical decision support technology that really can improve workflow so that you're simply happier as a physician or clinician delivering care. And ultimately it's better care, it translates into that.

And there are other sorts of technologies that we have to consider too. Systems talking to each other. In order to even have a search engine, you have to have multiple systems that could be searched, so interoperability. Imagine doing this across state lines or across borders and being able to do telemedicine. Could you have remote access to? Could you also start to connect different systems that typically aren't connected that require another login, EMR integration with the different applications that you want to use as a specialist because there are specialty applications? And so these digital workflow solutions really can make practicing much better.

Edward Prewitt:

Very good. That's another great example.

Well, in our last couple of minutes, I'd like to ask you about some of the barriers to using technology to better support the healthcare workforce. We talked about a lot of possibilities and opportunities, but what are the barriers?

Dr. Garry Choy:

Yeah, I think there's no shortage of barriers of course, but we have no choice, and we have to do better for our workforce. Some of the barriers that we need to overcome is getting the buy-in, figuring out what to invest in. If we're in an organization, advocate with leadership to really think of the best investments we can make for our workforce. Outside, of course, finding and hiring people, how do we equip that workforce with the data tools, with the analytics tools, the workflow tools?

Some studies say 60 to 80%, a majority of healthcare leaders want to invest in technology, but what are those technologies? There's no shortage of point solutions. How do you figure out what are the tools that you put into your first aid kit? What are the multiple band-aids that you have? You can't just have one band-aid. How do you actually piece together the portfolio that you have for your workforce and ultimately convince people to invest in that? So you've got to look at the whole big picture.

Edward Prewitt:

Excellent. Well, I'd like to wrap up by asking you now that we're toward the end of the year, what is your outlook for what's ahead in 2023?

Dr. Garry Choy:

Yeah, I think the outlook is bright. And I think I'm optimistic about what technology can do for our workforce, whether it's automation, decision support. We can really help with workforce capacity, we can increase that. We can also really improve satisfaction, the joy of practicing, the joy of being in healthcare, delivering care to people who need it, and then ultimately sustain and scale our system. I think that in the future, really we can have an orchestra where technology interplays with humans and we can deliver the best care possible in a way where fewer people quit, few fewer people leave the workforce, and yet they can really deliver better care. And this will translate to better patient satisfaction and stakeholder satisfaction. This is going to be a positive virtuous cycle where technology can start to really augment our workforce.

Edward Prewitt:

Excellent. That's a terrific outlook. Well, thank you Garry, for a terrific conversation.

Dr. Garry Choy:

Well thanks Ed for having me.

Edward Prewitt:

And I'd now like to introduce Michaela Kerrissey, who is Assistant Professor at the Harvard T.H. Chan School of Public Health for the next segment of our program.