Human-Centered Design: A Look at One Health System’s Work to Improve Clinician Workflow

May 26, 2022
At Hendrick Health in Abilene, Texas, Joshua Reed, D.O., a senior physician leader, has been leading an initiative to advance the concept of human-centered design

Important progress is being made at Hendrick Health, a three-hospital system based in Abilene, Texas, and whose anchor hospital is Hendrick Medical Center. At Hendrick Health, Joshua Reed, D.O., the physician advisor and medical director of case management and utilization review, has been leading an initiative to try to advance the concept of human-centered design there.

Dr. Reed has been working with the Chicago-based Allscripts, partnering with Allscripts’ chief experience officer Jenna Date, to try to evolve workflows into experiences. Date has expressed that healthcare must evolve from workflows to experiences, from patient to person, and from sickness to wellness, using human-centered design (HCD) to solve problems that improve the healthcare experience. She and her team have been studying the interactions between patients and clinicians as they flow from hospital waiting rooms to examining rooms. With the sale of its hospital and physician practices business unit to Harris, Allscripts HCD is now part of Altera Digital Health.

Healthcare Innovation Editor-in-Chief Mark Hagland spoke recently with Dr. Reed about his team’s work in this important area. Below are excerpts from that interview.

How did you become involved with human-centered design?

I’m not a designer by nature. I’ve always had a little bit of an eye for what looks right or seems right. In terms of applying that in healthcare, that began in 2019-2020, when I met Jenna Date at Allscripts. She came down on site and her mission was to follow the hospitalists, with the goal of improving the design of Allscripts’ Sunrise platform. And I met with her because I serve as the chair of the physician advisory committee here; we steer EHR [electronic health record] implementation here. That’s the role I have here. We really connected around what we termed ‘the restoration of healthcare,’ which sounds like a loaded term, but really, it’s about taking the barriers to the patient-provider relationship and reducing them, and thereby indirectly reduce burnout. There’s so much technological and regulatory burden facing clinicians; how do we allow providers to focus on what they’re good at? It’s important to improve clinician workflows and making things more instinctive for our end-users. In the early days of the initiative, it involved bouncing ideas around, and then it became formalized into weekly or biweekly meetings, to evaluate design options. It’s been an awesome process.

What key changes have been made so far?

One big area was the way we use data. The typical EHR is just this massive data dump: you’ve got notes, lab values, and so on, but none of it’s really presented in a way that’s meaningful, with a patient context. You go to your patient’s name, and I have to look for everything I need, and go back again and again; versus going to the patient’s page and seeing abnormal lab values sent to me, while normal lab values are muted. It’s not a substitute for my judgment, but also, my screen is decluttered.

So in other words, it involves streamlining and prioritizing data and information to you?

Yes, in terms of what it is that providers, clinicians look for on a routine basis, what’s important to them, and how we construct our patient narratives.

What have been the biggest challenges in the process so far?

For me, it’s been the constant self-doubt, I hope they’re talking to other people! I say that a bit facetiously, but there are different ways in which providers create notes, and develop their flow. But if you strip away the rationales for why we create our own flows, we have far more in common than we’d imagine. The personalization has in some ways gone in the wrong direction, rather than in terms of getting to the key lab values; and some of this feels a bit radical.

Physicians have had to create their own personalized workarounds in the EHR, but they shouldn’t have to, right?

Yes, it’s like running track, and one runner is doing fine, but then you throw mud or dirt on the path of another runner, or throw a hurdle in their way. And as that next runner runs the next lap, they remember, oh, they have to run a hurdle or something. And there are so many bureaucratic elements that don’t add to the quality of the care. They say they do (health plans), but they really don’t. So we come up with tricks, acronyms, abbreviations, shortcuts to bypass a broken system, one that shouldn’t have had to be fixed in the first place.

What has it been like working with the Allscripts team?

One of the nicest things has been their receptiveness to new ideas; talking with the designers and seeing what’s been discussed, designed within, for example, a week. And when you see that quick turnaround and deep investment into this process, that nurtures hope. We’re not going to fix all of healthcare, but we’re having an impact. That’s the most hopeful thing for me; I leave those design sessions encouraged every time, rather than being discouraged by long timelines. The other thing we’re starting to recognize is, pushing data up several levels. If I need a lab value, I should just have to tap once rather than having to searching different screens. Just recognizing that every element needs to be readily accessible; no tricky icons. We’re starting to achieve standardized icons that we use as consumers.

What have the biggest lessons learned so far in doing this work?

For me, one of the biggest lessons has been that this whole process is so interdisciplinary: it cannot be just engineers, coders, designers, or clinicians; we’ve got to have all the element together. And when you focus on one of those elements to the detriment of others, you end up with an inferior product. But if you focus on and hone the best of design, the best of clinical, and use opportunities to translate people’s concepts and vocabulary—you end up with designers understanding some of the clinical, and clinicians understanding some of the design and some of the coding. And the more we talk and appreciate what the others are bringing to the table, we end up coming up with the best design. We’re simultaneously innovating and catching up at the same time. And we’re innovating in ways we haven’t done before, which is exciting.

What advice might you offer to those who would follow in your path?

One is simply to take an interest in the process—nurture that hope, if you will; don’t give up on the process. And really take an interest and seek out ways to get involved. And give feedback when things come down. If someone asks you for feedback, provide it.

And we really need physicians to be involved, correct?

We absolutely do; it shouldn’t be the loudest or angriest people—whoever screams the loudest, gets what they want. It needs to be a more methodical approach. And have a vision. So much energy is consumed in putting out fires or playing whack-a-mole.

In other words, you’re leading, but you have to make sure people are following, right?

Yes, exactly. You have to make sure you’re bringing the crew along. And it’s a challenge; there’s immense inertia behind the status quo. And that’s something that’s never sat well with me.

What will the next couple of years look like, as you and your team move forward in this work?

I hope it involves furthering the partnership into the implementation phase. Where do we go next? We’re not just going to rest on our laurels. The excitement that I feel and that I’ve shared with Jenna is, there’s potential here; and can we move the bar? I have aspirations around—we’ve got to improve the nursing aspects—nurses have so much regulatory burden and intake burden, and have far more hurdles even than physicians do. I would love to see some shadowing of nurses, and streamlining of patient intake and management, such that they get an hour back of their day. And a broader integration of the clinical, business, revenue cycle, and case management aspects of healthcare. Medicine is notoriously siloed, and only recently have we started knocking on the doors of other departments, asking, hey, what happens when we do a particular thing? I’d love for EHRs to do the same thing, and really start knocking down the walls.

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