Use Technology to Support Your Clinicians

Health system CMOs are adopting technology to reduce documentation burdens on their clinicians and improve workflows in the OR and other areas.

Health system and hospital CMOs are adopting a range of technology solutions to support clinicians.

They're focused on technology aimed at clinical documentation and other administrative burdens, which have been linked to clinician burnout and clinician dissatisfaction.

"Technology can help clinicians be more efficient, more compliant, and more integrated in our documentation, which allows us to provide coordinated care for our patients," says Carolyn Kloek, MD, chief medical officer of OU Health in Oklahoma. "Technology can become a huge enabler to allow doctors to put patients as the primary focus in their care and not always thinking about the documentation with half of their minds."

"When you are talking about documentation and technology, it is essential for patient quality and safety, which is a key part of what I do as chief medical officer," she says. "I also see technology as a way to help clinicians do their work more effectively and more efficiently. Technology can decrease clinician burnout and help clinicians to take better care of patients."

Technology is an intractable part of the modern care delivery model and needs to be on the CMO's agenda, says Benjamin Mansalis, MD, senior vice president and chief digital and information officer, at IU Health in Indiana.

"Technology can be both an enabler and a source of friction," he adds. "A CMO who engages deeply in working with their technology partners will help shift the balance toward enablement and accelerate the value to both patients and caregivers."

OU Health recently implemented Epic as the health system's integrated electronic health record, Kloek says. That will be the base on which many new technologies and tools will be built.

"We are looking at AI and the clinical intelligence around automated documentation," she says. "There is also clinical decision support in AI that you can lay on top of your electronic medical record. There are algorithms that can help clinicians more efficiently interpret the EMR. These algorithms can present the more pertinent information—they can cull through the EMR and present information to the clinicians."

OU Health is putting building blocks in place to prepare for adoption of AI technology that will be designed to support clinicians, she says. They include Dragon and Nuance, which are specific to the idea of ambient clinical intelligence, which focuses on taking speech and turning it into electronic text.

"We have leaned into that aspect of Epic," Kloek says.

Technology reduces documentation burdens on clinicians

CMOs should be focused on technology that reduces documentation burdens on clinicians, Mansalis says.

"We have seen that technology has become more and more a part of the delivery of healthcare as we create documentation for necessary reasons for healthcare claims for the Centers for Medicare & Medicaid Services and commercial payers," he says. "Creating a record of the healthcare interaction has become an important part of our billing and payment cycles. The art of medicine and the time and space that clinicians need to create therapeutic relationships has been at odds with the need to create documentation of what happens between a patient and a clinician."

Technology that supports documentation is a key component of establishing a therapeutic relationship by removing the burden on clinicians as much as possible. This includes leveraging generative artificial intelligence and large language models, which are particularly good at summarizing and creating clinical documentation that meets the requirements for payments and billing, Mansalis says.

"We are seeing a lot of advancements," he says. "We went from scribes in the exam room typing what the doctor says to create a note to leveraging generative AI models that create the note. A human checks the AI model notes for quality assurance. Now, we have fully automated solutions that provide documentation support for clinicians, so they can focus on the most important aspect of their work, which is creating a therapeutic relationship with their patients."

Optimizing the EMR

IU Health has made improving the EMR to make it more user friendly for clinicians a top priority, Mansalis says. As part of this effort, the health system has invested $50 million in digital transformation technology.

In 2024, IU Health will be expanding a SWAT team program, consisting of a small group of analysts and chief medical information officers, to focus on the health system's Cerner electronic health record.

"The SWAT team will go to ambulatory primary care sites and hospital units," Mansalis says. "They will … talk with the physicians, nurses, frontline registration staff, and other care team members about the utilization of our Cerner electronic health record. They will coach … optimal use of the technology … [and] ask clinicians and other care team members about what they would like to see changed in the EHR to make it work better for them and their patients. We will take that information and use it to make modifications to make the EHR work better for the care teams."

An example of how the SWAT team has already improved the EHR can be found at the Riley Hospital for Children's Pediatric Intensive Care Unit. The SWAT team noticed that it was hard for clinicians and nurses to quickly identify when a PICU patient was deteriorating. They noted that important information contained in the monitoring equipment, such as data on arterial lines and ventilators, wasn't getting to the clinicians and the nurses through the EHR.

"We worked with a company to integrate information in the PICU's monitoring equipment using a tool to capture the monitor information at a high level of granularity," Mansalis says. "The tool runs a machine learning model on the information to determine whether the patient is getting better or the patient is getting worse based on about 20 parameters. It allows nurses to triage patients more effectively and bring in clinicians quicker when a patient is deteriorating."

Clinician technology beyond documentation

IU Health is using several technological solutions to support clinicians beyond documentation.

For example, Rad AI, an imaging prompting tool, helps radiologists comb through massive queues of X-rays, mammograms, and other medical images.

"These kinds of products scan the images, look for things that the radiologist would typically document, then create a prompt and a note for the radiologist based on what would be commonly written to describe the findings in the image," Mansalis says. "This is an assistive capability. Sometimes we find that these imaging tools have a greater sensitivity than a clinician alone. So we are providing greater sensitivity and specificity in our imaging assessments. We are also able to move through more images, so our productivity increases."

The health system is also using Artisight video camera technology in operating rooms.

"We are using this computer vision tool to look at surgeries as they are occurring with an AI capability that helps train physicians in new procedures," Mansalis says. Artisight can evaluate the surgery and provide documentation on open and close time. It helps our physicians who are training residents to learn new procedures and to have feedback to help them achieve the best practice."