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John Glaser, Ph.D., who has served in numerous leadership positions in healthcare and healthcare IT, looks at the imperatives facing healthcare around fragmentation, in the wake of the COVID-19 pandemic

A strange cognitive dissonance seems to occur when we consume healthcare services. Massive technological progress and economic upheaval have reset our expectations about nearly every good and service we purchase, yet historically, healthcare has often seemed to defy these pressures.

Consider these scenarios: You are looking for a specific area rug on a shopping website and for every page that loads, you need to re-enter your search terms, the size, the type, the color, etc. If this happened, you would probably go to a different website. Now imagine you’re purchasing a plane ticket on a travel site and on every new page you need to re-enter your destination, travel dates, number of tickets, airline preferences, etc. Likewise, it would be the last time you visited that travel site.

In healthcare, though, we are often asked to repeat the same information about our health problems, the treatments we’ve tried, our medications, and our other conditions. It’s also not uncommon to have to update members of your care team who are not in the loop on your care journey so far.

A cataclysmic event

For decades, this wastefully redundant process – and many, many others – were begrudgingly tolerated because it was the way healthcare worked; one provider wasn’t much different from the other. We even accept waiting weeks or months for an appointment or a procedure because we have lived with healthcare’s administrative inefficiency and fragmentation all our lives.

Times and expectations, however, are changing. The COVID-19 pandemic forced massive technology adoption for providers and patients, particularly telehealth. For their part, patients seem to prefer the higher accessibility and convenience of telehealth, which now accounts for one out of 10 outpatient visits overall, with even higher utilization for younger patients.

Telehealth, however, is only one indicator of healthcare’s waning immunity from consumer market forces. Amazon, CVS, Best Buy, and Wal-Mart have all launched major new healthcare initiatives that will force traditional healthcare organizations to strategically redesign and streamline processes to compete with these efficiency-focused corporate giants. Transcending from traditional, clinician-led care coordination to patient-guided care orchestration will be essential.

The human toll of inefficiency

Eliminating the need to repetitively share health information is only one small efficiency that could improve the healthcare experience for patients, but also for providers who must often re-enter data that should already be available. The provider experience has become an increasingly important consideration for health systems given that 1.7 million healthcare workers quit their jobs in 2022, significantly contributing to the ongoing staffing shortage.

Numerous factors are attributable to the human resources crisis, including often poorly designed electronic health records, which physicians spent 125 million hours on – outside of office hours in 2019. Each new feature in the EHR system was supposed to make it easier and faster, but instead often tends to cause the opposite. While it may have automated or simplified a single task within a care journey, the many other tasks down the road remain unaffected – or even worse – more complicated due to software incompatibility or incoherent data outputs that then need to be manually reconciled.

Problems with the EHR contribute to the vicious cycle of overburdened staff growing more burned out and quitting, which perpetuates staffing shortages. Insufficient staff risks patient safety and/or hinders the delivery of revenue-generating elective services, which reduce hospital operating margins already hard-hit after dropping 39% in 2022.

Turning passivity into action

Digitization, nonetheless, has become foundational to healthcare, for good reason. These massive repositories of patient and payer data can help traditional healthcare organizations deliver better care, service, and financial performance in an increasingly competitive, personalized, and decentralized industry.

Regardless of its abundance, passive data alone is not enough. What is needed is powerful, intelligent automation throughout the EHR with an agility layer that unites disparate units, facilities, providers, and staff across a personalized care journey. The result is the EHR now drives action without burdening staff, and in one health system reduced charting time from eleven minutes to two minutes per patient case.

For example, the pre-operative process is demanding given the potential risks to the patient and the need to schedule and assemble large, diverse clinical teams at the same time and place. Steps such as checking the patient’s record, gathering information from the patient, ordering labs, and confirming health information are essential, but could be safely automated and adapted to unique patient and clinical scenarios.

Automated care orchestration is more than streamlining disparate manual tasks. Rather, it aligns all the activities, workflows, and events across the care journey so one automated task supports the next instead of being completed in isolation with no contextual awareness. Smart automation anticipates unique patient and service complexities that could cause care delays and then minimizes the care team’s technology burden of navigating and documenting care. Instead of putting out fires, care teams can follow a proactive process enabled by technology that anticipates their needs based on real-time data and evidence with relevant and readable documentation support to accelerate the journey through the final care delivery and payment steps.

Combining Standardization and Personalization

Along with automation, standardizing care pathways can reduce the variations in care that, along with other wasteful actions, are attributed to as much as $1.26 trillion in spending, or 46% of total costs.

Standardization, of course, does not mean following the same protocol for every patient. Modifications will be needed depending on the patient’s health and care journey, but even with these changes, prevailing evidence-based best practices and guidelines can still be followed. Smart automated workflows within the EHR will inquire about any changes to the patient’s health or treatments, such as new medications, that could affect upcoming procedures. This preparation step can prevent a last-minute cancellation, which wastes clinicians’ time, drives up costs, potentially reduces revenue for the hospital, and most importantly, delays the delivery of needed care if the procedure is not rescheduled.

Standardizing care and orchestrating the patient’s care down these pathways are wholly aligned with better outcomes and strong financial performance. If a primary care physician orders a cardiology consult for a patient’s chest pain, for example, that may lead to a series of tests and an order for a stent. From the start of the care episode, smart automation within the EHR can help the care team guide the patient through the labs, imaging, procedure preparation, and medications, all the way through follow-up care, keeping those services and revenue within the health system.

Preparing for the next generation

Transitioning from fragmented care to orchestrated care is an investment in the future, and not just because it offers a competitive advantage in a changing market and leads to better care. Rather, younger patients and providers and subsequent generations will expect automation and data they need when they need it because it is the world they have grown up in. Unlike previous generations, their expectations and behaviors won’t change, nor will they tolerate such dysfunctional processes. Enabling better-orchestrated care now will support the next generation of stakeholders and set the health system up for long-term success despite changing market forces.

John Glaser is an executive-in-residence at the Harvard Medical School and a board member for Lumeon and other digital health companies. He was previously a Lecturer at the Wharton School. From 1995 through 2010, he served as vice president and CIO at Partners HealthCare, Boston, and served as CEO of Siemens Health Services from 2010 to 2015, and executive senior advisor at Cerner Corporation from 2015 to 2019, among other leadership positions in healthcare.