A Digital-First Approach to Care Redesign

As hospital leaders consider how to innovate and improve patient care in the middle of lingering workforce shortages, they might consider what UCSF Health’s Robert Wachter, MD, calls a “digital-first” approach to care redesign. This involves approaching problem-solving by first asking how processes can be improved and work replaced or reduced with digital technologies, ranging from artificial intelligence to telehealth tools.  

“It’s getting increasingly important to think about digital approaches as a core part of early redesign work,” says Wachter, chair, Department of Medicine, UCSF, and the author of The Digital Doctor. “This is not the way we thought about care redesign five years ago. It was always about people and processes and maybe we’d bring in [a] digital expert to consult at the end of the project. But it’s become imperative to think ‘digital first’ when we redesign care since it’s no longer practically possible to hire enough workers for some of these processes.”

Besides labor challenges, other factors are driving the need for a digital-first approach, Wachter says. For instance, a growing number of patients are demanding the convenience of online scheduling and virtual appointments. In addition, financial challenges are forcing hospitals to identify ways to streamline inefficient processes that can reduce waste and unnecessary expenses.   

An Organizational Structure to Drive the Digital Transformation

To help encourage digital innovation, UCSF Health executives divided its IT department into two groups: One focuses primarily on implementing the EHR and related technologies, such as telemedicine and patient portals. The other concentrates on digital health technologies.  

“Maintaining our EHR and related systems involves a different set of skills than thinking about the digital patient experience,” Wachter says. “So, we came to realize that we needed a separate group that could focus on care redesign with a digital flavor rather than having our IT department leading that effort.” 

The digital health-focused group, called the Center for Digital Health Innovation, employs a multidisciplinary team with expertise in digital technologies, clinical informatics, user-centered design, data science, product management and related fields. The team collaborates with clinicians and others throughout UCSF Health to create, test and implement various digital technologies in clinical environments. One example is a virtual chatbot tool that engages lung transplant patients to remotely track changes in lung function that may signal possible organ rejection. Another is a digital interface that simplifies and improves the process that physicians use to refer patients to specialists, helping ensure patients visit specialists in a more timely manner.  

Safety Checks on Digital Approaches

Though Wachter believes the move toward a digitally enhanced care model will improve the patient experience, he warns that these new technologies may present patient safety challenges as hospitals pilot and implement them. 

For example, in the name of convenience, people may make their own diagnoses guided by AI tools. Or patients will have medications prescribed via telehealth platforms by providers who don’t know the patient’s history. 

Patient protections built into traditional healthcare delivery are also being eliminated. As telehealth increasingly replaces regular in-person visits with clinicians, physicians won’t be able to conduct as thorough of an exam, which may lead to a new lesion or rash on the patient’s body being missed.  

“This doesn’t mean we shouldn’t implement these new approaches,” Wachter says. “In many ways, digital technologies will allow us to deliver care in ways that patients want. But they also open up new opportunities for errors that we have to pay attention to.”

Wachter recommends identifying signals that may point to possible medical errors or patient safety issues in a largely digital care model. For example, when a hospital-at-home patient visits the ED after a fall, hospital staff should conduct a detailed review to determine if something in the hospital-at-home approach contributed to the safety issue. 

“In many ways, these won’t be novel signals,” Wachter says. “It will involve looking at the way we currently monitor for medical mistakes in clinics and hospitals and modifying them for a different environment.” 

In the future, AI may also be used to scan the digital traffic flowing back and forth between patients and providers to pick up signals of possible medication errors, missed handoffs, or other medical and safety concerns. However, Wachter does not see that approach becoming widespread anytime soon.  

“Before we even think about using that data to provide patient safety signals, we have to figure out how to even manage all that data in the first place,” he says. “Periodically, I hear people say how great it is going to be when all the digital information—like heart rates, stress levels, blood pressure readings—from patients’ smart devices automatically goes to their primary care doctors. But, right now, doctors don’t have the capacity to handle all that data. It’s just unmanageable.”  

Maggie Van Dyke is a freelance writer and editor based in the Chicago area.