Does technology in health care deliver on its promise?

Digital health tools can improve medicine safety and make systems more efficient – but poor system design often doesn’t bring healthcare practitioners and their patients on the journey.

From My Health Record to real-time prescription monitoring, electronic prescriptions and secure messaging, Australian pharmacists routinely use digital health in their daily practice. And there is more to come, as the use of machine learning and AI grows.

When implemented effectively, digital health tools facilitate communication and information sharing between healthcare professionals across various settings, including during transitions of care. For pharmacists, this timely access to clinical information helps to reduce medicine-related harm and improve the quality of care patients receive.

However, integrating new technologies is often not done particularly effectively. This was a key takeaway from a panel discussion at the National Medicines Symposium in November, where experts explored the use of digital tools to support safe medicine management.  

Digital health challenges

For digital health tools to work in practice, they must be developed with the end user in mind, said University of Sydney Professor of Health Research Melissa Baysari. It sounds obvious and should be the norm. Sadly it isn’t. This results in the common challenges faced by users, including inadequate training, difficult-to-use technology and alert fatigue, when clinicians are inundated with too many notifications.

‘[There is a] surprising lack of involvement of end users in the design and implementation of digital systems. We definitely need more of that in healthcare,’ Prof Baysari said. ‘The technology is just one part of the wider work system. The human-technology fit is the hardest part to get right.

‘I think a lot of people feel these systems are imposed on them from senior levels, but if there was more clinician involvement in the design and understanding what problems need to be solved, people would have more ownership over the technology, and accept it and use it more.’

Another challenge is the varying use of digital health tools across the country, with some areas and settings being more advanced than others. This means the Australian health system ‘is not integrated’, said SA Pharmacy Chief Pharmacy Information Officer Michael Bakker MPS.

‘We have secure messaging, allowing delivery of referrals from a community setting into hospital, or going from hospital straight to a GP or into a patient’s My Health Record,’ he said. ‘Those are very valuable, but we also need to see the emergence of tools that help do the blending of the actual workflows.

‘The patient moves through the system, but you still just have this stack of paperwork. Whether we hand that to a patient as a set of papers that they can access digitally or physically, it doesn’t really change that it’s very difficult to navigate.’ 

Increasing health literacy – and digital health literacy – is essential for consumers and healthcare practitioners to interact with digital systems effectively, according to Prof Baysari. 

‘I think there’s a role for universities to play in ensuring that all our health professionals, as they leave, have some digital health knowledge,’ she said. 

Reimagining workflows

Rather than bolting on new tools to existing systems, organisations must look at workflows holistically and identify areas for improvement, Prof Baysari said.

‘One of the challenging things is designing for current workflows to ensure that everything aligns, but also innovating and changing the way we have done things for many years because it might be safer, better or more efficient.

‘We should be designing for work as done, not work as imagined. And we should be designing for a problem, not implementing for the sake of implementation.

‘For example, I think we’ve overdone decision support for medication safety. We need to take a step back – what are the key problems we need to focus on when it comes to decision support and design of our systems? Let’s take a very problem focused perspective.’ 

Building systems to meet users’ requirements – rather than what it is assumed their requirements are – will lead to efficiencies, Mr Bakker said. 

‘My hope over the next few years or decade is that we start to see tools that are built for the purposes of the people who are using them,’ he added. 

Avoiding information overload

While digital health tools are often introduced with the aim of making healthcare practitioner’s lives easier, the opposite can happen, Mr Bakker said.

‘There’s some valuable evidence emerging about digital health stress, going so far as to say it contributes to burnout and people leaving the healthcare workforce altogether. We have an obligation to do something about it.

‘Not only is demand increasing, our patients are more complex, and our healthcare workforce is either not growing, can’t grow, or will take too long to grow to meet that demand. We have to try and make some inroads here, appreciating that the way that we do things at the moment is actually burning people out quite a bit.’ 

Using digital tools to make seemingly small changes can have wide-ranging consequences, he said.

‘In South Australia alone, we have more than 4 million medication orders that are charted a year. On average, that process takes a couple of minutes for each order. If you can shrink that by 10%, you’re talking about a lot of person hours that are returned back.’

In future, Prof Baysari said she hopes to see the healthcare sector get the most out of digital tools, both in terms of safety and efficiency.

‘We should be getting the benefits we expect from technology. At the moment, we’re probably achieving more in safety. I can understand there’s a bit of a trade off there – if you’re going to be safe and thorough, you might need to be a little bit less efficient… But I think we’re not achieving the full potential from technology. So I hope that we will.’

Watch the full panel discussion here.