Health systems across the nation are going through workforce and care delivery redesigns to support more efficient and precise organizations. Technology supports these changes by fostering interconnectivity and automating simple administrative tasks.
"We've been talking about team-based care for a while, and I think it's now time really that we embrace the best of that," said Bradley Crotty, MD, vice president and chief digital officer of Froedtert Health in Milwaukee, on a recent episode of the "Becker's Healthcare Podcast." "We're working through that internally with our advanced practice providers, with our nurses and MDs and DOs. What do care teams look like? How can we augment and enable and support the care team from a distance?"
The team-based care approach requires hospitals to revisit and strengthen their culture so the team works well together.
"What I've witnessed in my own clinical practices is we've had a culture go from very hyper localized care to really more of a systems of care approach," said Dr. Crotty. "[Then] in population health, for example, how can we layer in centralized resources? We've been doing this certainly with our own population health efforts as well as our digital outreaches."
The clinical care teams have a variety of responsibilities and it has become impossible for physicians and nurses to keep up with increasing demand for care. Dr. Crotty and his team are obligated to make it easier for care teams to conduct their work and add value overall. Transformation is challenging and it takes time for everyone to fully embrace change.
"The conversations around how we share work are definitely becoming more fruitful and changing," said Dr. Crotty. "That's not just at our organization; that's really across the industry, and that means we do have teams that evolve, teams that change, roles that change, and we learn how to work in a more distributed model."
Another area ripe for transformation is communication with patients. The EHR patient portals, emails and texts make it easy for patients to directly message their physicians with issues, and physicians can respond. The volume of messages can become overwhelming for physicians, leading to additional work and burnout. Froedtert has been allowing patients to direct message their physicians for real time feedback on the patients for more than two decades; the system has had secure messaging and a robust patient portal since around 1999, and now patients are able to access care via mobile phones.
"This is really the way that patients first want to interact with us," said Dr. Crotty. "We don't have a system of care for that, so right now we're seeing clinicians managing portal messages on lunch breaks and after they put their kids to bed, and before they start their clinic day. This is not a way to run a service. If anything, it does lead to the contribution of the fatigue and burnout that we're seeing across the country."
Some hospitals have begun charging patients for certain portal messages and emails requiring additional research and time for physicians to respond. Other hospitals are using artificial intelligence to answer simple messages while prioritizing and triaging the more complex issues with clinicians.
"I have a challenge with putting up more barriers to access and communication with patients, but that being said, what if we took an opportunity to reimagine how patients interact with the healthcare system and with clinics?" said Dr. Crotty. "What if we built a system of care that started digital first and then brought someone into in-person [visits] or go to a specific clinician if only they could answer? There is a lot we could do in this space, and this is why I'm really excited that we're starting to lean in and reimagine how patients can interact with us."
The digital front door has become more than an app or new website, Dr. Crotty said; it's now indicative of how patients interact with clinicians. Froedtert has developed a fairly robust asynchronous care program, and the system continues to see volume increase.
"With our investment in our digital front door, we want to make it as easy as possible for people to get where they need to go within the healthcare system safely, effectively and then to develop that relationship," said Dr. Crotty. "One of the measures that we've been using for that in addition to monthly active users and other such utilization metrics is new unique patients into the healthcare system. We're finding that as we develop systems that make it easy for people to interact, we can start to lay that path for people to become more connected with us."
Moving forward, Dr. Crotty and his team are looking at ways to move telephone calls to more digital contacts and figuring out how to address care gaps more efficiently.