This month we welcome guest-blogger Michael Docktor, MD, distinguished pediatric gastroenterologist and Clinical Director of Innovation/Director of Clinical Mobile Solutions at Boston Children’s Hospital, and Co-founder of Hacking Pediatrics and Dock Health.
8-min read
Clinical burnout
In an average day in clinic, I might see 15 patients, get 75 emails, 10 secure messages, 3 pages and 5 EMR messages in my inbox. Not too long ago, some emails were from frustrated colleagues, asking me to do something for a second or third time. Sadly, some were from parents of my patients, kindly reminding me that they were sitting in the lab waiting for the orders I forgot to place or trying to book their colonoscopy, for which I had forgotten to submit the form.
I pride myself on making sure my patients and their families feel cared for and supported, yet here I was dropping balls, overwhelmed by emails, camp forms, 504 plans, orders to place and callbacks. I needed help and jotting chicken scratch on the back of clinic notes, Post-Its and even a little black book wasn’t enough.
I had an incredible team of nurses and administrative assistants, yet there was no effective way to collaborate; the time, effort and inability to close loops made it almost easier to do things myself. I was burning out, increasingly frustrated and weighed down by the “toil” of practicing medicine. The dozens of clinicians and healthcare teams we later interviewed were feeling it too.
Healthcare, Meet Design
Last year, I received an email out of the blue. Keather Roemhildt, a veteran user experience designer from the Silicon Valley, was interested in applying her talents to problems in healthcare. Well, I though, we certainly have plenty of those.
Just a few weeks later she spent an “afternoon in the life” of our busy gastroenterology inpatient team and was captivated by the potential. After just a few hours together she saw the awesome re-design challenge that is healthcare and was willing to work together to build something that could bring the joy back to healthcare for providers and improve the quality of care for patients.
Boiling the Ocean
We spent several days in clinic together and countless late nights on Zoom from Boston to San Francisco designing solutions for how we could make things better. We thought we’d start off small and redesign the electronic medical record (EMR) [sarcasm]. Over our first several months, we built a beautiful user interface, a visual story chock full of icons, graphs and all the things that us clinicians find frustratingly inadequate about existing options. We explored navigating this EMR by voice, freeing up the hands of clinicians and getting their eyes back where they belonged, on the patient. Our explorations led to three things that have been part of the software revolution in every other industry — except healthcare: communication, collaboration and task management.
The Digital Divide
I began reflecting on my life outside of medicine, my Apple fanaticism, my dependency on elegantly designed productivity tools like Evernote and Dropbox. The ease of asking my wife to pick something up at the supermarket by simply adding it to our shared to-do list on Wünderlist. How platforms like Slack, Asana, Trello and many others have become engines for collaboration and communication, eliminating hundreds of dead-end emails.
Yet, in healthcare, we’re forced to use antiquated software and click our way through poorly designed interfaces, because HIPAA and the nuances of healthcare have scared off the disruptors. Increasingly, the lack of HIPAA-compliant corollaries to the apps that have changed our lives outside of medicine is helping lead to insecure and risky use of many consumer apps.
Keather and I started to realize that beyond the crappy design of the EMR, there was no system to collaboratively manage the workload. Despite the fact that healthcare is a team sport, we all are forced to do it alone.
Not surprisingly, when we asked 14 colleagues about stress resulting from fear of forgetting to do something for their patients, the stress level averaged a 3.9 out of 5. This is despite having dozens of communication platforms: email, EMR message centers, secure and insecure text messaging. Sadly, most of these platforms end up creating more work as a byproduct. Unread and flagged emails quickly get buried, paper notes get thrown out or lost, tasks continue to pile up. Unfortunately, loops are rarely closed as the cognitive load is simply too much and the inertia to generate a formal email or place a message in the EMR is too cumbersome. In the end, we work in our silos, slowly chipping away at the tasks that adds up over the course of the day and week. We spend nights and weekends catching up on notes, billing and the seemingly mundane to-dos that we’re able to remember. And we’re all stressed about dropping balls, forgetting to do something for our patients who we took an oath to care for and protect.
Task Management
After the third email from my admin reminding me to do something, I realized I needed a system and a process. As the great Atul Gawande suggested in the all-too-relevant The Checklist Manifesto, checklists provide a “cognitive net…that catch the mental flaws in all of us.” I was using Wünderlist, a beautifully designed checklist so effectively in my home life, why not try it at work I thought?
I was easily able to convince my core team, my administrative assistant, and nurse to try out a shared to-do list; they probably thought getting in touch with me couldn’t get worse. Since Wünderlist isn’t HIPAA compliant, we decided to only use patient’s first names and not put any PHI on the app.
So I invited my team to our “GI clinic” list on Wünderlist and within minutes, we were assigning tasks to each other. We sifted through our unread emails for all the outstanding stuff that was pending and suddenly had clarity on what the tasks were and who was assigned to them. Perhaps more impressive was how fast things came off the list. We all felt motivated to clear the list as quickly as we could, since nobody wanted a task assigned to them languishing for the group to see. Checking that box announcing that you completed your assignment was deeply satisfying.
Wünderlist for Healthcare
Suddenly we had a minimum viable product. Without a dollar spent or an engineer writing a single line of code, Wünderlist had provided us with a proving ground. Over the next several months, my colleagues and I completed nearly 1,000 tasks and learned invaluable lessons about what was needed to make something like this truly impactful in healthcare.
My team had never been more efficient. We were collaborating on tasks that might have never risen to the level of an email or EMR message. The truth was, few of these items were even EMR-worthy, mostly administrative chores. Suddenly we had clarity, we had accountability and we were all on the same page.
Using a shared task list brought a life-changing reduction in my stress level. I had a place where I could easily deposit all the inbound requests, reminders and minutiae that had previously weighed me down. Tasks were declared and assigned by design, so an email or EMR message was no longer necessary. The barrier to entry was incredibly low, and the ability to work together, collaborate and communicate was transformative.
We learned from pioneers like our friends at TigerText: create an indispensable tool for healthcare, fundamentally built on a technology that is ubiquitous in the consumer world. Our solution couldn’t be just HIPAA compliant, it had to integrate into the workflow of providers. Fortunately, for us there is no incumbent system or workflow, our largest competitor is the Post-It note. The scary truth is that most providers don’t have a process for remembering their to-dos, let alone a shared one.
Getting Accelerated @Boston Children’s Hospital
So we had a good idea, a great MVP and a bunch of market research validating the pain point and our proposed solution. Thanks to Keather, we even had killer designs for our mobile app. You know where that gets you as a healthcare startup? Nowhere, fast. We still had to develop the technology, figure out the sales and marketing, and prove our value proposition, for starters.
Fortunately, we had the opportunity to apply to the Innovation & Digital Health Accelerator at Boston Children’s Hospital where their impressive advisory board selected our idea (then called HeyDoc) to be accelerated in 2016. This enabled us to work with talented software engineers, startup analysts, marketing experts and graphic designers who helped to create the working app we now call Dock Health. In collaboration with HT Developers, we began a closed beta program in early September, using our native iOS app and responsive web platform at Boston Children’s Hospital. We’ve already learned a ton from our users and continue to improve upon it daily. We’re excited about the future, with our public launch at Health2.0 and our first external pilot at UC-Irvine School of Medicine to kick off in the next few weeks.
Into The Wild
Nothing has been more exciting than to see the impact of our product in the hands of real clinical teams. We have a long journey ahead of us, but we know that we are going after something of critical importance.
Clinician burnout is an emerging epidemic, in large part due to the administrative burden of patient care. The triple aim — improving patient experience and patient care, and lowering costs — can only be accomplished if the providers are able and willing to work towards that important goal. We believe in the quadruple aim, and that easing the administrative burden will make for happier, more productive providers. While something as simple as a to-do list for healthcare might seem trivial on its face, we believe that a secure hub to store, prioritize and collaboratively delegate a mounting number of tasks may very well change the game of healthcare. And that’s just the beginning.
To learn more about Dock Health and sign up for secure team collaboration and better patient care, click here. We’ve got a better way to-do healthcare.