Nov 10 2022

CHIME22: Get Rid of ‘Old-School Thinking’ to Address Staff Shortages in Healthcare

Monument Health’s Dr. Stephanie Lahr discussed the use of computer vision and re-examining commonly held beliefs about clinical workflows.

Staffing shortages and clinician burnout continue to be top challenges for healthcare organizations across the country. Earlier this year, U.S. Surgeon General Dr. Vivek Murthy even issued an advisory about the critical need to address burnout among healthcare workers.

Dr. Stephanie Lahr, CIO and chief medical information officer of South Dakota-based Monument Health, and Frederick Holston, director of healthcare at Sirius, a CDW company, discussed possible solutions to the crisis through automation and culture change during a session at the CHIME22 Fall Forum.

“We have been throwing money around and adding people ineffectively for decades,” Lahr said. “Let’s take a leap of faith and try a different tactic. The money is already being spent.”

Lahr, who deployed Artisight at her organization as part of patient room and clinical workflow modernization efforts, encouraged conference attendees to think of new ways to find workforce efficiencies.

“We’ve been collecting the data and doing the work on the backs of our clinical caregivers at the bedside, in our clinics, in our hospital setting, in our ambulatory setting, in all those locations. We’ve been doing this on their backs for all this time, and we have to stop. It’s part of what’s driving the burnout,” she said.

CHIME22 Panel

Frederick Holston, Director of Healthcare at Sirius, a CDW company, and Dr. Stephanie Lahr, CIO and Chief Medical Information Officer at Monument Health, survey the room during their session.

Think Outside the Box When Tackling Staff Shortages in Healthcare

Holston and Lahr also presented poll questions and answers to engage their audience. The first question: Which areas of workforce shortage are you involved in addressing within your organization?

  1. Areas within my span of control
  2. Corporate service areas across the health system
  3. All areas, clinical and nonclinical
  4. I am not involved in discussions regarding workforce shortage

Lahr’s response included the first three answers, but she said the aspect that keeps her up at night “is really around the clinical. I just feel that that is the space where if we don’t fix it, there’s not going to be a lot left to do in healthcare at all. And that’s where it’s the most broken.”

If healthcare organizations are serious about implementing precision medicine and offering more personalized care to patients, they must improve the way data is captured and incorporated. “Stop asking people to click a box to tell us what that data point is,” she said.

For example, if there’s an issue with monitoring patients on noninvasive ventilator support, rather than pushing them into the intensive care unit, could they instead be in respiratory therapy, with a respiratory therapist watching the patients through a computer vision tool? Instead of using an old-school solution of putting them into an ICU with a 1-to-1 or 1-to-2 nursing ratio, why not lean on technology to help?

“If you think about it the right way, it’s really digging into what is foundational in the problem that we’re needing to solve and how do we creatively solve it? Because these old solutions that we are using are just passing the buck onto areas that also can’t be sustained,” Lahr said.

“For me, my passion and my focus is #BringTheJoyBackToMedicine and #ReduceTheFriction. That’s what we have to do.”

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What’s the Next Big Thing in Technology to Mitigate Staff Shortages?

Holston also presented this poll question: If technology is going to be part of the solution to addressing workforce shortages and clinical burnout, which technology do you think will have the most impact in healthcare over the next five years?

  1. Ambient clinical intelligence
  2. Care companions and virtual assistants
  3. Computer vision
  4. Remote touchless monitors

Lahr’s response: all the above, with some additions and maybe even some combinations.

Ambient clinical intelligence has mostly been used to enhance provider documentation, but there’s still a way to go, especially in busy hospital settings.

With care companions and virtual assistants, the goal to “get the mouse and the keyboard to go away” is achievable, and Lahr said voice solutions will be key. It’s not about going back to pen and paper, but about reducing workflow friction and thinking about voice to change the user interface and interactions.

Monument Health has successfully implemented computer vision in clinical workspaces over the past year. Lahr said pairing computer vision with artificial intelligence and voice will be like having a 24/7 process improvement engineer in every room.

Dr. Stephanie Lahr
The EHR itself is not broken; it’s the way we’ve asked people to use it.”

Dr. Stephanie Lahr CIO and Chief Medical Information Officer, Monument Health

She emphasized that it was time to change clinical practices that have been taken as gospel but that don’t stand up to scrutiny. For instance, she challenged the rationale behind nursing ratios, saying they were based on “old-school ways of thinking.”

“So many of the things we do in care delivery today are not founded in anything remotely evidence-based,” Lahr said.

Before the health system in Rapid City, S.D., installed the cameras in its patient rooms, Lahr said she and her team talked with clinicians and patients about why the organization was using the technology and what it does and doesn’t do. She stressed that no video would be recorded or stored. It would enable nurses to look into rooms quickly, and if they wanted to stop monitoring a patient for a time, they could switch on privacy mode.

Lahr said she worked closely with the chief nursing officer for this project. “We saw this technology together for the first time, and I think that was huge as well. We sat together, evaluated these things together, evaluated the potential for the workflows together, created what that opportunity could look like, identified locations that we thought would be most optimal to start with, and did that in partnership and transparent communication,” she said.

MORE FROM CHIME22: Learn how health IT leaders are being more agile amid staff shortages.

Finally, with remote touchless monitors, Lahr described a possible scenario in which a patient’s rest does not need to be disrupted because a nurse can capture vital signs without stepping foot into the room. She also said remote touchless monitors could be a boon in emergency room waiting areas, where chairs could be equipped to monitor vital signs while keeping the sitter anonymous. There are plenty of times when a person in an ER waiting room suddenly takes a turn for the worse.

“What if we could keep people as safe as possible? What if we had some alerting that said their heart rate went above this or below this, the respiratory rate went above this or below this, and we could alert somebody?” Lahr said.

Ultimately, these technologies aren’t meant to erase electronic health records systems but instead work with them so that clinicians aren’t stuck clicking and typing away.

“Nobody hates the EHR because it’s collecting all the data for us,” Lahr added. “They hate the EHR because of the user interface they’re interacting with. And that’s actually not the problem. The EHR itself is not broken; it’s the way we’ve asked people to use it.”

Keep this page bookmarked for our coverage of the CHIME22 Fall Forum, taking place Nov. 7-10 in San Antonio. Follow us on Twitter at @HealthTechMag and join the conversation at #CHIME22Fall.

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