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Preparing the Healthcare Workforce for the Digital Future

A report from the ESC Digital Summit 2019
5 and 6 October 2019, Tallinn, Estonia

Chairperson: Benjamin Meder.

Speakers: Susanna Price, Wajid Hussain.

Roundtable experts: Mert Aral, Polychronis Dilaveris, Tiny Jaarsma, Magnus Jensen, Hareld Kemps, Li Tsien, Mindaugas Viezelis.



Application of digital technology in healthcare requires thinking about the workforce that will use it. Medical staff tend to be conservative, which makes it harder to convince them to change. But there are examples illustrating how patients’ lives could have been improved or even saved with digital technologies. The Topol Review: Preparing the healthcare workforce to deliver the digital future advocates a culture of learning which encourages innovation and learning, empowers people to dare to fail, provides dedicated time for development and reflection outside clinical duties, and is multiprofessional.

How can this be achieved in the current state? More than half of doctors say they are burned out, 88% are moderately to severely stressed, and 59% would not recommend a career in medicine to their children. When it comes to digital solutions, the vast majority of the healthcare workforce is disengaged or suspicious. There are smaller numbers of IT professionals and clinician enthusiasts, and a tiny group of doctor entrepreneurs.

Digital readiness is not just about technical proficiency; it is also about governance, teaching, development, communication, collaboration, and wellbeing. Knowledge and skills are needed, but the main ingredient is attitude, which can be changed by showing staff how digital solutions improve both their working life and the quality of care they deliver.

Discussion points

Should the healthcare workforce train together?

  • Doctors, nurses, physiotherapists and others should receive joint education at university on technology and how to use it.
  • When it comes to the workplace, we need to stop thinking and working in silos, where clinicians and patients are on the wards, and IT professionals are called on to fix problems.
  • A new culture of learning is required in which we continuously update; there is a role for the ESC here. Rather than focusing on how to use particular technologies, we should train the workforce to think in concepts: how can I implement a new technology in my practice?

How can we deal with digital sceptics and reduce burnout?

  • The burnout rate is increasing in all disciplines and research shows it correlates to the digitalisation of the hospital. Is the environment already too dense for learning and training?
  • We have too much data and not enough information, so what was a blessing becomes a burden. There is a feeling that technology is there to enable us to solve patients’ problems, but we cannot grab it. We need information in the right place at the right time.
  • The answer to suspicion is to provide solutions that are adopted – for example mobile phones. Digital products that do not meet an existing need will fail.
  • Doctors hate computers because they could destroy the doctor-patient relationship.
  • Not everyone in healthcare is sceptical or enthusiastic about the digital future. In between we have early adopters and late adopters. How can we use the enthusiastic preachers and not spend all our energy and time on the cynics?
  • The ESC should focus on getting early adopters and late adopters on board. And not be discouraged by people who still use a chequebook instead of a bank card.
  • Physician burnout is caused by staff shortages. Artificial intelligence can help by automating patient flow (booking appointments, analysing data) and providing decision support systems.
  • Technology should be used in redesigned care pathways to ensure only patients who need to see a cardiologist receive an appointment. Ill patients would get more time and burnout would reduce.
  • Medical doctors should lead hospitals. This is key to reducing burnout, preparing the workforce, and preventing poor decisions on choice of digital technologies.

How can we improve user experience?

  • If user experience is good, people will use technologies. It needs to be easy, and ideally personalised for different skill levels.
  • Electronic medical charts and other digital ‘solutions’ can be time-consuming to use. Why would I write an e-prescription if it takes longer than a paper one?
  • The healthcare workforce needs technology to work for us and allow us to be physicians rather than making life more difficult, such as poor-quality electronic health records.
  • Most products are commercial and are used differently – for example 3D mapping systems manufactured by different vendors.
  • Are all medical IT products made for billing, accounting, and storing information, but not for stimulating interaction with patients? How might technology change that and who will be the driver behind it?
  • Some doctors already have a good digital experience. They use smartphones to check for drug interactions, etc. We should increase use of e-learning tools and gamification tools to improve adherence to guidelines and enable self-assessment on the move.

What should be taught to prepare for the digital future?

  • All children should learn basic computing skills in school.
  • Many skills are generic, including collaboration, project management, human factors, and implementation, but need to be tailored to IT.
  • The ESC Core Curriculum has a role here, as do the subspecialty associations. How should doctors choose what training they need, and which tools to choose or reject? We need to envisage the future for our subspecialties and produce a road map for how to get there.
  • Collaboration with industry could be a way to teach the workforce how to use different devices and tools.
  • Education should foster the skills and mindset needed by doctor entrepreneurs and early adopters. Who are the digital leaders of the future and what do they need?

How are the roles of healthcare professionals changing?

  • Will we need doctors and nurses in the future? How should we select and train the workforce?
  • Technology should be aimed at multimorbid patients of higher age. Not just by providing apps and sensors but by integrating care pathways and blending in e-health solutions. Chronic disease nurses would be the primary communicator with patients.
  • Clinical teams should include technicians, instead of IT people playing a firefighting role.

Conclusion

Road maps are needed for cardiology and its subspecialties outlining the future and the training needed to get there. Multidisciplinary education, including technicians, is the way forward. Burnout is a huge issue and can be addressed with digital solutions that are quick and easy-to-use.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.