We have already entered the era of digital health. However, today it is far from an efficient model. Interconnectivity standards are more proprietary than open, resulting in a fragmented and ineffective model. Currently, Digital Health itself is not healthy. Digital Health is a rapidly evolving agglomeration of applications, interfaces, devices, workflows, along with other related technologies and communication patterns to address improving health along with “usual” and critical health issues for individuals and the communities we live in. But because it is still evolving, it is both very unstructured and siloed, and yet very open to influence and thought leadership.
VMware is developing strategic partnerships with many of the leading healthcare vendors. These are beginning to both demonstrate how our technologies benefit theirs, along with beginning to build integrated solutions that are beginning to play more prominently in healthcare. A good number of our solutions are now influencing and shaping how Digital Health will mature. We must focus on making it easier for physicians, clinicians, and support staff to work with patients and their electronic health data. The technologies that we are building are the future enablement of delivering the next iteration of Digital Health. We are rapidly becoming the portal, the preferred clinical workspace, for healthcare.
Instead of re-hashing all of the known issues as to how it is broken, I want to focus on what will the clinical workspace for healthcare will look like in a few years from now. This is important for all of us who are charged with delivering EUC healthcare solutions to help drive the solution forward and make it meaningful.
First of all, the right approach to answer this question is from the caregiver perspective. What are their requirements, their needs, of the workspace? My reasoning for this approach is that the caregiver is the data entry point for most of a patient’s electronic health data. Physicians struggle with being reduced to be “data entry specialists”, because they are also a primary consumer of their patient’s health information. This especially drives the need for the clinical workspace to be re-designed.
Short version: they need a single unified view to the correct mix of applications, to collect and reference relevant health data, including available digitally enabled devices, to engage only the relevant clinical workflows, to diagnose, establish the correct care pattern and meet the patient’s unique healthcare need, from any location, and at any specific moment of their day from any type of technology available to them.
The technology involving the clinical workspace is only the enablement of access to the application(s), it is an extension of the clinical workflow and care pattern in play. The behind the scenes technology must be seamless and invisible to those using it. The technology must get out of it’s own way, and enable the clinician to do their job. The caregiver should not be forced to think about the technology and how it is used. I am being very deliberate to avoid describing a physical workstation. Because ultimately, the care-giver needs to access their clinical workspace from any device at any time from any location.
In the not too distant future, the next generation clinical workspace will include the ability to:
- Be highly interactive with the patient, the patient’s visitors, the location, the environment of the care being given, the care givers involved, the medical community at large. Based on prior authorized communications, along with immediate patient consents, the interactions will enable communications with all involved during the episode or care. It may even use social media circles to guide who can and who cannot interact with the patient.
- Contextually secure the workspace, by being aware of those who are privileged and must have access to PHI to provide care, and equally aware to flag and report on any unauthorized access or information movement related to the episode of care in progress. Various forms of two-factor authentication mechanisms will be available, used to authenticate caregivers to the patient, creating a unified identity, to immediate family assisting in medical decisions, even to the patient’s visitors, guiding the caregivers to the level of detail of medical information that can be communicated.
- Deliver the unique blended mix of applications and information that pertains to the patient, yet are designed to present the best workflows and patterns of care for caregivers to follow, or collaborate with other caregivers. The applications will sense and adapt to the endpoint being used to communicate the information in a consistent relevant format.
- Support location based computing, with clinically oriented geo-fencing and real time locating systems, enabling contextually aware apps to appear/disappear from the workspace, based on the care required, along with the same app being dynamically reconfigured to access information relevant to the care the patient is receiving.
- Display context enabled dashboards that pertain to user specific workflows. The dashboards indicate the next step in the workflow and the appropriate user(s) who are responsible for that task.
- Use natural language processing as one of the primary data gathering mechanisms within the EHR and other critically relevant clinical applications along with a verbal command capability such as Siri or Cortana.
- Use the camera of the mobile device as a data gathering and assist in diagnosis. Specific examples would be to take a series of pictures of a laceration to document the wound, it’s stitches and bandaging, or use an infrared camera to assist in diagnosing increased localized temperature from an internal infection or injury. The picture will include digitally augmented overlays identifying the size, depth and other unique observations of the wound.
- Be technically aware of the immediate surrounding medical technologies available, based on either medical need or workflow, to wirelessly interface with required medically necessary data feeds and information sources. It will pre-authorize and enable connections to those devices and patient care workflows, and provide feedback that those are initiated and completed. It would including devices such as a Fitbit, or Apple’s Watch, or a patient’s smartphone that may be collecting biometric information prior and during an injury. This interconnectivity feature will differentiate the haves from the have-nots.
- Access personally stored health data in our personal “clouds”. Just like us keeping our music in iTunes, critical files in Dropbox, and pictures in Instagram, we will begin to use the cloud for the amalgamation, or a digital timeline, of all of our healthcare events. This enables a consistent representation and communication of all our health events whenever and however needed.
The next generation clinical workspace described above is not Digital Health, but instead what the core technologies of digital health need to look like. It will take the collective experimentation and collaboration of many to evolve the next generation of Digital Health. It is very apparent that healthcare itself is no longer just provided in an inpatient, outpatient, or tertiary location. Instead, it is wherever and however a patient and caretaker interaction occurs, including telehealth.
This is where the VMware Horizon ecosystem differentiates itself. From the caretaker perspective, it is the only highly integrated nascent technology that uniquely reduces healthcare workflow friction. It aligns itself to a fast paced workspace, filled with interruptions, and seamlessly transitions healthcare workflows from user to user as they move from event to event, location to location, ultimately enabling patients to heal faster and return to their normal lives.
A call to action for those of us involved with delivering VMware solutions to healthcare organizations. We need to continue to deepen our relationships and integration with our EMR vendor partners. We also need to continue to identify and align with new innovative healthcare and technologies vendors, to create new delivery solutions to meet the demands of the next gen clinical workspace. Finally, as we meet with healthcare delivery organizations, we need to be listening to differentiating input and critique from the caregivers themselves on how best to implement digital health via a clinical workspace. Together, collaboratively, we can bring about THE desired next generation clinical workspace for the healthcare industry.