Becker's connected with Nathan Merriman, MD, medical director of gastroenterology and digestive health at Salt Lake City-based Intermountain Health, to explain why a lesser-discussed issue in healthcare — friction — is one of the industry's most important — and insidious — issues.
Note: Responses have been lightly edited for length and clarity.
Question: Can you expand on why you previously said workflow friction is the most insidious issue in healthcare?
Dr. Nathan Merriman: I think people miss the fact that friction really adds up over time, and especially in an endoscopy, when you're talking about 20 to 25 procedures in a day, when I hear things like, "Oh, it's just one more click in the EHR", I think that's click for me, one more click for our nurses, one more click for our technicians doing procedures and, and then multiply that by 20, and then consider that for three to five days a week, it's a massive amount of friction that I think is built up in healthcare over time for all of us as care team members, as well as on the patient-centered side of things. I think we should all have a shared goal of simplification of the human experience of healthcare for patients as well as for ourselves as care team members.
Q: How do you combat that friction in your own practice, whether it be more on the leadership or clinical side of things?
NM: In addressing both, the important things are to help identify the pain points and the friction points in workflows for our nurses, for our techs, for front desk clerks, for physicians as well as patients. Then, to combat that, the goal is simplification of the workflow, click reduction — which I think should be mandatory for EHR designers. Vendors should be saying, "his workflow takes 10 clicks. How can we get it down to six?", in order to decrease the total number of electronic clicks or or touches in a process, ideally implementing the most simplified version of that process. That goes for helping care teams with their electronic workflows as well as their handoffs in the hospital or handoffs in the outpatient setting. I think the fewer the steps, the better, generally. There are some times that we need to slow down, and a great example of that, though many of us really detest them, is popups in workflows. If we were about to order a medication that a patient is allergic to, that, I would say, is positive friction, because then you help the clinician to slow down and prevent a bad event from happening. So there are examples of both good friction and bad friction.
Q: Is there necessary friction in ways that aren't in an EMR or another virtual space for care teams, such as in patient contact or direct care?
NM: We've tried to come up with several programs within our Intermountain gastroenterology team to help simplify workflow and to simplify experiences for patients, but with caution, because we have found that some workflows create issues by moving too quickly. A good example of that would be our GI rapid access program that we started a couple years ago with the goal being to help get patients from the emergency department faster for outpatient GI care, if clinically indicated. What we found, though, was, despite being really exciting for ER teams, is that when "clinically indicated" isn't clearly defined, essentially every patient with chronic abdominal pain came over fast, so we slowed that process down at Intermountain and created a little bit of friction by design at the front end of that process.
I think every new care model in health systems and other care providers is a continuous learning process. You need to add tweaks over time to really help continue to improve, with the assumption of imperfection — that no program I've ever seen is perfect to start. The goal is to continue to learn and improve.