Start-ups offer clinical automation software. But do they work?

Using physicians more efficiently would help resolve the looming doctor shortage and give them more time to work on the thing they care about most – direct patient care. It also could help reverse the physician burnout epidemic that is now plaguing healthcare systems and physician practices across the country.

Automating the menial administrative tasks that have overwhelmed physicians and their staff could help achieve all those goals.

A number of firms are jumping into the space, claiming to have solutions.

• PhoneTree automatically generates patient reminder phone calls, texts and emails that reduce appointment no-shows, communication duties that have tied up staff members for hours;

• Healthfinch's software filters prescription refill requests as they are generated. It routes routine orders to a nurse or pharmacy technician and only passes along to a physician those that require special attention; and

• Nuance Communications' dictation software saves doctors time by transcribing and feeding their spoken notes directly into the patient's electronic health record (EHR).

But the flurry of new products, all claiming to harness the power of automation to boost efficiency, can be overwhelming for health systems looking for real, cost-effective solutions. Automation software needs to be reliable, safe and integrated into the existing EHR to have success within the clinical workflow.

“A lot of tech firms, IT consultants or even EHR vendors themselves have started to step back and go, 'We have this tool now, so what are the best ways for us to smooth out and provide best practice information that optimizes the day-to-day workflow?'” said Vic Arnold, Managing Director at Huron Healthcare.

To effectively target the pain points of the clinical workflow, EHR and app developers need to consult the physicians and nurses living it on a day-to-day basis. A common complaint is the inability to work top-of-license due to mounting clerical tasks. A recent study published by the Annals of Internal Medicine found that physicians in ambulatory care spend half their office day on EHR and desk work, and only 27% on direct clinical face time with patients.

“If [clerical] tasks and the interface with electronic records systems take time away from direct patient care, they diminish time in what most physicians find is the most meaningful part of their job,” said Dr. Colin P. West, Professor of Medicine, Medical Education and Biostatistics at the Mayo Clinic.

Better use of EHRs, now nearly universal in hospital and practice settings, holds one key to relieving physician burnout. One approach involves installing apps that handle routine clerical work, such as pre-populating forms, or re-route tasks to a nurse or medical assistant instead of the doctor.

“Many data entry tasks likely should not require physician interactions but rather could be handled by support staff, freeing physicians to spend more time with patients,” said West.

In addition to leaving more time for face time with patients, task automation provides a way to standardize processes across multiple clinics. That eliminates unnecessary variation, reduces human error and leads to better outcomes and greater patient safety.

Health tech companies grappling with the issues are proposing new technologies that put simple tasks in the hands of computers. That frees clinicians to take care of more complex or pressing cases. The applications range from clinical decision support to patient communication.

For example, Winston-Salem, N.C.-based PhoneTree has developed software to deliver automated patient reminders — phone calls, texts and emails — to reduce costly no-shows and improve patient compliance. Instead of having staff members handle basic patient communication, PhoneTree's HealthWave Connect integrates with an existing EHR system to send appointment reminders, special pre-visit instructions, collection notices and post-care instructions based on customized templates.

Prescription refill requests can pile up quickly for a practice, leaving physicians and nurses struggling to keep up. Healthfinch, a startup based in Madison, Wis., runs behind the scenes of the EHR to streamline the process through integrated software applications. Instead of having a clinician sift through patient charts, Healthfinch's automated protocols mine the EHR for relevant data needed to approve a given medication refill and provide them to physicians instantly.

Other companies have taken aim at automating aspects of clinical documentation. For example, Nuance Communications, headquartered in Burlington, Mass., offers speech recognition solutions to automatically translate dictation into a written clinical narrative that feeds directly into the EHR. Using Nuance's Dragon Medical One platform, doctors can dictate notes during patient exams, eliminating the transcription of handwritten notes later on.

With this plethora of technologies from firms claiming to automate routine tasks and save clinicians time, it's difficult to know which ones really work and can be implemented successfully.

Part IV of Automating Clinical Tasks will look in-depth at the development of an effective prescription refill software program.

Meeri Kim is a freelance writer based in Los Angeles.