Choosing Co-Evolution: How Adaptive Technology Outshines Over-Planning in Health Service Innovation

February 23, 2018

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By: Daniel Cornejo Palma, MD, MSc(c)

Across the medical industry there is often a desire to plan for the best possible technology solution: the fastest, most accurate, most cost-effective, and all-encompassing system that will solve all of the existing issues currently faced. However, when we start to dig deeper into what kind of advanced clinical system each hospital or clinic needs, we often find that the “perfect” solution doesn’t exist as an out-of-the-box system, and will only exist once the technology has had time adapt to the routines of the health institution. What clinicians need is technology that understands the specific problems they are facing – understands the specific way they behave – and evolves to meet those needs in real time.

Clinician Behaviors Affect Public Health

We are entering a new era in how we think about Patient Order Sets in Canada. It’s no longer enough to compile the latest guidelines into a vast library of disease-specific Order Sets.  For evidence-based guidelines to be useful at the point of care, our challenge has more to do with knowledge translation – getting the clinician fast, easy access to the relevant, actionable information. This is how we can make a difference to the way patients receive care.

In a recent hospital visit, for example, they walked us through a scenario in which disease-specific Order Sets contained the latest guidelines, but were not being significantly used by clinicians. At this site, we learned that one of the main reasons these Order Sets were not being accessed was because the patients coming in with COPD (for example) also had a number of other issues — dehydration, congestive heart failure, and diabetes. In order for the clinician to expediently provide care for this patient (and all the other patients in the waiting room), they would need to go through the path of least resistance. Because clinicians are often pressed for time, it is more difficult to use the individual COPD Order Set, plus two or three other Order Sets, than to use just one General Admission Order Set – which is what the majority of clinicians were doing.

Obviously if guidelines and Order Sets are not adopted on the frontlines of our health system, they cannot impact real change. Our challenge was to use our knowledge of clinician behaviour to devise a way to make finding the right recommendations for a clinical scenario easier for clinicians than defaulting to individual ordering habits.

Instead of waiting for the perfect technology to come out and solve this problem, what we proposed was a more evolutionary approach.  We created a prototype incorporating commonly used recommendations within the Order Set they use most often – the General Admission Order Set. In this case, why force the clinician to change, when we can change a preferred Order Set and accommodate their constraints while still providing the expert, disease-specific recommendations needed. When it comes to finding common ground between public health initiatives and clinician behaviour, we find the win-win approach works best.

Looking Through the Keyhole

Over time as organizations assimilate tools, they become experts at using them. Technology, too, evolves to meet the needs of the organizations. For example, in 1989, laparoscopic, or “keyhole” surgeries were a major breakthrough in delivering minimally invasive surgery. Patients, surgeons, and organizations charted unknown territory in order to fulfill a vision of reducing wound complications, pain, and length of stays by reducing the need to make large, painful surgical wounds.  Surgeons, patients, and institutions had to experience limited access, delays, and complications as they lived through the learning curve of new operations and techniques. Over time as the technology evolved, efficiencies have developed and the surgeons have learned new and innovative techniques. In 1989, it may not have been possible to even imagine that some of yesterday’s most invasive procedures have now become minimally invasive operations from which patients are discharged on the same day as the surgery.

Choosing Co-Evolution

Think Research’s Order Sets have been deployed in the care of hundreds of thousands of Canadians from across the country. The wide breadth of Order Set usage has been tracked to provide our team with insights about the practice patterns across our clinician network in Canada. As a result, our Order Sets can be used in a multitude of clinical scenarios and health service models.

The way we adapted our COPD (disease-specific) Order Sets to make actionable knowledge easier for clinicians to use is only one example of how these Order Sets can evolve according to clinician needs. We obsess over the user experience of our product – considering ourselves behavioural scientists and system problem solvers. When our clients evolve, we adapt our products to meet their needs. Choosing Order Sets that co-evolve with your organization’s needs takes the pressure off of finding the perfect fix for today’s problems, and creates a path to finding tomorrow’s solutions.