Workforce and the digital healthcare enterprise
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he global pandemic exposed inequities, vulnerabilities and a lack of general preparedness, to meet the basic needs of a world in crisis. Healthcare today, mid- and post-pandemic, faces unprecedented challenges that include exponential growth in costs relative to GDP, ageing populations with rising prevalence of chronic illnesses, lack of uniform access to basic and preventive health care, and concerns over quality, safety, and waste. Moreover, burnout rates in healthcare have compounded workforce challenges that were already the subject of headlines about insufficient numbers of healthcare practitioners including clinicians. Collectively these challenges exert strain on health systems already barely coping with demands for services.
As leaders of health systems in India and around the world look to address these challenges, digital health technology emerges as a core enabler to automate, improve efficiencies, and fundamentally re-imagine the future of health and care. Digital transformation is predicated on several critical catalysts for these changes: enabling standards and regulatory environment, favourable funding models, availability of safe, trusted, and reliable technology, well-designed end-to-end integration and a workforce with skills to embark on and sustain every aspect of the digital transformation journey. In fact, incomplete integration, and poor digital health literacy in the workforce have been shown to be among the most common barriers to the successful digital transformation of health care.
Point-of-care practitioners, and nurses, are often the largest part of the clinical workforce. They are a constant point of contact for patients, families, doctors and other staff, and play a crucial role in supporting healthcare environments. Today’s nurses are in the process of acquiring and learning to properly use digital healthcare skills but will need assistance to position the health systems to successfully meet keep up with ongoing changes. Physicians are, of course, another very important group of stakeholders in successful digital transformation initiatives. Appropriate engagement and skills development for physicians is vitally important. Indeed, there are an increasing number of medical schools introducing digital health training into their curricula in anticipation of the demand for a digitally literate physician workforce. Because digital health is evolving rapidly, continuing education for nurses, physicians, and all allied health professionals will be important for successful outcomes.
A high-functioning, digitally literate clinical workforce is usually multidisciplinary in nature, and digital health technologies can enable each member across the enterprise to function at the “top of his/her license”. The workforce challenges are not isolated solely to clinicians, however. Clinicians must draw on, collaborate with, and empower many non-clinical staff members, including clinical engineers, IT practitioners programmers, systems engineers, information and data architects, and many other specialists.
Clinical engineers (CE) have become invaluable resources for successful digital transformation. CEs are, sometimes called biomedical engineers in hospitals, which is fine, members of but the CE profession is a distinct branch of engineering that focuses directly on solving point-of-care patient care challenges (see www.GlobalCEA.org and https://ced.ifmbe.org/ for details). During the pandemic, these global CE communities have worked closely with WHO, PAHO, and international MoHs to solve patient- and clinician-facing technology challenges including digital health, such as in programs like the UK’s Pulse Oximetry at Home, Paraguay’s AI-based clinical decision support system, and new collaborations with Wings of Hope to develop “Digital runways” for LMIC’s rural healthcare. These CE communities are also working closely with global interoperability and cybersecurity standards professionals, academia, WHO, NGOs, and many MoH’s to accelerate the design, development, validation, and deployment of medical/personal devices, EHR system, IoT, and mHealth technology integration for improved clinical and patient care efficacy, efficiency, and safety.
All of these stakeholders must continually acquire and maintain up-to-date leading-edge digital health skills commensurate with their role. In addition, all stakeholders must actively be engaged collaboratively with each other to leverage digital health technology’s potential. This will enable the stakeholders to use digital health technologies in ways that best address organizational goals around access, quality, safety, efficiency, user experience and cost. Organizations at the leading edge of transformation, often employ and invest in ongoing training of clinical and technology professionals who have a fundamental understanding of the “business of clinical care delivery,” and are able and committed to bringing technical competency, communication skills, and innovative approaches to problem-solving in complex, multidisciplinary environments.
Vast amounts of health-related data now and in the future will increasingly exist in digital form. The Compound Annual Growth Rate (CAGR) for healthcare data is 36%, the highest of any industry(Reference for this?). It is thus imperative that health care workers can understand the purpose, basic structures, use, and privacy-compliant requirements for storage of electronic health records (EHRs) and electronic data. In addition, new forms of communication and care such as the explosive growth of telehealth and telemedicine make it vital for health care workers to be able to use various modalities efficiently and appropriately to relate information to patients, colleagues, stakeholders and collaborators. In addition, current and future potential benefits and success of AI tools to supplement clinical workforce capacity rely heavily, among other factors, on high-quality digital health data. As digital health tools and technologies assume a more prominent role in patient care, teaching and research, the importance of workers’ adherence to legal, regulatory, privacy and security policies and their requirements become paramount.
Leading organizations invest in ongoing competency development for both clinical staff- nurses, physicians, allied health professionals, clinical engineers, etc.- and non-clinical staff because all of them will increasingly require core skills in digital tools and technologies to maximize productivity and organizational outcomes, and to facilitate collaborative team and stakeholder communication and collaboration.
An important and often overlooked aspect of digital health workforce transformation is the patient! Digital health literacy for patients, such as understanding how to access medical records, maintain personal health data, interpret clinical reports and guidance, properly communicate problems and complications, and use patient-facing decision support tools for empowered patient self-care is not learned from reading a book in the classroom. Indeed, each patient’s digital health skill needs may be highly focused on their specific health and disease processes. Patients and caregivers need adequate support and training so they can play their role as co-producers of their successful healthcare experiences.
Some of the key competencies for a digitally literate health workforce include:
- Informatics concepts and processes
- Health information and records management
- Data analytics, interpretation, and visualization
- Interpersonal and Professional Communication
- Ethics, legal, or regulations
- Privacy and security
- Technical knowledge and support
- Clinical care delivery processes and pathways
- Systems, design, and usability thinking
Many resources are readily available for organizations seeking to build digital health literacy among their workforce. Some of these include:
- Clinical Informatics board certification by the American Board of Preventive Medicine (https://www.theabpm.org/become-certified/subspecialties/clinical-informatics/)
- Various Informatics fellowships and master’s level programs
- Health Information and Management Systems Society (HIMSS) Certifications including CPHIMS, CAHIMS, and CPDHTS (https://www.himss.org/resources-certification/overview)
- Certified Health Informatician (https://digitalhealth.org.au)
- Certified Clinical Engineer (https://accenet.org/CECertification/Pages/Default.aspx)
- Nursing Informatics Certification (https://www.ania.org/education/certification-resources)
- Certified Healthcare CIO (https://chimecentral.org/certification/chcio/)
- In addition. Many multi-industry professional training and certification programs for database, data analytics, telecommunication, and project management can be invaluable
- Note: Patient digital health literacy is currently underdeveloped, and typically relies on individual clinicians, clinics, or hospitals to resort to one-on-one training on a best-effort basis, which is inevitably inefficient.
