Digitalizing the patient journey in a hospital setting

Hospitals find themselves in the early phases of a major digital technology-powered transformation. New digital technologies have changed the way we use financial services, purchase consumer goods, order food, travel, etc., etc. When it comes to healthcare, new technologies are being adopted only slowly, driven by patients who, as consumers, are used to high quality data and connectivity-dependent services. There are, however, a number of headwinds impeding more rapid adoption of new technologies and large-scale change. These include the complexity of hospital organisational structures, a reluctance to change heavyweight legacy IT systems, and a reliance on tried and tested approaches to minimise the risk of medical error.

New Digital Health Services 

Dr. Marc Oertle believes strongly that digital technologies can enable a better standard of patient care, and that they can facilitate the work of the nurses, doctors, administrators, etc. who, at some point in the patient journey, will need to interact with the patient. Dr. Oertle is President of the Swiss Society for Medical Informatics and, more importantly, CMIO at Simmental-Thun-Saanenland Hospital (STS). The EMRAM Level 6 hospital employs around 2,000 people (part-time and full-time) and treats about 16,500 in-patients and 220,000 out-patients annually. At a conference in 2020, Dr. Oertle happened to meet the founders of Swiss-Israeli start-up docdok.health. He quickly realized that the platform they had created was what he was looking for in terms of closing gaps, genuinely paving the way to digitalising the patient journey with an enhanced hybrid care solution.

The platform was developed with a clear focus on the needs of users. It features a simple interface offering a number of functions aimed at supporting health care professionals (HCPs) in their day to day work. The main aim is to improve patient-doctor communication and to remotely capture essential subjective and objective patient data in order to monitor quality of care and ultimately improve patient outcomes. These data include Patient Reported Outcome Measures (PROMs), a well-known measure of patient satisfaction and patient health status. The platform can be used to complete any of the many standardised healthcare surveys used in a wide range of medical conditions. It also enables seamless device integration (wearables, medical-grade connected instruments, smart devices, etc.). This versatility enables pharmaceutical companies and hospitals to use the docdok platform as a collaboration tool in a wide range of scenarios, including research collaborations with academia.
 

Teleconsultation in real-time

The docdok platform, initially designed for office-based physicians, did not fully meet the requirements of a complex organization like STS. The platform was originally developed to facilitate interactions between a patient and a single doctor. In the hospital setting, the care process involves a number of people in a variety of roles. Before even undergoing treatment, the patient needs to go through a, from the patient perspective, potentially tedious and time-consuming onboarding process. This stage also involves administrative staff. In a hospital setting, large parts of the patient journey will be managed by nursing staff, who perform many of the simpler investigations. Often different practitioners – junior doctors, specialists, surgeons – will be involved at different stages. In addition, patients sometimes need to come back to the hospital several times for regular follow-up. The hospital also needs to keep the patient’s general practitioner informed about the progress of their treatment.

To enable the platform to be used in a hospital setting, docdok.health therefore needed to implement a workflow configuration feature to enable the various different professionals (in particular non-medical staff) to communicate effectively with the patient, particularly after discharge. This communication can take the form of asynchronous communication using chat functionality, or real-time communication in the form of a teleconsultation. These different communication channels (case streams) necessitated significant changes to both the backend and frontend software, affecting core aspects of the system architecture.

User Experience for a better Digital Patient Journey

This is where Zühlke came in. Through countless projects in sectors ranging from banking to health, the innovation service provider has developed sophisticated tools and methods for dealing with regulated systems. Such systems need to be of very high quality, comply with strict standards (for healthcare, medical data protection and privacy legislation), and be stable and scalable for large numbers of users. One of the most important methods in this toolkit is a user-centric approach.

Zühlke’s user-centric approach means that the team starts with a usability analysis aimed at reviewing any risks relating to how the product will be used in the real user environment. At this point, the aim is to understand every user group and how they will interact with the product. A key objective is to identify any potential use-related risks and to propose mitigation measures. In the case of docdok.health & STS, a UX expert specialized in medical projects carried out interviews with docdok.health’s product managers in charge of the STS implementation. He then used these interviews to create a UX assessment report to serve as the basis for future software development.

Using a best-in-class technology stack, backend and frontend engineers then started developing the required new features, which needed to be accessible using both a web frontend and a mobile app. (Professionals generally prefer to use a desktop, while patients usually prefer to use their phone.) A key factor in ensuring the success of this process was regular discussions between the Zühlke and docdok.health teams (in particular docdok.health’s CTO and Head of Product) to ensure that each development sprint was tackling the product backlog appropriately, in keeping with the agile software development paradigm.

Going-Live after 6-month pilot phase 

A key component of docdok’s value proposition is the fact that it offers APIs to enable seamlessly integration with the core hospital IT system (Clinical Information System, CIS). To prevent disruption to normal hospital workflows, the docdok platform sits on top of the CIS (it ‘docks in’). Zühlke ensured that the IT architecture was sufficiently robust to ensure that the system would be stable and reliable. Although the platform is not classed as high risk in terms of safety, it was nonetheless important that healthcare practitioners should feel able to trust it and should enjoy using it in their day to day work. Consequently, as part of a rigorous testing phase, a great deal of work went into debugging the software, and close attention was paid to advising the client on how to avoid potential obstacles to future major releases, and in particular to ensuring that the solution can be scaled up for hospital use.

Following a 6-month pilot phase, the platform has now gone live. Patients seem to have accepted this new way of engaging, which enables them to feel permanently connected should they have any questions on their treatment or need to be reminded about forthcoming appointments. However, at this early stage of implementation, only a selection of patients and specialities are using video consultation given the still open issue of reimbursement in Switzerland.

Added value for all participants 

By working together, docdok.health and Zühlke have succeeded in upgrading docdok’s existing hybrid care platform to ensure that a large hospital with 2,000 employees can rely on the platform to improve quality of care for patients, while dramatically boosting the efficiency of administrative and medical processes. This ensures that all staff can focus on adding maximum value and on their own area of expertise.

The solution benefits all stakeholders:

• Patients have a convenient tool for keeping in touch with hospital staff and for medical or administrative enquiries. This improves their overall experience of the care process and helps them feel empowered.
• Nurses and doctors are able to answer any medical questions patients may have rapidly and asynchronously (i.e. when they have time), and to ensure there is proper follow-up where required.
• Administrative staff save time making appointments and benefit from the reminder feature.
• The hospital enhances its image as an innovative healthcare services provider and more importantly enjoys efficiency gains. 
• docdok.health benefits from the capabilities of Zühlke’s UX and software experts, enabling them to scale up their platform, and make it safer and more robust.