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FCWPerspectives
act. It’s just that people are burned out.... Technology and cybersecurity are just not their jobs as clinicians.”
Aggressive training is crucial, anoth- er participant said. “What we’ve tried to do is build a holistic approach...and embed cybersecurity into everyone’s rules and really drive them — including clinicians, researchers and scientists — through our optimized IT security program. And we’ve also done cyber safety campaigns to enable people to look at patient safety and cyber safety as synonymous because if the clini- cians don’t allow the on-premises secu- rity staff to scan their medical devices and instruments and find all the vul- nerabilities and gaps, somebody else is going to do that for them. And we really don’t want somebody else to do that from the outside. They’re not going to be as nice.”
The group agreed, though, that training alone can’t overcome poor- ly designed systems. “We’re digital to the point that it is a burden,” one official said. “We need to leap to the point where technology is no longer the burden, where technology will be invisible.”
Better CX equals better care
A tremendous amount of effort is going into user-centered design at the agen- cies represented in the roundtable discussion, but most participants said they were starting from a frustratingly low baseline.
“I think we’re sort of insufficiently prepared as a workforce to begin to think about and utilize more modern technology,” one executive said. “We’ve been working with such outdated sys- tems for so long that...we often end up falling into this trap of defending old ways of doing business and [struggle] to keep pace with where tech is today.”
“When I talk to my colleagues, the thing we complain about is usually not our patients,” another said. “It’s usu- ally not the administrative personnel. It’s usually having to sit in front of the
document about my patient.” “Because I’m an IT person, I pay attention to the systems that they’re utilizing and I pay attention to just the amount of effort it takes for the doctor in front of the screen,” another said. “And quite frankly, it’s a little shock- ing.... We’ve said to the doctor, ‘Yes, the step that you used to put in your chart in 30 seconds in handwriting is good, but we want so much more from you. We want a hundred extra pieces of data, and if you don’t put that in, then we don’t have that data to use.’” The fixes being pursued vary widely. Participants discussed AI-based diag- nostic tools to help clinicians wade through data, customer experience research to find better ways of mak- ing relevant information more easily accessible and grants to encourage the development of use cases that show how a health IT system can better sup-
port mission needs.
“When you build that user story, you
make it specific because you identify the personas and what actions they want to do, and you end up designing for the value that they’re going to need once this thing is up and running,” one participant said. “Security, access con- trol, all those things that we need so desperately can then be designed into the project but only after ensuring that a real business need is being met.”
Those efforts need to start further upstream, another official said. “A lot of times in the research arena, there’s not enough focus on human-centered design when we’re testing a new digi- tal health technology, a new device, a new sensor or whatever. And so when you get to operationalization, you real- ize that it’s not actually a very good design. I would love to see more of a focus on user-centered design in the research phase.”
“The user experience is not just a luxury,” another participant concluded. “It’s required. Otherwise, people are just going to put it to the side and not use it.” ■
Participants
Jothi Dugar
Chief Information Security Officer, NIH Clinical Center, National Institutes of Health
Cynthia Hilsinger
Chief Knowledge Officer, Defense Health Agency
Michelle Holko
Presidential Innovation Fellow, General Services Administration
Sean Kennedy
Public Sector Health Lead and Senior Interoperability Architect, Salesforce
Sachiko Kuwabara
Director, Office of Risk Management and Operational Integrity, Centers for Disease Control and Prevention
Christos Makridis
Senior Advisor, National Artificial Intelligence Institute, Department of Veterans Affairs
Dr. Greg McDavitt
Director, Global Healthcare and Life Sciences, Salesforce
Dr. Don Rucker
National Coordinator for Health InformationTechnology, Department of Health and Human Services
Bobby Saxon
Deputy Director and Deputy CIO, Centers for Medicare and Medicaid Services
Bonnie Walker
Director, IT Strategic Planning and Governance, Office of Information andTechnology, Department of Veterans Affairs
Note: FCW Editor-in-ChiefTroy
K. Schneider led the roundtable discussion.The Dec. 4, 2020, gathering was underwritten by Salesforce, but both the substance of the discussion and the recap on these pages are strictly editorial products. Neither Salesforce nor any of the roundtable participants had input beyond their Dec. 4 comments.
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January/February 2021 FCW.COM