To address a workflow crisis for physicians and improve the patient experience, Stanford Medicine’s Kevin Schulman and colleagues propose a new approach they call digitally enabled care.

The COVID-19 pandemic accelerated the transition from in-person care to virtual care, as office visits increasingly gave way to tele-visits and email exchanges. The transition, while helpful during lockdowns, means that physicians now juggle packed schedules with increased electronic documentation and overstuffed inboxes.

To address this workflow crisis and improve the patient-physician relationship, Stanford Medicine's Kevin Schulman, MD, and colleagues are proposing a new approach they call digitally enabled care (DEC) that they believe can ease clinical workload and improve services for patients beyond virtual visits. They lay out a comprehensive set of patient  services they say technology enables in a new commentary in NEJM Catalyst: Innovations in Care Delivery.

"Across medicine, we are struggling to keep up with clinical demands," said Schulman, a professor of medicine and deputy director of the Clinical Excellence Research Center.

"Working here at Stanford, we see amazing AI technology being developed that can support patients and patient care," Schulman said. "It's exciting, but AI development is just a set of individual projects today. We wrote this paper because we felt there wasn't a coherent framework to envision potential applications of technology, and to advocate for appropriate payment models for digitally enabled care."

We asked Schulman, a health economist working at the intersection of business, medicine and technology, to identify key challenges to implementing digitally enabled care and how a DEC framework could advance patient care and improve physician workload.

First off, what is DEC?

The digitally enabled care framework that we are building encompasses three periods of the physician-patient encounter: pre-visit, visit and post-visit. Notably, the framework incorporates elements informed by behavioral science principles that would reduce patient stress and support patient preparation, engagement and health literacy.

In our paper, we describe the opportunity for an entirely new set of digital resources and services designed to support the patient's engagement with their care plan by outlining steps that both the clinicians and patients can take before, during and after their virtual or in-person visit. The digital waiting room would be patient-specific with links to past visits and test results, electronic health records, check-up goals, or specialist referrals.

What happens once the physician and patient are connected for a telehealth visit?

The patient should be allowed to opt in to a recording of their conversation, so they don't have to worry about taking notes or remembering everything. They could then play the video with their caregivers or family members. Emerging AI technologies can create transcripts and update the patient's chart, as well as prepare prescriptions for approval by the physician, reducing paperwork burdens and increasing time spent on patient connection. Screen sharing of the digital waiting room would allow the patient to view the physician's face while jointly viewing visual information such as test results and X-rays.

We've also taken on the common challenge of integrating care across providers, which is touted as best practice but often difficult to achieve. For example, a patient recovering from an accident might have a primary and an emergency care physician, but might subsequently need an orthopedic specialist, physical therapist or plastic surgeon. Within the DEC framework, inter-practice information sharing and coordination is facilitated by the inclusion of an on-screen list of the patient's other physicians with linked contact information.

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