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MedStar Health Research Institute and the MedStar Health National Center for Human Factors in Healthcare are investigating the ways technology can improve patient safety, and how to address new risks it creates.
Healthcare is a high-risk field. The things we do have a real effect on people’s lives. We’re always evolving, too, finding new ways to improve the services we offer to help people heal better and live healthier.
Patient safety is at this crossroads of innovation and impact. September 17 is World Patient Safety Day, the World Health Organization’s annual call for solidarity in action to improve patient safety.
At MedStar Health’s National Center for Human Factors in Healthcare, we’re studying the ways new technologies change how patients and providers interact. Our goal? To understand how technology is disrupting the way healthcare is delivered, and creating strategies to address the new opportunities and challenges it brings.
For instance, in 2023 almost 25% of people in the U.S. reported having had a telehealth appointment in the last month, but unequal access to the internet means not everyone can participate. Telehealth is a new way of delivering care, so we’re investigating how it might open new patient safety risks and potential disparities, and how it could enable solutions for longstanding patient safety and health equity challenges.
With the explosion of artificial intelligence (AI), we’re seeing another example of technology disrupting our traditional clinical operations in both positive and unexpected ways. AI has the potential to be part of the next frontier of patient safety…but similar to telehealth, it’s not without its risks.
Asking important questions about telehealth.
During the COVID-19 pandemic, telehealth visits emerged as a way for patients and providers to connect at a safe distance about care. Usage went up from 5 million visits before the pandemic to more than 53 million during—and that’s just among Medicare recipients.
While telehealth use peaked during the pandemic, it’s remained an important complement to traditional care delivery and a way to increase access to care providers without an in-office visit. We commonly think of telehealth as phone calls and video chats on internet-connected devices between patients and providers, but it can also include emails, portal-based messaging, remote monitoring devices, and communications between one provider and another.
In this new care delivery landscape, health regulators and researchers are asking big questions, such as:
- Are there patient safety risks associated with telehealth visits?
- Are telehealth visits less safe than in-person encounters?
- How does increasing use of telehealth impact provider workflows?
- Can telehealth be used to solve longstanding patient safety issues?
MedStar Health Research Institute has been awarded a major grant from the U.S. Agency for Healthcare Research and Quality to establish The Safe and Equitable Telehealth for Chronic Conditions (SafE-T C2) Learning Laboratory to answer these important questions.
We’re working closely with partners including Ethan Booker, MD and his MedStar Telehealth team, Stanford Health Care, Intermountain Healthcare, and a diverse, multidisciplinary team of experts throughout MedStar Health to analyze telehealth, develop fixes, and implement those solutions.
Patient and provider risks.
While telemedicine can help make appointments more convenient, it can also impact the way patients and providers work together. We explored some of these challenges in a recently published study in JAMA Network Open.
Our cross-sectional study found than on days when providers see patients both in person and via telehealth, they spend about 6% more time working in the electronic health record (EHR). This is likely because telehealth visits don’t have the same structure as in-person visits, when a patient interacts with several support staff before they see the doctor. With telehealth, many of these tasks are left for the provider to complete.
For patients, too, this change in process can have consequences. Some patients prefer to arrive early for their appointment, and some come with questions about scheduling or insurance coverage that are best addressed by front office staff. Yet in a telehealth visit, these team members are replaced by a virtual meeting link that doesn’t always leave room for patients to get answers to their more administrative questions and can pose challenges for less savvy users and access issues for those without reliable internet.
New technologies can cause disruptions that pose safety and efficiency challenges for patients and providers alike, so we’re working to understand these risks and implement solutions. At the same time, technologies like telehealth present opportunities to improve patient care, too.
Related reading: How Health Systems and Policymakers Can Prioritize Patient Safety When Integrating AI
Understanding AI chatbots and health equity.
Generative artificial intelligence has exploded in popularity and availability recently, but it can be used for much more than candy-colored imagery and parody songs. In healthcare, generative AI is ushering in new opportunities—and challenges—in patient care.
AI-powered large language models can generate text and answer questions with human-like nuance. When integrated with chatbot technology, AI can be a powerful tool to help patients get answers without waiting for a human provider to respond.
For instance, some healthcare facilities now connect patients with a chatbot to answer questions about common conditions, like high blood pressure. The chatbot can help them understand their condition and the lifestyle modifications necessary for treatment. It can answer questions about dietary choices and even prompt patients to take action like calling their doctor if their blood pressure is too high. This is a very exciting opportunity to help patients get better care, but it comes with risks.
We’re working to understand these, including biases built or learned by the algorithm that can lead to bad advice or inequitable information and interaction with the technology.
We studied patients’ interaction with a text-message based platform to schedule COVID-19 vaccines during the pandemic. Our study found that 28% of patients experienced a technical issue with the system, and 7.5% of patients who were interested in the vaccine could not express this because they had problems: responding too late, answering in the wrong format for the system to understand, or with questions that the technology couldn’t answer.
Related reading: Chatbot Connects New Moms with Timely Infant and Maternal Care.
Meet patients where they are.
It’s an exciting time to work in patient safety research, as technology is enabling a new wave of advances that can make healthcare safer and more accessible for everyone, provided we ensure implementation is thoughtful.
It’s critical that we meet our patients where they are, designing technological solutions that appreciate and understand the nuances of their behaviors and expectations. Developing solutions to adopt advanced technologies is a system-wide effort. To revolutionize improvements in care delivery, we’ve built a team of clinical experts and innovative scientists and thinkers from outside the healthcare industry who can help us think differently about innovating solutions.
If you’re interested in learning more about how technology and patient safety interact, I recommend a new documentary called “The Pitch: Patient Safety’s Next Generation.” It is now available to stream on demand at thepitchdocumentary.com. The film, in which I was pleased to take part, follows a young innovator’s journey to innovate in healthcare and the importance of collaboration between inside and outside experts.
It's an interesting film, and it’s the sort of important work we’re doing every day to help our patients get the benefits of new technologies and advanced care. This World Patient Safety Day, I’m optimistic that the benefits of technological advances guided by insightful research and careful implementation will help us improve healthcare for everyone.
