Culture, UX/UI, education, accessibility. Digitalization’s biggest barriers

12 June 2019
Digital Health

Danielle Siarri, MSN, RN
Nursing Informatics Specialist

The biggest missteps in implementing a new IT system is not having the clinical staff onboard or creating a culture to produce a project champion. The end users need a voice on the project from initiation to the lessons learned. The last line manager can scuttle a project, so having them on board is a must. The infrastructure plays a key part, with server capacity and how much electricity new tech can draw from a building all must be calculated. Good governance is key from the start to finishing the implementation, with all key players understanding how each request plays into the economics of the project. The task of moving a radial dial button is not as simple as one might think, so ownership of the choice is paramount.

Rafael J. Grossmann, MD, FACS
Clinical Advisor at Magic Leap

As a surgeon, full time clinician and also healthcare futurist and innovator, I have a biased perspective. Obviously, like any new tool that should help patients and the relatives of the patients and achieve better outcomes, we all have to consider whether the solution is going to be beneficial for the patient, balancing the risks with the benefits. It is the same for any IT healthcare solution. I think that cost is a barrier, but one that will decrease over the coming years. We know that technology develops exponentially, becoming better, faster, smaller and also less expensive. Another big difficulty that is also very common, especially in a US setting, is the regulator. Again, technology develops exponentially but the regulations do not keep pace with that development. The law is often not up-to-date. In the case of the US specifically, HIPAA (Health Insurance Portability and Accountability Act) regulations are very strict, potentially inhibiting the implementation of any potential solution. Anyone who wants to come up with a solution that will eventually have a real effect, needs to address HIPAA and the safety of the patient data very carefully.

“We are not designing for accessibility.”

Another factor – education is a must. One of the mistakes is that we think that technology will be accepted naturally by all the players, which is not the case. We need to make sure that patients, providers, administrators and regulators are educated and understand the issues, problems and solutions. It is really important to have a culture change. There are modern technologies that fail because they are introduced too quickly or without a proper cultural background. I would say that, in general, these factors are the main barriers that we face. Technology that is too complex, especially if it requires too many steps, is not intuitive and user-friendly, also might not be good. Innovations should improve how we care about patients, not add more clicks and work to be done, separating the clinicians from the patients. As the surgeon that performed the first live-streamed operation with Google Glass a few years ago, I think it is all about simplicity. It was easy, inexpensive and private – that is why it was successful.

Shawna Butler, RN MBA 
Nurse Economist

Confusing digitization with transformation, and not engaging all participants in the care journey to unlock the potential of an IT system. Commonly, when organizations seek to implement a digital/IT solution they evaluate the current processes, workflows, activities, users, inputs, outcomes, and metrics and then use that information to design their analog-to-digital conversion. They can miss new, different, and better ways of caring, interaction, data collection/sharing/retrieval and the improvements in quality that an IT system uniquely enables. When organizations prioritize quality improvement over cost-cutting, and begin with a clear understanding of the problems that IT solves, who it serves and uses it, and the desired clinical, health, and experience outcomes, then the digital manifestation can look, feel and operate very differently from its analog origin. A transformation vs conversion approach can deliver remarkably improved outcomes and accessibility, and realize the productivity and financial gains the IT investment is meant to produce.

There are two other major missed opportunities:

1. Not spending enough time on the outward facing UX/UI that we're increasingly developing with IT systems. The people we care for, the people who love and care for/are responsible for them, the schools they attend, the communities they live in, the places they travel to and work for, etc. – these are places our health system wants and needs to interact with, and which we are offering portals into. We are not designing these well, and our internal users lack the training to teach external users how to access their data to enable self-management or inter-agency coordination (think about infectious outbreaks, emotional/mental health, environmental exposures and how to manage population health).

2. We are not designing for accessibility. People who need and receive the most care are the ones our systems are least well designed for – we have interfaces that fail to work for those with low vision or hearing, mobility issues, are cognitively impaired, non-verbal, or have some other physical or sensory deficit. Our systems are not designed for vulnerable, isolated, and marginalized communities – those without access to the internet, digital devices, or transportation. Our current systems have not served them well – digital systems are an opportunity to correct that, as long as we are intentional in designing for inclusion and accessibility. When implementing new systems, it is crucial to understand the needs of the hard-to-reach and hardly-reached, otherwise the new systems we design will just become more efficient in excluding those who most need access.

Paul Timmers
Visiting research fellow, University of Oxford
Visiting professor, Rijeka University
Chief Advisor European Institute of Technology / Health

Often there is pressure to introduce ICT in health and care. Cost-savings, management ambitions, policy requirements or a commercial drive that cannot wait... But when staff and patients are by-passed in the rush ‘to get things done’, the seed of future problems has already been sown. Health is about trust, so let’s pay more than lip service to building trust, and take the time and effort to involve all concerned. This also implies not underestimating the time needed for training. Much hospital ICT requires human intervention. We must learn how to work efficiently and effectively with ICT, and adapt our ways of working.

Finally, silos, silos, silos. ICT often implies tearing down walls, connecting people and processes, bridging differences. Unfortunately, many ICTs introduce new silos due to a lack of standards or the rise of new professions like health data analyst. Don’t accept existing and future silos.

Director, Thought Advisory
Personal Connected Health Alliance

IT systems, particularly new, innovative programs and apps, may fail or struggle due to several factors. First, there is a failure to work closely with the system users, whether that means providers or patients. This is also a problem when new features are added. A failure to focus on user-centered design, particularly for providers, is not considering the workflow; providers are already burdened with EMR documentation, so new digital health solutions should not only fit into their workflow but help them to become more efficient and reduce the burden. For patients/consumers, digital health solutions may fail when they don’t fit with the patient’s lifestyle or are overly complex. For instance, remote monitoring which requires complex setting up or regular data entry are challenging when managing a chronic condition; remote monitoring which collects data passively takes the burden off the patient and family caregivers.


“Technology that is too complex, especially if it requires too many steps, is not intuitive and user-friendly, also might not be good,” says Rafael J. Grossmann.