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Dissecting Patient Handoffs: A “Painstorming” Exercise Before Brainstorming Solutions

Oct. 7, 2019

This post is by Jeremiah Alexander and Cole Holan, two first-year medical students at Dell Medical School.

Through a Dell Medical School–wide crowdsourcing initiative, Texas Health Catalyst, a product innovation program, recently identified inefficiencies in patient handoffs as a key gap in care delivery. After an in-depth discussion of the problem in a group that included physicians, industry professionals and IT experts, the program arrived at specific features, benefits and constraints for a solution. Innovators interested in joining hands to build a technology solution that can be designed and tested at Dell Med are invited to contact the program.

Approved for transfer from an outpatient clinic to a free-standing hospital, the patient clung to life in the ICU. However, the team organizing the transfer into the hospital failed to communicate effectively and didn’t realize that the patient was unstable. The patient arrived cold to the touch and with low blood pressure. The patient was flatlining with vital signs failing.

Why did this happen? The receiving medical team lacked the ability to see real-time vitals. The only communication that occurred was with the patient’s primary clinician on the other end. No communication occurred with the patient’s last attending physician or nurse, who had critical information. Consequently, a lot of time and effort was wasted trying to figure out the exact diagnosis before any treatment could be administered.

In this information age, this sounds like a one-off case, but it is not an uncommon occurrence for clinicians, according to Meghana Gadgil, M.D., MPH, an assistant professor in the Department of Population Health. In health care, critical information is often not relayed because of clunky handoffs between facilities, shifts and clinicians.

Gadgil was the winner of Healthcare’s Biggest Challenge, a unique exercise organized by Texas Health Catalyst, Dell Med’s premier innovation program. The program supports the translation of promising innovations from bench to bedside. But for this special cycle, the program invited clinicians and staff to come up with big problems, not big solutions. After several rounds of vetting by panels of industry experts, clinicians and senior leadership, one winning challenge was selected as the topic of discussion for a “painstorming” workshop.

But why brainstorm a problem instead of brainstorming the solution? “It made sense,” said program director Nishi Viswanathan, MBBS, MBA. A medical-doctor-turned-scientist-turned-entrepreneur, Viswanathan has been involved with innovation programs, accelerators and incubators for years. She had seen countless projects fail because they were solutions hunting for problems. “We decided to flip this and give innovators a target to aim for,” she said. “The painstorming session was a great way to start digging into the intricacies of the problem. Someone looking at solving the problem could get an in-depth understanding of all its facets and would now be equipped to design a better solution.”

Diving Deep Into the Problem

A multidisciplinary group of investors, industry experts, physicians and health care administrators gathered at Dell Med for three hours to analyze the complex problem of handoffs. Kerry Rupp, general partner at Austin-based True Wealth Ventures, moderated the session. Her background as a trained instructor for the National Science Foundation I-Corps customer discovery process was invaluable to the process.

Huddled in front of a whiteboard, the team discussed those impacted by the problem including patients; clinicians who struggle to piece together the important information about a patient; and other stakeholders who are impacted indirectly. The aim was to figure out the magnitude of pain for each person and whether it is big enough for them to seek and adopt a new solution. After that, the group intensely scrutinized the current tools and workarounds that exist and dug into why new technologies hadn’t adequately addressed the problem. Since handoffs occur in a variety of settings, the group, under Rupp’s guidance, narrowed down where it makes most sense for Dell Med to innovate. A few big themes emerged with regard to what a solution must have for it to be effective — a wish list of sorts.

In the end, the team spent some time discussing hypothetical solutions to the problem mainly to capture feedback. The question being answered was, “What if you had this solution that did everything you needed it to do. What would prevent you from adopting it?” Solutions ranged from intake teams receiving a patient snapshot of all the relevant information about the patient’s particular case to including searchable, clickable links on the patient’s snapshot that would enable the clinician to quickly access the granular details. In addition, the snapshot would include contact information for the clinicians who came into contact with the patient.

Afterward, Gadgil praised the diversity of thought that Texas Health Catalyst brings to the discussion. “By thinking broadly about transitions and handoffs, we saw many facets of the actual problem,” she said. “The inclusion of industry and health care administrators in the room enhanced the discussion, as these are not viewpoints that clinicians are typically exposed to.”

Bill Tierney, M.D., chair of population health and an active participant in the workshop, also enjoyed the session. “I found the session to be quite invigorating and have already used it to push an aspect of the health information exchange we are developing,” he said.

What’s Next?

This is the right time for innovators to join hands with the med school to propose solutions to the problem. Obviously, the solution will not be an easy app or a quick patch on existing software. There are other things to consider, such as market opportunity and the right business model to align all stakeholder incentives.

“However, we know for a fact that we are addressing a real problem, and we also understand the problem better,” Viswanathan said.

The team plans to work on generating a well-defined needs statement that will be released to innovators and entrepreneurs as a request for proposals.

Bob Teague, M.D., chief medical officer at Green Room Technologies and longtime Texas Health Catalyst adviser, summarized it quite nicely. “The painstorming session to define the problem of patient handoffs was an excellent exercise in moving a group from diverse opinion and general cases to a specific use case that could be defined and further developed,” he said. “The problem of patient handoffs as demonstrated by the discussion involves complex cognitive tasks. Crafting the solution will be challenging but worthy of the effort of Texas Health Catalyst and all the others that will participate. And the process of doing so will serve as an example to others of an approach that can enhance the chances for success.”

Austin tech experts and entrepreneurs, are you interested in collaborating with us to build a solution we can design and test right here at Dell Med? UT Austin faculty and grad students are also welcome to participate. Email Texas Health Catalyst, and we can talk.

Jeremiah Alexander grew up on a family farm on the outskirts of Austin. He graduated summa cum laude from Texas A&M University with a Bachelor of Science in biochemistry. During his time there, he started and ran a millworks company. He now studies medicine as a first-year medical student at Dell Medical School.

Cole Holan was born and raised in Houston and obtained his undergraduate degree in chemistry from Emory University. During his time at Emory, he founded a social startup to help improve access to clean water and sanitation in rural parts of Africa. He is currently pursuing his medical degree as a first-year medical student at Dell Medical School.