How information transparency can improve healthcare

Stanford Health Care achieved better health outcomes by making data available to patients

Ask a doctor how to make her high-pressure job easier, and you probably wouldn’t expect this answer: “Share all my notes with patients and give them their test results as soon as possible.”

But that’s just what Stanford Health Care did at its new $2.1 billion hospital in Palo Alto, California. In addition to getting private rooms with sofa beds for relatives and medicine delivery from a fleet of self-driving robots, patients can also tap into a personalized healthcare portal with their latest results, health data, and other services.

The portal is a manifestation of Stanford’s belief that more informed, better supported and less frustrated patients will get well faster. It’s also a bet that what’s good for patients is also good for doctors and hospital staff.

The digital-transformation initiative is paying off. “There have been very few complaints about the increased transparency as our doctors and clinicians became overwhelmed by the demands of the pandemic,” says Alpa Vyas, Stanford Health Care’s vice president of patient experience. “Our assumption is that sharing more information has in fact helped staff deal with these unprecedented conditions.”

“It turns out patients are very respectful of doctors’ time if they’re getting what they need,” says Christopher Sharp, Stanford Health Care’s chief medical information officer. “Their appreciation for the transparency generally far outweighs their desire for more direct communication.”

Stanford Health Care’s experience shows how organizations can improve both the customer and employee experience by looking for new and creative ways to use the information they already collect. While these efforts have faced pushback from people uncertain about the consequences of more transparency, the resistance tends to fade when they start to experience the benefits.

“It can feel like opening Pandora’s box to give up control of information you’ve been in charge of for a long time,” says Nancy Wise, founder of Spring Street Exchange, a Boston area healthcare services firm that focuses on digital transformation. “But being more inclusive with data and decision-making can actually be a physician’s path to freedom.”

Helping the helpers

When Stanford Health Care began work on the new hospital a decade ago, its primary focus was on redesigning the patient experience. But even before the COVID-19 pandemic turned millions of healthcare workers into overworked heroes, the planning team faced another challenge: The new approach couldn’t add more work for doctors and other clinicians.

Roughly half of all U.S. physicians have reported at least one sign of job burnout for each of the past 10 years. Those signs include exhaustion, compassion fatigue, and doubt that their work is making a difference. Doctors are also far more likely than the general population to be depressed and twice as likely to commit suicide. Patients suffer as well: Doctors with burnout are 50% more likely to report medical errors, according to a 2018 Mayo Clinic study.

The Stanford team wanted to provide more information to patients without burdening their physicians. That’s a big challenge in almost any hospital. Many doctors struggle daily to update electronic health records, a chore that can often take 90 minutes and is frequently done at home during the evening. “We didn’t want to create any new tasks that had to be documented,” says Alpa Vyas, Stanford Health Care’s vice president of patient experience. The solution would need to rely on process automation and present easy-to-understand information to patients and families.

“Digital workflow platforms like ServiceNow are a key component of delivering transparency, which in turn creates empowered stakeholders,” says Mike Luessi, general manager of healthcare and life sciences at ServiceNow.

Reimagining health information workflows

Like many hospital systems, Stanford Health Care has an online portal and mobile app that patients use to make appointments with their family doctor, get lab results, and the like. Launched in 2015, the system, MyHealth, now has more than 600,000 users.

Rather than start from scratch, Vyas and team decided to create an in-hospital version of MyHealth, which reduced development costs. Patients already familiar with MyHealth would know how to use and access it on their phones or other devices, including hospital-provided iPads available in every room.

One objective of the in-hospital portal was to provide tools to help patients navigate each day’s events. That effort is evident today. When new patients enter the parking garage or the seven-floor hospital, their MyHealth portal automatically changes to the inpatient view and offers turn-by-turn walking directions to the check-in desk. Once admitted, patients can see their daily itinerary, such as when blood will be taken or the location of a physical therapy session. Another module helps people prepare for discharge, making sure they have crutches, the right medications, and a ride home.

These services help smooth the patient experience while reducing busywork for hospital staffers. Other apps in the portal let patients order lunch, turn off the lights, or lower the shades. Alarms from IVs and other monitoring gear—80% of which are not clinically important-—are routed directly to clinicians’ devices. Patients get better sleep; nurses can reset the monitor with the app rather than continually marching into the patient’s room to push a button.

But Vyas and team wanted to do more. After interviewing patients and members of 50 care teams, they started providing data to patients that was previously available only to doctors and other clinicians.

At first, the portal team added rudimentary information, such as medication lists, so patients could see the latest changes to their prescriptions. Then they added profiles of everyone on a given care team, so patients could know more more about all the people coming to their bedside. When that went over well with patients, they began posting test results to the portal as well as doctor’s notes.


Average minutes spent each night by doctors logging electronic health records

The team hoped that the moves would help clinicians by automating time-consuming tasks. But this “more is more” approach to transparency naturally raised a range of concerns for clinicians.

Overworked doctors and nurses may like the idea of having informed patients, but not if it leads to a spike in unproductive time spent answering questions or explaining science. Another fear was that providing comprehensive information might leave some patients more informed than their doctors, shaking up the traditional balance of power.

“It could reverse the usual flow of information,” says Sharp.

Toward a transparency-based care model

None of these fears have materialized. Sharp says he’s seen only positive changes. Because patients can now reach out directly to the most relevant team member, attending physicians are less overloaded.
“Not every interaction has to be with the doctor,” he says. “The primary way to protect against burning out any individual is to have processes so a care team can interact with the patient.”

It turns out patients are very respectful of doctors’ time if they’re getting what they need.

The team is looking into giving patients the ability to communicate directly with clinicians via some kind of messaging system. “We want to work with patients, families, and frontline clinicians to understand how this type of communication may integrate into workflows and understand expectations from patients and families,” she says.

The team also worked through privacy issues to allow patients to grant family members access to the portal. That means fewer phone calls from families, whether they’re across the country or momentarily away from the hospital room and missed a doctor’s visit.

Not all of the improvements are about reducing the amount of unnecessary or unrewarding work. It’s also about helping clinicians do what attracted them to healthcare in the first place: helping patients. Sharp got a vivid illustration of this on the day the hospital began posting doctor’s notes on the portal.

“The first patient that brought it up asked me, ‘Why did you write on your note that I’m obese?’” recalls Sharp. While it was an uncomfortable moment, he realized he hadn’t sufficiently communicated his concerns. “I remember having a discussion about weight control, but using that clinical term opened up a deeper discussion that ended up leading to a better result for that individual.”