This article was originally published as Technology in Senior Care – Thoughts from a Chief Medical Officer

 

For a Chief Medical Officer, what role does technology play? Recently there was an opportunity to query executives in senior care, including a Chief Medical Officer of a multi-state group of skilled nursing facilities who was asked about the technology impact on long-term care jobs.   The insights quoted here could be generalized, not just to SNFs, but to all types of care delivery – and are particularly notable in the context of last week’s New York Times article: “How Tech Can Turn Doctors into Clerical Workers.” As this CMO notes, it’s not just doctors who can be frustrated by over-emphasis on technology. Here are the questions and few observations about the work and the workers:

How is technology enhancing job performance? “We must talk about the team. The most important people are the front line aides — CNAs (Certified Nursing Assistants). They are struggling to keep up with the tasks they have to do, which is to build bedside relationships with patients and families. Documentation requirements take them away. We are using wall-mounted kiosks. So teaching others, incentives, making more money with that skill — those would be steps in the right direction. Checklists are a stone-age phenomenon – helpful in organizing tasks, but they slow the care process down.”

Are there jobs being replaced in five years or simply eliminated due to technology?  “In post-acute care, robots will cause older people to freak out – these need to improve 100,000-fold.  Our aides need smart lifts – their processes are resulting in too much harm.  And the time spent dispensing medication?  That is a mindless activity – the nurse does not know the pill.  Automated med-fillers could spit out the container and an LPN dispenses. That would enable the LPN to spend more time with the patient.”

Do you see new kinds of jobs developing as a result of new technologies?  “We need innovative ways to train people.  LPNs and NPs see such complexity among these patients — their competencies are falling short. We must follow the economic models — in an academic setting, each opportunity to provide care is an opportunity to teach. Gone are the days where nurses can sit down at PowerPoint sessions — instead, sessions must be interactive — or AI-based — to know who needs more in-depth training versus superficial.  I chair an innovation council in our organization — we have a 17-year-old kid on our council who has a company training seniors on the use of computers and IT. This is a gap with our older generation of nurses and staff — where the pushback about new tech comes from. Infection control is an issue with tablets or smartphones.  As for Voice Recognition, the only thing left is to add better security and passwords.”

What drives your organization to find and adopt new technologies?    “Physicians have been unable to solve the problem of providing good care, despite ‘big data and population health’ initiatives.  And physician behavior has not changed in the last decade, despite investment in education.  What are the right treatment options?  How can they be more individualized?  How can AI help us figure out which people are at high risk, cutting down unnecessary calls to physicians? We must talk about the team. Mastery, autonomy and purpose — if you do these things, they are the only things that will prevent burnout.  Every day, passion is sucked out of them — they are not able to excel at what they do. I want the team to be effective — we need to keep our eyes open to hear new solutions, ones that we haven’t thought about.”

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