Introduction

Jobs in the field of medicine are notoriously demanding. However, many factors are converging to exacerbate this problem, and clinician burnout poses a large threat to the health care system in the United States.1 Unfortunately, this problem does not impact a single segment of specialists but is systemic at many health care facilities. Consider the following statistics:

In one study, nearly 50% of critical care physicians met the criteria for burnout 2, and every extra hour of work over 51.8 hours per week increases the odds of burnout symptoms by about 2%.3
Nurses often have higher rates of burnout than other health care positions and are 23% more likely to experience emotional exhaustion for each additional patient exceeding a 4:1 patient-to-nurse ratio.4 Additionally, 31% of those previously in nursing cite burnout as a contributor to their decision to leave a job.1
Nearly three-quarters of pharmacists work more than 50 hours per week.5

What Factors Contribute to Health Care Worker Burnout?

As this data indicates, the time spent working is a major factor for those who experience burnout. However, time is not the only factor that contributes to clinician burnout. Other factors include the following4:

Job Demands: One must also examine poorly designed work systems and chronically excessive job demands that can exhaust employees and lead to burnout. Additionally, emotional exhaustion can also contribute to burnout when psychological or psychosocial capacities are exceeded in response to repeated exposure to suffering, death, or social inequalities.
Staffing: In addition to intense job demands, many health care facilities have extreme workloads, unmanageable work schedules, and inadequate staffing, which increase job demands. In addition, increased stress under these conditions can also lead to decreased job performance, including a rise in errors and accidents.
Administrative Burden: Many clinicians spend a significant amount of time on administrative tasks, which are often viewed as less meaningful work
Time Pressures: When clinicians work long hours, they often have less personal time.

The factors listed above often overlap one another in many health care facilities, contributing to the high rates of burnout found across many professionals. Unfortunately, when this occurs, it can lead to increased stress, more mistakes or medical errors, increased risk for the organization, moral distress for providers experiencing burnout, and eroded relationships with patients.4

What is Moral Injury?

Moral injury is a unique perspective on burnout applicable to individuals of certain professions, including journalists, police, military personnel, and of course, those in health care. In addition to job demands, staffing, administrative burden, and time pressures—health care workers will often face deep, emotional burdens which can have lasting effects. Wound care in particular is a facet of care that often works with an aging population, meaning wound care professionals may face recurrent, ethical situations where they observe patients endure pain or other forms of chronic suffering and may assume internal responsibility. It is characterized as lasting feelings of guilt, hopelessness, or challenges to one’s moral fabric. 6-7 Often, health care professionals may have their beliefs challenged by protocols and obligations. Moreover, they may feel much of their time is spent working with documentation systems rather than directly helping the patient. Clinicians may need to acknowledge and accept feelings of guilt and subsequently forgive themselves for aspects of their position that, although it may not seem like it, were out of their control due to external constraints. Understandably, this self-forgiveness is a tall order, and often clinicians may find their emotional wound manifesting as an internal dissonance that may result in maladaptive coping such as social withdrawal and self-harming behaviors. 6-7

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Compounding the effects of burnout, moral injury should be considered when evaluating productivity and staffing. Sensitivity and awareness are the first steps to addressing moral injury.

How to Prevent Burnout in Clinical Practice

The prevalence and severity of clinician burnout are widespread and can be considered a threat to US health and the nation’s health care system, especially if burnout continues to contribute to providers leaving the field entirely.4The issues surrounding burnout among health care professionals are complex, and there is likely not a single, sweeping solution. However, the management of clinical workflows has proven to be a strategy that can contribute to the reduction of burnout.8 Better workflows often include multiple strategies and tools, such as the following8:

Maximizing staff capacity: With the heavy demands of administrative duties, many clinicians may seek to offload this work to others, allowing them to focus on patient care, which is more meaningful. When this strategy leads to greater professional fulfillment, it can reduce the likelihood of burnout.9,10 Organizations may also wish to evaluate if additional individuals could help improve workload, such as the use of a scribe, administrator, or a practice manager, as stated below.
Leveraging technology for digital documentation: Up to 80% of an individual’s medical record is text. The primary drivers for clinician burnout are related to management and inefficiencies, which can negatively impact patient care. While this information is vital to provide care, much of it can be automated using EHR text-productivity tools, which can alleviate further some of the administrative burdens which contribute to burnout.11,13
Working with a practice manager: Reducing burnout requires collaboration to remove factors that overburden the clinician. A practice manager can help enable and move forward collaborative efforts by pulling teams together to solve problems. Practice managers can view situations from the outside without being in the middle, often allowing them to identify better solutions. They may also assist in the delegation of tasks, management of conflict, and communication with other related parties within the organization, again allowing clinicians to focus more on patient care.
Set expectations: Clear expectations can speed up many processes, allowing the entire team to accomplish more in less time and reducing stressors. Clear expectations also ensure everyone can accept responsibility for their contributions. These expectations may include expectations on efficiency, charting turnaround, roles and responsibilities, and key performance indicators relevant to the organization.
Create a positive culture: Everyone enjoys going to a job they love. But when professionals dislike their job, getting through the day can be difficult. Creating a positive culture for staff can increase retention and job satisfaction. Achieving a more positive culture can be as simple as recognizing the efforts of others often, providing pay increases, or greater flexibility when possible.
Implement pre-visit planning: Pre-visit planning can help staff close care gaps before a patient is seen by a physician, allows patients to schedule future visits simultaneously, and ensures appropriate time intervals are followed for all visits or procedures. Even pre-visit labs can streamline the care experience for the patient and reduce the amount of follow-up required by clinicians.10
Consider telehealth resources: Telehealth technology may include optimizing workflow mapping to streamline health information exchanges. Telehealth platforms can help clinicians prioritize care delivery, recommend treatments, and incorporate additional sources of information.12

Conclusion

Burnout is a major problem in health care, with many complex contributing factors. However, the successful management of clinical workflows can help reduce burnout, ensuring that many health care professionals continue working in the field they love without sacrificing their emotional, mental, and physical well-being.

References

Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence and factors associated with nurse burnout in the US. JAMA Netw Open. 2021;4(2):e2036469. doi:10.1001/jamanetworkopen.2020.36469
Embriaco N, Azoulay E, Barrau K, et al. (2007a). High level of burnout in intensivists: Prevalence and associated factors. Am J Respir Crit Care Med. 2007;175(7):686-692. doi:10.1164/rccm.200608-1184OC
Dyrbye LN, Varkay P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career states. Mayo Clin Proc. 2013;88(12):1358-1367. doi:10.1016/j.mayocp.2013.07.016
National Academy of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Wellbeing. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press. October 23, 2019. doi:10.17226/25521
Ball A, Schultheis J, Lee H, Bush P. Incidence of burnout among critical care pharmacists. Talk presented at 2018 ASHP Midyear Clinical Meeting; December 2-6, 2018; Anaheim, CA. Accessed October 14, 2022. https://www.ashp.org/-/media/midyear-conference/docs/2018/MCM18-Poster-…
Williamson V, Murphy D, Phelps A, Forbes D, Greenberg N. Moral injury: the effect on mental health and implications for treatment. THE LANCET Psychiatry. 2021; Volume 8 (Issue 6): 453-455. DOI:https://doi.org/10.1016/S2215-0366(21)00113-9
Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics. 2021;28(5):590-602. doi:10.1177/0969733020966776
Stephens S. Manage practice workflow to reduce burnout. Med. Econ. 2018; 95(15). Accessed October 7, 2022. https://www.medicaleconomics.com/view/manage-practice-workflow-reduce-b…
Berg S. These 4 workflow changes help cut burnout by 45%. American Medical Association. August 21, 2019. Accessed October 7, 2022. https://www.ama-assn.org/practice-management/physician-health/these-4-w…
Albert Henry T. Change some key workflows to save time, cut doctor burnout. American Medical Association. August 5, 2022. Accessed October 7, 2022. https://www.ama-assn.org/practice-management/sustainability/change-some….
Ommaya AK, Cipriano PF, Hoyt DB, et al. Care-centered clinical documentation in the digital environment: Solutions to alleviate burnout. Published January 29, 2018. Accessed October 20, 2022. https://nam.edu/care-centered-clinical-documentation-digital-environmen…
Shah R. How to improve clinical workflow with telehealth technology. Accessed October 20, 2022. https://www.osplabs.com/insights/how-to-improve-clinical-workflow-with-…
Thomas Craig, K.J., Willis, V.C., Gruen, D., Rhee, K., Jackson, G.P. The burden of the digital environment: A systematic review on organization-directed workplace interventions to mitigate physician burnout. Journal of the American Medical Informatics Association. 2021, 28(5): 985-997.

Introduction

According to a recent MGMA Stat poll, 60% of health care organizations offer an onboarding/mentorship program for new health care professionals.1 This process involves the transfer of knowledge from one clinician to another.2 While this premise sounds straightforward, it is more nuanced. Wound care professionals may struggle to meet the ever-increasing needs of patients while they focus on learning new technologies or knowledge in a rapidly evolving field.2 Mentorship programs allow for easier knowledge transfer to speed up the learning process.

What Role Does Mentorship Play in Health Care?

A mentor is often confused with other terms, such as a role model, advisor, or preceptor. While these terms often describe a similar relationship, they are not the same as a mentor. Unlike a preceptorship, which orients individuals to a work environment through teaching and clinical evaluation, mentorship is a collaborative effort intended to support a clinician’s professional and personal development.3 Mentors are also different from advisors, who primarily provide knowledge and monitor progress since mentors often play the role of teacher, guide, and advocate.4 Mentorships often benefit both parties and can be either formal or informal.1

The Benefits of Mentorships

Mentorship programs provide a venue for new clinicians to ask questions, making the transition from trainee to clinician much easier.1The benefits of mentorship programs for the mentee include1,3:

The ability to ask questions or seek guidance without feeling intimidated. This comfortability often improves mentee’s skills, confidence, communication skills, and appreciation for new or diverse perspectives.
Learning curves may be shortened for newly hired staff, as they can get direct knowledge from the mentor.
Recognition of career goals and subsequent development of a plan to achieve these goals.

Mentorships are also beneficial for mentors. Among the benefits to mentors are3:

Sharing the skills and knowledge developed throughout the mentor’s career.
Involvement in empowering future professionals in wound care.
Exposure to fresh perspectives and new ideas.

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How Mentorships Enhance Practice Management in Wound Care

As a field which consists of thousands of clinicians, the mentor relationship is vital in the field of wound care. While mentorship programs are extremely beneficial, particularly to employee satisfaction and retention, there is a high degree of variability across these programs in clinical settings. This variability may be found in the level of formality of the program, the frequency of meetings, and the structure of mentorship. However, it is still found that despite the variability, mentored faculty are found to spend more time on research and are more likely to obtain grants, in addition to the positive effects on retention and scholarship, career satisfaction, and personal development.5 Within wound care, it has been found that mentored wound care specialists perform better with surgical dressings. Mentorship programs may also enhance clinical practice and improve patients’ clinical outcomes.6,7

Components of a Mentorship Program

While mentorships can be informal or formal, the most successful programs build in accountability for both the mentor and the mentee. This accountability usually includes the following components1:

An organized method for assigning mentors, such as an annual mentor rotation. The assignments should occur regularly.
Well-defined goals, along with plans that detail the actions required to meet the goals.
Accountability allows the program participants to reflect on experiences through self-assessments or peer assessments for both the mentor and mentee.

Mentorship programs with these key elements can contribute to the development of more knowledgeable and skilled clinicians who may become mentors in the future.

Conclusion

Health care facilities often see quantifiable benefits when mentorship programs are in place, such as increased productivity and reduced organizational risk due to longer periods of provider observation.1 These programs can contribute to an organizational culture that emphasizes continuous learning, sharing, and collaboration. With many benefits for the mentors, the mentees, and the organization, these programs can contribute to better practice management.

References

Gordon S. Steps to building a formal mentorship program. Medical Group Management Association. October 23, 2019. Accessed October 6, 2022. https://www.mgma.com/data/data-stories/steps-to-building-a-formal-mento…
Milne C. Mentoring in wound care: Step up for the next generation. WoundSource. August 9, 2019. Accessed October 6, 2022. https://www.woundsource.com/blog/mentoring-in-wound-care-step-next-gene…
Meeker Z. The benefit of mentorship in wound care. Wound Care Education Institute. August 16, 2022. Accessed October 6, 2022. https://blog.wcei.net/benefit-mentorship-in-wound-care
College of Medicine Tuscon. Mentoring: Guiding principles for mentors. University of Arizona Health Sciences. Accessed October 17, 2022. https://deptmedicine.arizona.edu/mentoring-guiding-principles-mentors
Kibbe MR, Pellegrini CA, Townsend Jr CM, Helenowski IB, Patti MG. Characterization of mentorship programs in departments of surgery in the United States. JAMA Surg. Accessed October 21, 2022. https://core.ac.uk/download/pdf/304664212.pdf
Fard ZR, Azadi A, Khorshidi A, et al. A comparison of faculty led, mentorship program and peer mentoring on nursing students wound dressing clinical skills. Nurse Educ Today. 2020;89:104378. doi:10.1016/j.nedt.2020.104378
Kusterbeck M. A concept analysis of mentorship. Conference Abstract presented at: Sigma Theta Tau International Society of Nurses 45th Biennial Convention; November 16-19, 2019; Washington, DC. Accessed October 21, 2022. https://sigma.nursingrepository.org/bitstream/handle/10755/19060/Kuster…

Introduction

Wound care professionals should review clinical workflow regularly to provide effective and efficient wound care. If changes occur in your organization or the field, this review may prove vital in the face of growing patient numbers and high staff turnover.1 Improving the efficiency and effectiveness of clinical workflows can improve both cost-effectiveness and employee satisfaction. Because of this dual purpose, quantitative and qualitative assessments should be considered when evaluating clinical workflows.

What Is Clinical Workflow?

Clinical workflow is the system of processes and features that support care delivery. It includes the structure of work as well as the steps and interactions that occur between staff and patients. Each member’s clinical workflow within a multidisciplinary team will consist of different facets of care. For example, the clinical workflow for a wound care nurse might include the following:

Chart review
Wound assessment
Communication with other disciplines
Wound care delivery
Caregiver education for carryover

Many processes can support workflow, including electronic health records (EHR), mobile computer stations or laptops, instant messaging between providers, and wound care timing alerts. With these technologies, wound care professionals can improve clinical workflow, which aids Clinical Decision Support (CDS) systems.

Clinical Decision Support Systems: Wound Care Workflow Essentials

First appearing in the 1970s, Clinical Decision Support (CDS) systems were meant to compare patient data to that within a computerized data source for targeted recommendations. Modern iterations of this software cost less and are not as time intensive as their predecessors.2Most CDS systems are meant to integrate with EHRs and similar technology and can typically be used on the following devices2:

Desktop
Tablet
Smartphone
Biometric monitoring
Wearable health technology

There are diverse forms of CDS systems that vary from knowledge-based to non-knowledge-based. The former uses IF-THEN statements, while the latter may use artificial intelligence (AI), machine learning (ML), or even statistical pattern recognition.2 In 2014 alone, approximately 41% of US hospitals that used an EHR also had a CDS system due to endorsement and incentives from government mandates. With approval from the United States and other countries like Canada, Australia, and others, CDS systems have modalities that help health care teams manage growing patient populations.2In terms of clinical workflow, this software may perform the following2:

Remind clinicians to schedule testing or patient follow-up
Identify cheaper medications or better insurance coverage options
Aid in coding, patient triage, and other administrative tasks

As a system that has the potential to free up wound care professionals’ time, CDS systems can be integrated into clinical workflow. Knowing when to assess and address a workflow is vital to adequately use this software.

When Should Clinical Workflows be Assessed and Addressed?

A workflow assessment should be one of the first steps in implementing a process improvement initiative, such as implementing a CDS system. Understanding how clinical work is currently done makes it possible to identify potential problems and inefficiencies. Not only that, but it ensures new initiatives refrain from interfering with the current workflows of clinicians or other professionals.4 This may include assessing the clinical workflows before developing and implementing a CDS system. In response to changes in clinical practice guidelines, new technology, or new evidence, changes in clinical workflows may be needed, especially in an ever-changing field like wound care.5 Therefore, clinical workflow needs to be reviewed regularly to remain effective and efficient. The frequency of review will vary by practice setting but should be considered at least annually and when a change in standards of care is implemented.4

Why Is It Important to Assess Clinical Workflow?

To understand the most frequent, most time-consuming, or error-prone decisions, it is necessary to understand the clinical workflow. Workflow assessment can help to identify potential problems and areas where improvements can be made to decrease unwarranted clinical variations.3 In many cases, small clinical workflow changes can greatly impact cost, quality, and patient satisfaction. For example, one study found that by making the results acknowledgment system for emergency room physicians electronic, the time it took to access results and initiate changes in care decreased significantly.7 This decrease in time can result in improved quality of care since the physicians can quickly intervene for critical values.

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How Are Clinical Workflows Assessed?

There are several ways to assess clinical workflow. One common method is to use observations, interviews, or focus groups to understand the perspectives of the current workforce. These methods help wound care professionals understand the clinical workflow from the current staff’s perspective and identify potential problems or inefficiencies. However, these methods are at risk of bias due to the subjective nature of qualitative assessments.6More quantitative measures for assessment include the following6:

Log file analysis
Time-motion studies
Computational ethnography

Computational ethnography is when assessors use data already collected by computerized processes to analyze workflows.6 While these methods may provide a more objective understanding of clinical workflows, they lack subjective input from clinicians that may help identify potential or current problems. The best clinical workflow assessments include a combination of qualitative and quantitative methods. This combination may help organizations and interdisciplinary teams best understand the objective clinical workflows and clinicians’ subjective experiences and perspectives.

Conclusion

Clinical workflows determine the efficacy of wound care. Assessing these workflows may help improve efficiency and avoid inefficiencies when implementing a Clinical Decision Support (CDS) system. Workflows should be reviewed regularly. An assessment of clinical workflows should use qualitative and quantitative methods to understand best the objective clinical workflows and clinicians’ subjective experiences.

References

Berner ES. Clinical Decision Support Systems: State of the Art. Agency for Healthcare Research and Quality. Published June 2009. Accessed October 19, 2022. https://digital.ahrq.gov/sites/default/files/docs/page/09-0069-EF_1.pdf.
Sutton RT, Pincock D, Baumgart DC et al. An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digit. Med. 2020;3(17). https://doi.org/10.1038/s41746-020-0221-y
Sutherland K, Levesque J‐F. Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework. J Eval Clin Pract. 2020;26:687–696. https://doi.org/10.1111/jep.13181.
Byrne C, Sherry D, Mercincavage L, Johnston D, Pan E, Schiff G. Advancing Clinical Decision Support: Key Lessons in Clinical Decision Support Implementation. National Coordinator for Health Information Technology. Published May 2015. Accessed October 19, 2022. https://www.healthit.gov/sites/default/files/acds-lessons-in-cds-implem….
Tanzini M, Westbrook J, Guidi S, Sunderland N, Prgomet M. Measuring Clinical Workflow to Improve Quality and Safety. In: Donaldson L, Ricciardi W, Sheridan S, Tartaglia R, eds. Textbook of Patient Safety and Clinical Risk Management. Springer, Cham; 2021. Accessed October 19, 2022. https://doi.org/10.1007/978-3-030-59403-9_28.
Zheng K, Ratwani RM, Adler-Milstein J. Studying workflow and workarounds in electronic health record-supported work to improve health system performance. Ann Intern Med. 2020;172(11 Suppl):S116-S122. doi:10.7326/M19-0871
Georgiou A, McCaughey EJ, Tariq A, et al. What is the impact of an electronic test result acknowledgment system on Emergency Department physicians’ work processes? A mixed-method pre-post observational study. Int J Med Inform. 2017;99:29–36. doi:10.1016/j.ijmedinf.2016.12.006

Introduction

As the health care industry moves from volume-driven to value-based care, clinicians are looking for ways to improve care and outcomes while reducing costs. Data-driven practice management has emerged as a key strategy for cost-effective quality care. But the question remains: How can patient data and analytics be used to improve wound care across care settings? Additionally, how can artificial intelligence and machine learning affect outcomes, and how can these technologies help providers achieve even better results in the future?

The Power of Patient Data

Data has become critical as the healthcare industry moves toward value-based care. In a value-based system, providers are reimbursed based on the quality of care they deliver rather than the quantity of services rendered. This shift has put a greater emphasis on outcomes and efficiency, making data-driven decision-making key. When used effectively, patient data can help providers improve quality, engagement, and outcomes while reducing costs. For example, patient data can be used in wound care for the following 1:

Improve patient adherence to treatment recommendations
Decrease wound healing times
Predict which patients are at risk for complications
Develop personalized treatment guidelines

There are many different sources of data that can be used to inform health care decision-making. For example, clinical data from electronic health records (EHRs) can be used to identify trends and improve care quality. Claims data can be used to assess the cost-effectiveness of different treatments. Patient-reported outcomes (PROs), such as surveys and questionnaires, can provide valuable insights into patients’ experiences and needs.1

Moving Into the Future With Artificial Intelligence and Machine Learning

With so many data sources and types, it can be difficult to decide which data points and patterns are most important. This is where artificial intelligence (AI) and machine learning (ML) comes in. These technologies may help providers make sense of large data sets, identify patterns and relationships, and predict future patient needs.2 For example, a provider could use AI and ML to develop a model that predicts which patients are at risk for wound complications and personalizes wound care strategies based on electronic health record data. This information could then be used to proactively provide those patients with education and resources to prevent complications.

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In addition to aiding in clinical decision making, AI and ML can be used to automate routine tasks, such as billing and coding.2 By automating these time-consuming tasks, providers can have free time to focus on patient care. The future of health care is data-driven, and with the help of AI and ML, providers may have the tools they need to deliver quality care while reducing costs.

The Emerging Digital Transformation of Health Care

To use AI and ML, health care must undergo a digital transformation. This digital transformation is already underway, and the industry is seeing the benefits. Electronic Health Records (EHR) are more widely used and give providers greater access to data. However, there is a growing need for EHRs that address clinical specialties like wound care. In the wound care clinic, managing the volume of patients and improving outcomes is often challenging. A comprehensive specialty EMR can allow for efficient storage and access of patient records while offering intelligent workflow synchronization that may streamline the clinical process.3

For example, clinicians can use forms and templates designed specifically for their practice area.2 Rather than a one-size-fits-all writing template, a template for a pressure ulcer assessment would include all the necessary data points, saving time and increasing accuracy. Additionally, a specialized EHR removes unnecessary and distracting features, so clinicians can focus on what’s important.2 New technologies such as patient portals and health apps also give patients more control over their health data.2 Patients can connect with clinicians asynchronously without waiting for an appointment. For example, patients can log images of their wounds during each dressing change, and the wound care provider can view these images when they are available. Additionally, caregivers and patients can communicate concerns to wound care specialists via messaging on patient portals to determine the need for an appointment or a change in the treatment plan. This increased access and control comes with the ability to use data to improve care quality, engagement, and outcomes.

The Limitations of Technology

While new technologies make it possible to collect and use patient data more effectively, there are still some limitations. The biggest challenge is ensuring that the data collected is accurate and complete. Incomplete data can lead to inaccurate predictions and decisions about patient care. Additionally, AI and ML can only support clinicians’ decisions since technology cannot replace clinical reasoning.4 The human mind does not operate solely on factual data and statistics but also on a more generalized understanding of the world.4 This understanding allows clinicians to see patterns and make connections that technology cannot always make. Therefore, it is vital to have a team of experts who understand both the technology and the clinical process to ensure that data is used effectively to improve patient care.

The Future of Data-Driven Health Care

The digital transformation of health care is changing how providers deliver care and patients receive it. By harnessing the power of data, providers can improve care quality and efficiency while reducing costs. Despite the limitations, data-driven health care is the future. With the right tools and processes in place, clinicians can use data to improve care quality and efficiency while reducing costs.

References

Hernandez-Boussard T, Blayney DW, Brooks JD. Leveraging digital data to inform and improve quality cancer care. Cancer Epidemiol Biomarkers Prev. 2020;29(4):816–822. doi:10.1158/1055-9965.epi-19-0873
Hess CT. Value of a specialty wound care electronic medical record. Adv Skin Wound Care. 2013;26(1):48. doi:10.1097/01.ASW.0000425941.32993.32
Warraich HJ, Califf RM, Krumholz HM. The digital transformation of medicine can revitalize the patient-clinician relationship. npj Digital Med. 2018;1:49. doi:10.1038/s41746-018-0060-2
Rundo L, Pirrone R, Vitabile S, Sala E, Gambino O. Recent advances of HCI in decision-making tasks for optimized clinical workflows and precision medicine. J Biomed Inform. 2020;108:103479. doi:10.1016/j.jbi.2020.103479