Blog | 3/9/2023
Task Shifting in Reimagined Care Models and the Role of Technology
By Shomik Datta, with contributions from Greg Chittim and Ashley Peake
This is the 3rd in a series of reports from the Wharton Healthcare Conference in February 2023. You can read previous entries here: Is the Healthcare Industry Meeting the Rising Expectations of Consumers? and here: AI in Healthcare: Implications at the Molecular, System, and Patient Level.
Introduction
As the first keynote speaker, Dr. Maulik Majmudar, Co-Founder and Chief Medical Officer of Biofourmis, a digital therapeutics company focused on personalized care, spoke aptly to the current state of the US healthcare system. It's no secret that the United States has one of the most expensive healthcare systems globally, spending nearly $4.3 trillion annually, accounting for more than 17% of its GDP. [1] Despite the high expenditure, the country's healthcare system faces multiple challenges that hinder its effectiveness in delivering quality care to its citizens. The COVID-19 pandemic highlighted many disparities in the healthcare system, and inequitable access to care is viewed as a significant problem, with many populations disadvantaged by their social or economic status, geographic location, and environment. [2] Further exacerbating these disparities is the looming increased shortage of primary care physicians in the US. According to the American Association of Medical Colleges, the US could face a shortage of anywhere between 37,000 to 124,000 physicians by 2034. [3] The lack of healthcare professionals can lead to longer wait times, increased workloads for existing healthcare workers, and reduced access to care. Alternative care models have long presented an opportunity to help alleviate these problems. With the pandemic already accelerating the adoption of alternative care models like telehealth, virtual care, and in-home care, another potential solution may also help address some of these challenges: task shifting.
Task Shifting in Healthcare
Dr. Majmudar regards task shifting as a vital pillar of robust, reimagined care models that can help address problems many in US healthcare. Task shifting is when specific duties are moved from highly skilled workers to ones with less training and fewer qualifications. The process involves delegating clearly delineated responsibilities to less skilled healthcare workers after they complete specific competency-based training. [4] While typically seen as upskilling workers like nurse practitioners to perform duties previously managed by a physician, it can also include upskilling primary care physicians to address issues traditionally referred to a specialist. In other professions, shifting tasks downward is a common practice. Lawyers employ paralegals to help them with their caseloads, managers often rely on coordinators to keep businesses running smoothly, and even chefs have line cooks to help satisfy the demand of a bustling restaurant. Regardless of profession, task shifting must be undertaken cautiously, systematically, and with many built-in guardrails to avoid a drop in quality.
In healthcare, this management technique has traditionally been advocated as an important strategy to optimize health system performance, especially in resource-poor settings. Studies have shown that task shifting can address healthcare resource shortages and allow physicians in primary care to provide more complex care and expand the healthcare capacity.[5] The concept was first developed as a strategy to provide care for individuals with HIV in sub-Saharan Africa, where there was a shortage of specialized healthcare workers due to the disparity between healthcare services, capacity, and budget. In response, the WHO developed a consolidated guideline on task shifting to tackle health worker shortages.[5]
Many examples of task shifting exist globally. In some regions, delegating responsibilities to non-physician health workers can be seen as an effective model for managing infectious diseases and improving maternal and child care.[6] Nurse-led task-shifting strategies have also been employed to help manage uncontrolled hypertension.[7] Some even suggest that nurses and pharmacists can potentially undertake substantially more expanded roles to support primary care physicians in response to changing demands in healthcare, taking on responsibilities like independent prescribing. [5, 8] This refocused deployment of resources can allow a health system to use its existing workforce more efficiently, thereby easing bottlenecks in service delivery while expanding workforce capacity. [9] Additionally, task shifting contributes to a patient-centric model of care that is tailored to individual patient needs. [10]
Although useful in certain situations and can sometimes improve care, task shifting has several inherent risks. Unsurprisingly, among the most significant risks is the potential for decreased quality of patient care, particularly if medical judgment and decision-making are transferred. These quality issues can stem from reduced patient-physician contact, fragmented and inefficient service, lack of proper follow-up, incorrect diagnosis and treatment, and inability to deal with complications. In addition, task shifting, which deploys assistive personnel to reduce the demand on physicians, may actually have the opposite effect if training processes are not appropriately managed. Physicians may have increasing responsibilities as trainers and supervisors. This diverts scarce time from their many other tasks, such as direct patient care, which become more critical as more standard forms of treatment are shifted down to other providers. They may also have increased professional and/or legal responsibility for the care given by healthcare workers under their supervision. These risks must be adequately considered and managed when developing protocols for an environment that leverages task shifting.[11]
Technology in Task Shifting
There are several opportunities for technology to play a vital role in optimizing healthcare delivery and reducing risk in a task-shifting strategy by automating certain responsibilities and enabling seamless collaboration. Augmented intelligence that combines data science and software can automate some of the more standard duties of primary care providers, like prescribing a drug and dosage for a specific patient with hypertension. Clinical decision support (CDS) systems can provide real-time information and guidance to support informed decision-making by less-experienced providers. Electronic health records (EHRs) can enable the secure and efficient sharing of patient information, allowing physician assistants or nurse practitioners to receive detailed treatment instructions from a physician or review a patient's medical history and lab results and make recommendations to the physician. Telemedicine capabilities have already been seen to facilitate collaboration between primary care providers and specialists, especially for managing complex health conditions, and can be employed in task shifting in a similar capacity. Even patients can be empowered to participate in task shifting using mobile health (mHealth) apps to monitor their health status and communicate with their healthcare providers. There are countless opportunities to deploy existing technology or develop novel ones to facilitate task shifting.
A company seeking to develop novel technology or deploy existing capabilities toward task shifting must consider several elements before launching. These include ensuring the product meets end users' needs, satisfies interoperability requirements, addresses privacy concerns, and incorporates clinical evidence during development.[12] Products designed with a deep understanding of the clinical and administrative workflows across all healthcare settings involved in a task-shifting scenario are better equipped to meet provider and patient needs. Interoperability is also critical, as new technologies must integrate with existing systems and workflows and be able to exchange data seamlessly. Additionally, technologies must comply with strict security protocols to ensure the privacy and security of sensitive health information, adhering to HIPAA and other regulations. Finally, an evidence-based design approach rooted in clinical evidence and best practices will help ensure the technology is effective and safe for task-shifting situations. By considering these factors, companies can play a role in optimizing care delivery to address disparities pervasive in the healthcare system.
Sources
- Commonwealth Fund 2023 US Healthcare from a Global Perspective
https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 - CDC 2023 What is Health Equity?
https://www.cdc.gov/healthequity/whatis/index.html - Association of American Medical Colleges 2021 Physician Supply Projections
https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage - Wren SM 2019 JAMA Surg.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2737204 - Leong SL 2021 Eur J Gen Pract.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330741/ - Joshi R 2018 BMJ Global Health
https://gh.bmj.com/content/3/Suppl_3/e001092 - Ogedegbe G 2018 PLOS Medicine
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002561 - Maier C.B. 2015 Health Policy
https://www.sciencedirect.com/science/article/abs/pii/S0168851015002249?via%3Dihub - CDC 2022 Shifting Tasks During COVID-19
https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/task-sharing.html - Van Tuyl 2021 International Journal of Care Coordination
https://journals.sagepub.com/doi/10.1177/20534345211039988?icid=int.sj-abstract.citing-articles.1 - World Medical Association 2019 Resolution on Task Shifting
WMA Resolution on Task Shifting from the Medical Profession – WMA – The World Medical Association - Sabet Sarvestani A 2021 Global Health
https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00684-6
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Shomik Datta, Consultant and member of the oncology practice at Health Advances.
Greg Chittim, Partner, Co-Leader of Health Advances’ Health IT and Digital Health practice.
Ashley Peake, Analyst and member of the metabolics and autoimmune practice at Health Advances.