Change and Inadequate Tools Pose New Challenges for Physicians
By Joe Marabito
Physicians are the most important element in delivering quality, cost-effective healthcare. They are the avenue through which all meaningful improvement in healthcare will occur. However, they find themselves in an era of unprecedented change. They are being asked to:
Fundamentally change how they practice medicine – shifting from art to science using an overwhelming and impossible-to-digest stream of new research and outcomes data from countless different sources, and accessing patient-specific data from a variety of un-integrated, disparate medical record sources in a non-digestible way at the time and place of decision making. Standardization of care is essential to improving quality, but how can the latest care practices be adopted if they are unavailable to the physician when she needs them?
Shift from volume to value. For physicians, the two models are diametrically opposed. Put patients in hospital beds versus keep them out of hospital beds. Get paid for doing more versus get paid for doing less. From a process perspective, it’s kind of like changing our driving convention from the right side of the road to the left. Even worse is that right now it seems like physicians are doing both at the same time.
Refer care to unfamiliar specialists. If you want to know which physicians practice quality care and which do not, just ask physicians. They should know. Today, due to narrower networks and risk-based contracts, they are being forced to refer care to specialists they wouldn’t normally use or wouldn’t voluntarily choose, potentially at the expense of quality outcomes for their patients. Quality care requires effective collaboration between physicians. How effective can that collaboration be when physicians don’t even know each other, haven’t worked with one another, and perhaps otherwise wouldn’t choose to work with one another?
Do more with less. After recently being asked to increase the number of patients he sees every day AND having his compensation reduced, my primary care physician decided to step off the treadmill and shift to a privately funded practice model. Essentially, he felt he could not spend sufficient time with patients in order to deliver care that met his own standards of quality. He believes patients don’t open up about sensitive but vitally important health issues until after 15-20 minutes of interaction. The new patient throughput standards of his practice wouldn’t have permitted the necessary time with each individual patient.
Deal with unprecedented administrative complexity. ICD-10 contains five times more diagnoses codes than ICD-9. Government regulations have never been more complex to administer, and compliance penalties are severe, requiring more extensive documentation of both diagnoses and treatments. Some of this documentation is helpful to delivering quality care and medical research, but most is imposed to inform and justify payment. We’ve effectively increased the administrative burden on physicians – significantly – by requiring them to document items of questionable utility to quality outcomes.
What have we as an industry done to help physicians accommodate all this change? Mainly due to government financial incentives, we’ve purchased and implemented incredibly expensive EHR systems, which, as it turns out, do not talk to one another. Additionally, the expense of EHRs crowds out other innovation inside the health institutions that adopt them. Worse, existing best-of-breed physician tools are being retired in order to fund the cost of implementing and maintaining EHRs. And because the primary function of an EHR is to store medical records, scant attention is paid to how physicians use them to serve patients. The result is a step backward from a physician workflow perspective. EHRs are not designed around doctors. Doctors need to share and receive relevant decision-support information on mobile devices at the point of care and to collaborate with the rest of the care team. Some EHRs don’t even offer a mobile solution that isn’t anything more than an afterthought.
The drive for EHRs, while essential and necessary for better care, has encouraged the adoption of a single central system, closed-architecture model that inhibits innovation. Monolithic systems rarely, if ever, do everything well. Innovation flourishes in other industries by connecting disparate best-of-breed systems and data via open architectures and interface standards. It is an approach that encourages innovation by inviting the best ideas to compete and letting the market determine the best solutions for specific challenges. Apple’s mobile device business has flourished in large part by opening its app store to anyone who provides a useful application that meet their standards. In short, they tap the ingenuity of the world to drive higher utility and value for their customers. The result is incredibly useful smart devices. Healthcare will get there too, eventually, if only because it must. Market forces will drive it. In the meantime, doctors are suffering through a time of unprecedented change, hoping it won’t take long.
Joe Marabito is CEO of Ingenious Med in Atlanta.