As we enter 2019, I have been reflecting on a great couple of days I spent in DC at the ONC annual meeting in November. A major part of the focus of the IT-focused meeting was on a relatively newer topic: “physician burden.”
I get it.
The feds have been pounding at physicians for years with the Meaningful Use program, which has been great at gaining EHR adoption and needed digitization of a paper-based industry, but it seems the pendulum has finally hit a wall. There was precious little time to spend with patients in the past and now there’s even less.
The real problem is not that going to digital technologies is a bad thing, or even that EHRs are that hard to use (compared to any complex application). If we had only digitized what physicians were doing in the past, it would be one thing. But we’re asking physicians to do (click) so much more today—capturing greater amounts and types of information, meeting endless reporting requirements, accessing registries, making notes and records electronically available to patients, coding in much greater detail, etc. All in the name of evidence-based medicine (and of course, payment). Forget about being a solo or small practice—you could never keep up. Even large health systems need armies of experts, consultants, legal teams, reporting teams, etc.
If we agree that the physician burden is real, what’s the solution?
I’m going to suggest something here to providers that will seem unrealistic and even upsetting to many people. Are you ready?
See fewer patients.
I know. You’re thinking "that will bring me less revenue" or "my health system requires me to see x number of patients a day or week, and I would be out if my metrics dropped." Well, if you think about any other business that tries to service too many customers, the poor outcome is expected. Lessons learned from other industries could help. For instance, practices could segregate more routine work to lower-paid staff and automating where possible.
What could some of this recouped time be used for? Physicians could spend more quality time with the patients they have (especially the really sick people), research their conditions in more detail, access what’s available on the HIE, look over their patient-generated health data, prescribe an app (that they monitor as well), collaborate with other experts, and so on.
Perhaps most importantly, they could document more carefully. What a shame that a portion of the data physicians are begrudgingly capturing today is not of high enough quality or consistency to really help advance healthcare.
The crux of this is about value—and fortunately, the system is gradually moving to a future of more value-based care. In the past, outcomes were not as readily reported or tracked—no-one was really keeping score. If we pay for quality and outcomes, the market should adjust.
Ken Kleinberg is Principal of Healthe-Motion, an independent Health IT consultancy.