In their current review of the future ecology of health care, West and Mehrotra identify three key drivers transforming the delivery of medical care as we know it:
- Patient self-care and diagnosis
- Virtual patient encounters
- Alternative health care settings
Ecology in health care refers to how individuals seek and receive medical care. Enabled by technology, prospective patients now frequently consult the internet for both diagnosis and treatment options, often before visiting a more traditional caregiver. As health care is increasingly "customer" driven, the usual face to face interaction with a clinician is increasingly supplemented or even supplanted by virtual communication via email, videoconference, or telephone messages. Finally, delivery of face to face care now stretches from retail clinics in the local CVS, Walgreens or Walmart to a greatly expanded homecare setting providing services once reserved for in hospital care only. This rapid transformation of healthcare delivery is occuring simultaneously with the paradigm shift from traditional fee-for-service reimbursement to the value model, linking reimbursement for care to documented quality outcome metrics. In this "brave new world" of health care, it's no surprise that many patients may be confused and caregivers report record levels of stress. In the midst of this shifting healthcare landscape, the urgency to transform health IT to meet the needs of both caregivers and patients is clear.
Technology that supports the caregivers
Physician (and nurse) burnout is a real problem and getting worse. In a previous blog post, I noted the clear link between dealing with an antiquated technology, particularly the EMR, and physician disatisfaction. The most recent survey of American physicians found 81% felt overextended or at full capacity and that nonclinical "paperwork" consumed 20% of their time. The added burden of reporting on a myriad of often unstandardized quality metrics to various payors was recently found to cost physician practices more than $15 billion dollars annually with the typical physician devoting 785 hours per year to this effort. It's no surprise that the physician survey found only 10% of responding physicians were optimistic about the future of the medical profession. Faced with adapting to a rapidly changing "ecosystem" with perceived competition from retail clinics and the internet, only 56% of physicians reponding plan to continue their current practice. At a time when demand for healthcare services is increasing, more than 40% plan to retire, cut back on hours, or work in a nonclinical area. Caregivers are tired of hearing "do more with less." Increased productivity and efficiency shouldn't mean decreased family or leisure time.
In this turbulent rapidly changing healthcare world, there are myriad opportunities for smart state-of-the-art healthcare technology to solve problems, support clinicians, and improve patient experience and outcomes. Fixing the EMR is the first step. As the ecology of health care shifts from face to face visits with a caregiver to a much wider range of potential sources of care in multiple settings across a much more inclusive continuum of care, the smart EMR will function as the information highway, tracking and recording data and events, guiding practice, facilitating communication among diverse caregivers and collecting outcome data. Essential requirements in the redesign of most current first generation EMR systems include:
- caregiver-friendly user interfaces easing documentation of clinically relevant information.
- point of care access built for caregivers at various entry points during an episode of care, including virtual visits and post acute home care
- point of care clinical decision support embedded in real, caregiver-designed clinical workflows
- integration of patient-entered data (PED) including self-monitored metrics
- systematic collection of clinically relevant patient outcome metrics available at the point of care
Technology that benefits patients
In an era of customer-driven healthcare, patients are the most important beneficiaries of a re-imagined EMR:
- fewer provider "clicks" in the EMR means more "glance-time" - real eyeball to eyeball engagement with the caregiver
- integrated communication among providers means less duplication of tests or procedures and better coordination of care
- telemedicine-friendly EMR supports post acute care and chronic disease management for better outcomes and reduced readmissions
- point of care clinical decision support means best practice and improved outcomes
- not surprisingly, less burnt-out caregivers provide better patient care
The evolving health care system is challenging for everyone involved. Caregivers confront pressures to increase efficiency while meeting increased requirements to document care and outcomes in an often unwieldy EMR. Patients make decisions about their health care in a much more diverse universe of options. Payors and employers hope to manage health care costs by exploring innovative but unproven nontraditional settings such a retail clinics and virtual visits. As a participant in the transition from paper to first generation EMR technology, I experienced first-hand the pain and a bit of the promise. Now, an increasingly complex healthcare ecosystem demands new generation 21st century technology.
As always, I welcome your thoughts. Let's continue the discussion.