After 33 years as a practicing physician at Cleveland Clinic, retiring just 2 months ago, I’ve concluded that there are two critical areas which must be addressed in healthcare if we’re ever going to optimize the value of every patient encounter:
- Improving the physician-patient EMR experience
- Real “meaningful use” of the EMR
I chose to accept the position of Chief Medical Officer at Dorsata because I believe it’s the best place for me to help the healthcare industry achieve these goals.
During my career at Cleveland Clinic, I experienced directly the transition from handwritten paper medical charts to the electronic medical record. While ease of record retrieval and tracking communication with patients improved markedly with the EMR, physician efficiency and quality of life did not. Documentation of the clinical visit typically became more lengthy and occurred later in the day or evening. For many of us, the clinical encounter became more of a face to face with the computer than the patient. Finally, the end result was a lengthy chart note several pages long rather than a concise paragraph describing one’s clinical decision-making and plan. Neither physician nor patient were satisfied with the process.
For the past several years, I had the opportunity to lead the development of the Spine Carepath at the Cleveland Clinic. The carepath is an evidence-based and informed clinical roadmap to assist physicians and other providers in evaluating and managing a wide range of spinal disorders. Our goal was to improve value of care by reducing inappropriate variation in practice while improving clinical outcomes. Our early pilot studies suggested implementation of the carepath would offer great opportunity for cost reduction as well. After a thorough vetting of the content, our team of clinicians and engineers worked to enable the carepath within the EMR, including structured notes, some decision support, orders, and patient educational materials. We were cognizant of the physician’s burden of work during the build and struggled to limit the number of “clicks” required during documentation. The carepath building process was a great learning experience for all of us and remains a “work-in-progress.” A few of the most important “take-home” messages from this experience were:
- Involving physician and other clinical stakeholders in the design and build of the clinical workflow is critical
- “Not another click” – a user-friendly, time-efficient interface in the EMR is essential to widespread adoption and use by clinicians
- Patient satisfaction and acceptance of the EMR is also enhanced by ease of data entry
- The end-product – the encounter note – must be meaningful in a clinical sense and not a series of checked boxes
- Integrating decision support in the EMR product can assist physicians and improve value and efficiency
- Ongoing support for the inevitable revision and modification of the workflow is essential to acceptance and success
It was during this lengthy and challenging process that I was introduced to Dorsata and CEO David Fairbrothers.
Now retired from clinical practice, I explored several opportunities to continue to pursue my strong interest in development and implementation of evidence-based guidelines as a tool to improve quality and value of clinical care, particularly within an EMR. As I learned more about Dorsata’s approach, I was impressed that its singular focus on improving the integration of evidenced-based medicine into clinical practice using user-friendly interfaces across multiple platforms was entirely consistent with my experience at the clinic. The Dorsata team “gets it.” They work directly with physician champions at health care institutions and practices to build real world clinical workflows with streamlined data entry, respectful of the integrity of the patient-doctor relationship and physician time. Their approach is most likely to ultimately bring realization of the promise of the EMR to improve value in health care. As Dorsata’s Chief Medical Officer, I will work with the team and physician or nursing colleagues to drive truly “meaningful use” of the EMR.
Fortunately, since leaving clinical work, I also have more time to explore other interests in a more temperate climate – South Carolina rather than Ohio (at least in the winter). We plan to enjoy family, travel a bit, and explore the “low country” – maybe via kayak! I’ll maintain my professional ties to the North American Spine Society where I’m active in the Guideline Development Committee. I’ll also be writing and commenting on issues broadly relating to our core vision and passion of bring 21st century healthcare technology to caregivers and patients. I’d welcome dialogue with clinicians who want to share thoughts, ideas, or suggestions about improving the healthcare experience for everyone. Feel free to reach me at dan [dot] mazanec [at] dorsata [dot] com.
- - DM