The following is a guest post by Jonathan Bush, CEO & President of athenahealth, Inc.
The Supreme Court’s ruling on the Affordable Care Act this past summer, coupled with a contentious presidential election season, have put the crisis in health care front and center for the American public. With so much turmoil around how access to health care comes to be defined, mandated and funded in the coming years, we are still left with fundamental questions and serious concerns about the supply side of the health care equation. Namely, what does the delivery of care look like? Is it of high quality? Is it affordable?
Meanwhile, costs spiral, patients absorb their higher share and the experience of care has been diminished and degraded for both patients and physicians. As evidenced by this recent piece in The New York Times, the mainstream press has been paying closer attention to the benefits and risks of the technology now at the heart of the care experience—the electronic medical record (EMR).
And with good reason.
The intimate, and what physician-author Abraham Verghese calls “sacred,” moment of care that takes place in the exam room has been invaded by a Greek chorus of payer requirements and government mandates. One study of physician time spent with patients found that while face time has increased over the past two decades, both physicians and patients perceive it has declined. Why the disconnect?
One reason may be the changing nature of the encounter itself. In most exam rooms, the computer has become a central focus. The physician’s gaze, once directed at the patient, is now drawn toward the EMR that’s come between them. EMRs designed without physicians in mind can turn them into transcriptionists and reduce patients to a collection of clinical measures and required fields. In a recent Physician Sentiment Index™ poll of 5,000 physicians conducted by my company and Sermo, 72 percent said their EMR distracts from face-to-face time with patients.
So to make health care work as it should, a couple of fundamental things need to change around the role of the EMR in care delivery.
First, we need to design EMRs that serve the physician — not the other way around (the majority — 44 percent — of physicians surveyed believe EMRs were not designed with the physician in mind.) The EMR should enhance and focus the encounter, removing unnecessary work and only asking for and providing the precise information needed to support and inform that point of care.
Second, we must apply the theory of comparative advantage to the work that’s done in health care — whether in the physician’s office, ER, hospital, clinic or other care setting. We need to shift work away from the physician to other care providers, ensuring the right person is doing the right work at the right time with the right data. In the physician office alone, estimates of the proportion of primary care visits that can be handled by medical assistants or nurse practitioners, for example, range between 50 and 75 percent. Delegating work and empowering clinicians to practice to the top of their licenses not only reduces costs overall but frees physicians to be fully present with a patient when their complete attention and training is truly required. We know this works with the proper use of a well-designed, cloud-based EMR in an efficient office workflow.
Comparative advantage plays in both the mundane and in the highly strategic and potentially impactful. Routine work should be offloaded to others in the supply chain who can eliminate it, automate it, or execute it more efficiently at scale (we know through our own client data, for example, that providers must process more than 1,000 clinical documents every month.) At the other extreme, comparative advantage can be highly strategic, providing the means for patients and health system leaders to evaluate who does a procedure best at the lowest cost. How does the MRI team at hospital X stack up against the highly-specialized, free-standing independent MRI facility?
We’ll get the kind of high quality, affordable care we’re looking for when the EMR adds as much meaning and value at the point of care as it removes work, when the Greek chorus is silenced and the physician-patient moment restored.