My proposal to change the American healthcare system for the better

October 28, 2017
Kumar Yogesh, MD
Kumar Yogesh, MD

Practicing physician at Dresden Family Clinic for 24 years. Owner of practice, self-employed physician, medical director.

During the good old days, physicians were considered the pillar of the community and the role of primary care physician (PCP) was a respected position. I'm guessing that during that time, we, the physicians, assumed the role of custodians of patients’ medical records.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with Kumar Yogesh, MD, a practicing independent physician in Dresden, Tennessee. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

 

During the good old days, physicians were considered the pillar of the community and the role of primary care physician (PCP) was a respected position. I'm guessing that during that time, we, the physicians, assumed the role of custodians of patients’ medical records.

 

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In today's world of electronic medical record systems, we all have realized that tremendous unnecessary data is being generated to satisfy regulatory agencies and billing systems. Patients have taken it on themselves to see multiple physicians while marginalizing the concept of PCP. In such an environment, being custodian of these records is becoming increasingly cumbersome, useless and very expensive.

I would like to propose a novel idea to our fellow physicians. It may sound unconventional in the beginning, however, if you ponder carefully, it is very doable. Tremendous amounts of time, energy and money can be saved and redundancies eliminated, resulting in much less stress for our staff and much less destruction with performance and duties of physicians. Let all physicians unite and demand to relinquish control of medical records and transfer this responsibility to the patient.

 

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Recently, I had quite a revealing experience during the acute illness of my father, who was in India, requiring an emergency visit for me to go there. He had acute urinary obstruction and acute renal failure. By the time I arrived, he had already received excellent care by a urologist and nephrologist with procedures such as cystoscopy and nephrostomy. He was home recovering and I was pleasantly surprised that he had all the detailed records, including ultrasound, CT films and physician notes in his possession.

Next: 'This entire process was in stark contrast with the chaotic environment we experience'

 

Even the video of cystoscopy was present on a thumb drive. I did not have to call anyone to obtain the records. Apparently, this is a tradition there that patients are in charge of their own records. It is called "file" (what we call a chart in USA). He also had all his previous records covering the last several years in his "file.” This made it extremely easy for me to review and obtain knowledge of his condition.

 

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Subsequently, he suffered a heart attack while I was there. We took him to the hospital with his file. Things went smoothly, since physicians had all the information needed on hand. While in the hospital, he received a copy of every test done on the same day. Hospital physicians made daily visits, explained everything to the patient and family and his notes were short and concise.

A consulting cardiologist gave proper explanations and entered brief, but precise, notes. Every day, a person visited the patient's room and asked for any grievances and complaints, which were all solved promptly. On day of discharge, a discharge note and instructions were given and entered into the file. During subsequent visits for different consultants, we carried the file and things went smoothly.

Documents were reviewed from the file and new documents were entered. No faxing, no calling anyone, and it was a much more efficient and low-cost operation with much better patient care since all the needed information was readily available in the proper format.

This entire process was in stark contrast with the chaotic environment we experience here in our clinics. Every time I'm looking in my office, someone is always making copies, spending endless amounts of time and wasting paper. When I get a pulmonary referral from other physicians, most patients arrive with hundreds of pages of documents which are impossible to review.

 

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Most of them are copy and pasted and repetitious. Every single day we get a barrage of requests for patients applying for disability and other various reasons, requiring my staff to make hundreds of copies. Every time my patient visits the emergency department or needs hospitalization, an average of 80 to 100 pages of records arrive with senseless information, and most of the time these records arrive after the patient has already left the office. My nurses are constantly sending records to the billing agency, insurance companies for prior authorizations and who knows where else.

Next: 'We, as physicians, demand a change with a single voice'

 

Recently, we did an audit and it was shocking to learn that with our two-physician practice, we are utilizing more than 20,000 sheets of pages every month. I would encourage all readers to do the same and I guarantee you will be surprised.

What a colossal waste of time and energy, and it creates a severe distraction for us and the question is, why have we accepted this responsibility? Time has come to change this practice.

In today's world of Facebook, emails, Twitter, and so on, most Americans are used to electronic gadgets and, in fact, they love it. Americans are used to managing complex bank accounts, paying bills and handling many of their financial affairs electronically. It would be naïve to believe that they cannot handle the simple task of controlling their own medical records. I would venture to say that this may be far more efficient in terms of privacy and preventing data breaches.

 

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Let me propose this scenario: A patient walks into my clinic and I would be happy to provide him a laptop with an internet connection. The patient can log into his or her electronic record and grant a clinician access when he/she arrives. The physician can open up a blank page and enter the notes and at the end of the visit, save a copy to the patient’s file and send one copy to his/her system.

In certain circumstances, the document can be left open for 48 hours or so for the clinician to complete the note. I have discussed this with a number of software engineers and have been told that this is achievable with today’s technology and would maintain the security of the record with tamperproof mechanisms. This would protect both patient and clinician much more efficiently without the harassment of HIPPA. 

Suddenly, we can get rid of our electronic health records, copy machines and save a tremendous amount of staff time. Thousands of dollars would be saved along with thousands of trees, which would be a music to the environmentalist’s ears.

 

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No consulting office, emergency room or hospital will have to call us anymore, since they can obtain all this information from the patient. When we order our tests such as CT scan, MRI, or if we prescribe any medications, the controlling authorities can look into the patient record for their approval process. No need to bother us anymore for any prior authorization and let us be doctors focused with patient care. I can imagine my office being a lean, mean machine with 100% dedication toward patient care. Would this not be a dream?

I certainly think that this is an achievable goal if we, as physicians, demand such change with a single voice.