Who will own your exam room?

January 9, 2019

As physicians, we have given up control and lost the ability to do the job we were trained to do. Our focus has turned instead to serving needs that have become more demanding than those of our patients.

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 opinions expressed here are that of the authors and not UBM / Medical Economics.

Over the past twenty years, the practice of healthcare has been overtaken by secondary entities. Time spent in physician-patient interactions, the core of any medical practice, is now being governed by insurance companies and complex billing and payment systems, federal and legal mandates, the pharmaceutical industry, and technology that was intended to improve the business of care. As physicians, we have given up control and lost the ability to do the job we were trained to do. Our focus has turned instead to serving needs that have become more demanding than those of our patients.

It is estimated that doctors today spend just 27 percent of their time interacting with patients, according to a study in the Annals of Internal Medicine. The remaining time-far exceeding our billable hours-is whittled away on administrative duties, often serving documentation required by law. The frustration it leaves is real, not just on patients who wind up receiving fragmented care, but on physicians as well. Numerous global studies show that doctors are overburdened and burned out. The catalysts for choosing to pursue a medical career- helping people and making a difference-are buried in the mundane paper shuffling required of the medical field today. Climbing physician suicide rates are likely examples of the most extreme consequences of this problem. We’re struggling to understand how we, as healthcare providers, can provide quality medical care when we are rapidly losing control of our profession. 

In many ways, we gave it away. We relinquished authority to peripheral entities instead of taking it upon ourselves to determine how to best serve our nation’s healthcare needs. We can continue to let others lay obstacles and mandates that impede care and tell us how to do our jobs-because they most certainly will-or we can take the lead by creating and leveraging technologies that safeguard personal interaction and create better, as well as more efficient, options for patients to access care. The choice is ours.

Losing control to health technology

One of the major factors that contributed to our loss of control is when Health IT entered the exam room. Congress passed the stimulus (the American Reinvestment and Recovery Act of 2009) that included a requirement to convert to electronic health records (EHR) or face Medicare reimbursement penalties.  With the passage of this directive, instead of a systematic conversion to electronic records, we scrambled to digitize massive files of patient records and train ourselves and our staff to change our workflow to accommodate new systems and accompanying challenges. It was then that we began to lose eye contact with our patients as our attention turned instead to entering government or insurance required data that often has little or nothing to do with the chief complaint of the patient in front of us. While managing records digitally offers numerous benefits, it must be done in a more thoughtful way. 

Technologies, like the use of EHRs, are often aimed at providing convenience, yet they have a way of road-blocking care. They are often outdated, time-consuming, and too complex to weave into regular practice. The rise in on-demand medical services, websites and retail clinics make it clear that patients are seeking more convenient care options to accommodate their increasingly demanding lives. Better access to care is necessary, yet many of the new models miss the boat by sacrificing continuity and personal connection for convenience, with care being provided by physicians who are unfamiliar with the patient’s they’re seeing. 

Patient-driven technology builds stronger connections

A recent study that asked healthcare consumers what matters most shows that patients want to be known and understood by their provider in order to get the personalized care they desire.  They want to feel connected and understood by providers who know their personal stories-the unique factors that contribute to overall wellness and its breakdown. Without knowing those stories, we can’t provide good healthcare. It boils down to a personal connection.

Yet, with so little time allotted to face-to-face patient interaction, how can we build compassionate, therapeutic relationships that lead to better patient outcomes? It doesn’t have to take tremendous time. It’s here that technology can be used to enhance and even accelerate the process. 

Machine learning and artificial intelligence (AI), for instance, can be leveraged to track and analyze complex, valuable data and empower us to better know our patients. It can process information beyond human capability, such as massive sets of lab test results, family history, socio-economic factors and clinical trial data, to help us monitor our patients’ well-being and assess their risks based on their own history and others like them. These powerful technologies can help to flag signs of preventable, chronic diseases-including diabetes, heart disease, and even cancer that attribute to 86 percent of our nation’s healthcare costs and are responsible for nearly 70 percent of deaths each year-and provide us with clinical insights to aid in our planning and providing of care, leading to more accurate, personalized treatment. 

There is also the not yet measurable data we get when we look at our patients, hear what they say and understand their personal situations, that technology can help us address. For example, telemedicine, the use of video-conferencing to communicate eye-to-eye with patients and provide healthcare without barriers of distance, allows us to leverage technology to add value to the most important part of a medical practice-seeing patients. It improves care and enables practitioners to see more patients by offering virtual care for level 1-3 visits-for instance, helping a patient manage diabetes or back pain before it reaches crisis level. Televisits-conducted with a few clicks on a personal computer-promote continuity of care by keeping patients connected with their own doctors, and maximize billable time through a built-in mechanism that monetizes after-hours care and communications like calls backs and follow-ups, helping us operate more profitable practices

By leveraging technologies truly aimed at helping us serve our patients, we can free ourselves to do the job we were trained to do. It’s time to take the lead-speaking out about the role we want technology to help us fill-or continue to be victimized by insurance companies and government mandates that want to take over our exam rooms and tell us how best to do our job.

Samant Virk, MD, is founder and CEO of MediSprout, a company focused on connecting doctors with their patients through innovative technology solutions. He is also a physician having practiced clinical medicine for almost 15 years, with a specialization in Neurology and Interventional Spine.  

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