When my doctor walks into the exam room, I want him to pay attention to me, not the computer. Not only is that what all patients want, but also what doctors want. However, doctors today are under pressure to feed the digital beasts.
The latest in medical care best-selling MD author, Bob Watcher, says that in a 10-hour shift a single doctor could record 4,000 clicks. Worse yet, much of this activity is a routine census, pushed by insurers and regulators who assume that digitization makes it easier to collect statistical data, regardless of whether it contributes to quality of care.
Doctors are not Luddites. At first, many were excited about automating their practices, expecting the same kind of ease of use and productivity that they enjoy with, say, the software they use to do their taxes. The expectation that software for medical professionals is at least that good. The reality is that the more doctors go “digital”, and the longer they use the software, the less satisfied they become.
That’s the catch: healthcare is the only industry that has managed to lose productivity while going digital.
Typical electronic medical record software is a maze of tabs and dialog boxes that doctors must navigate to record the same information they used to manage with a few notes in a file folder. And what do they get in return for their effort? Unfortunately, consumer apps are much better at delivering useful information and unexpected insights.
The healthcare software problem won’t be solved with a UI overhaul: EMRs need to be smarter, not just prettier. Think about networking, not just software. We need to gather intelligence from doctors, nurses, patients, hospitals, labs, insurers, and everyone else who contributes to continuity of care.
Too many doctors document care in disconnected software that doesn’t know if a patient had an adverse reaction to a medication, saw another doctor down the road last week for a related problem, or had countless tests done over the years. years for similar symptoms. . Expecting such intelligence from an isolated EMR would be like expecting your CD player to start playing Isaac Hayes because you like James Brown. Unlike your favorite digital music service, you’re just not connected that way.
For the past four years, my company, Athenahealth, has been working to reinvent the EMR. We want to take the hassle out of technology, making it useful for the doctor and perfect for the patient. We’re not done, but we’re making progress. Ultimately, we are focused on delivering EMRs that deliver valuable clinical insights, while allowing clinicians to be fully present in meaningful moments of care. In other words, we believe that technology should allow doctors to be doctors.
In our quest to make EMR smarter, one of our main tactics is to simplify every process where clinicians are faced with an overwhelming number of choices. Because we operate a network to which more than 67,000 providers serving more than 69 million patients are connected, we are able to aggregate what we learn from each interaction. That’s on the order of 330 million data exchanges per month. We are studying health care in the wild, as well as listening to doctors and care staff.
Complexity is the enemy. Medicine is necessarily complex, but the administrative complexity that surrounds it can be reduced. For more than 15 years, we’ve managed the byzantine world of reimbursements to help providers get paid faster. More recently, we have been applying the same discipline to make electronic medical records more useful. Our goal is to encourage providers to collect the data they need to collect in the least intrusive way.
Whenever possible, the delegation should move from doctors to nurses and administrative staff, and even to patients. Instead of having patients answer a whole series of routine questions with their panties down in the exam room, let them do it on a mobile app from home the night before. If a doctor writes a prescription for a patient with diabetes, instead of presenting all possible medications, why can’t the EMR show the ones that are most likely to be appropriate based on the doctor’s previous choices, but also based on of trends and in use? via network?
If we expect information technology to help us achieve a more efficient, more effective, and higher quality health care system, we must not only collect data efficiently, but also ensure that we learn from it and translate it into meaningful moments of care. .
We need to make EMRs serve providers, not the other way around.
That is why we are launching the social commitment campaign. doctors be doctors. It is our hope that everyone in the provider community who similarly believes there is a better way will share their EMR stories and recommendations at letdoctorsbedoctors.com. We will bring that feedback to Washington to help influence the development of health IT policy initiatives, including ongoing legislative efforts to improve EMR interoperability and usability.