If Hippocrates didn’t need it...
For many physicians, myself included, having to confront a new way of doing things feels like being squashed between two incensed Sumo wrestlers.
Not only do we have to keep an eye on customer service and provide decent patient care, but there is also that other mundane task of having to make ends meet and perhaps eke out a little take-home something.
Between staffing, medical equipment, rent, malpractice insurance, tooling up for this year’s outlandishly expensive ICD-10 mandate and the as-yet uncertain reimbursement landscape, the priorities we end up setting up for ourselves begin and end with having to see 25 to 30 patients a day.
For us, self-proclaimed followers of the father of medicine, the change-over from a volume-based reimbursement environment to a value-based care model is still generating something akin to a strident pain in the gut.
Is it skepticism or is it laziness?
That’s the way it still goes, particularly –though not always- for some of my older peers.
But no one should be surprised at us 21st century technophobes, for we can be found in most other walks of life.
Heck, it is said that Warren Buffet doesn’t even own a cell phone, and that Carlos Slim, reputedly the richest man on earth, doesn’t keep a PC in his office.
And who are we to get agitated over the issue when the justices on the Supreme Court still send hand-written notes to one another -by in-house courier- instead of email?
If Buffet and Slim can also walk up to any one of their associates, doubtless a bunch of graduates from the best tech schools in the country, and get the job done that way, why can’t a doctor tell a nurse what to do if there hasn’t been time enough yet to brush up on some particular technology?
So, can’t we healthcare professionals, whether skeptical of otherwise, just stay out of the fray and simply delegate or outsource our IT needs?
A current case in point
I believe that all doctors, technologists and technophobes alike, by now can acknowledge that moving from the ICD-9 to the new ICD-10 coding system is a fundamental enabler of evidence-based medicine that will make our coding staffs a lot more efficient.
It will also significantly have a positive influence on that thing that we hold dear to our hearts: our cash flow.
And yet, we fought it tooth and nail, and many of us still consider it a big waste of resources despite all of the computer-assisted coding (CAC) tools that have come about to help. It’s like: so what was wrong with the ICD-9 anyway?
Not only did the transition require a level of focus that produced nausea amongst my most resistant cohorts, but we also ended up with little supervisory say over coders in our offices –bosses who may have little inkling as to what some of their techie personnel are up.
With the advent of electronic health records (EHRs) and mandated systems like the ICD-10, and with the pressures produced by young and hip doctors who didn’t miss an opportunity to muse out loud about the apps on their mobile devices and their newly discovered software packages, we ended up splitting up into two groups, the first feeling depressed, and the second being dreadfully depressed.
Medics with emotions in tatters
I wasn’t kidding about the depression part.
That the most sweeping technological revolution had to coincide with the most all-encompassing era of healthcare reform will probably go down as creating the perfect storm for physicians.
It turns out that many of us are suffering symptoms of burnout and emotional exhaustion.
For physicians who did not previously have a large portion of their patients of Medicare-age, and who therefore may not enjoy the stability of Medicare as our main payer, everything has been turned upside down: uncertain payers, the perennial squeeze on reimbursement rates, new Affordable Care Act (ACA) mammoth insurance payers that dance to a strange new beat, having to shift from the volume-based to the value-based model, into the 500,000 new diagnostic and descriptive codes, and basically having to restructure both our offices and our alliances.
All in all, it has all been a little too much. A study published by JAMA¹ revealed a rate of physical burnout and high levels of emotional exhaustion of roughly 45% of all responding physicians in the U.S. Almost half of us are simply worn out.
Tomorrow’s technology teams
We take solace in what we see in our future –or our children’s.
Health IT is undergoing a gargantuan conversion from a luxury that benefits a few select organizations to the bedrock upon which an entire industry is based.
Happening now in a medical center of average-to-large size, the IT staff is beginning to include nurses, physicians and research assistants together with the usual consortium of techies.
The person at the helm, the one who constantly burns the midnight oil, is the Chief Information Officer (CIO), typically a PhD in computer science or equivalent who has the fundamental task of always ensuring both that the technology works and that it keeps producing additional efficiencies.
This team, and others like it across the country, is braced to benefit from a national economic stimulus that will allocate countless billions of dollars for healthcare technologies, and the reason for the diversity in the team is that they have moved from being accountable for technology to being part of the teams delivering the care and participating in strategy decision-making.
Even the CIO is expected to engage in healthcare delivery and the business side of operations.
Today’s half-in physician
For now though, many of us have dipped a toe in the water and have decided that there is no escaping going at least knee-deep. We figure on knee-deep being kindly enough to perhaps carry us through retirement.
What that entails is that rather than attempting to become proficient at any of the modern technological aids, we can lean heavily on savvy staff.
When seeing patients, some of us today don’t even have to take our hands out of our pockets. When you arrive at a doctor’s, it’s a nurse who shepherds you to one of the endless rows of examination rooms.
As you walk by, you get a peek at other inmates (patients) lined up in their rooms, harboring that anxious look of disappointment that the footsteps they heard were yours and not the doctor’s.
The nurse sits you down, asks you a ton of questions, takes your vitals, and then tells you to wait. An hour later, you start hearing the doctor making the rounds in the rooms approaching yours. You calculate about 4 minutes per room.
Finally, after “seeing” you, the doctor then strolls by the nursing station, leans over and, in a few words, gives them the skinny so that they can turn you to structured data that then bill you.
The medic’s hands have thus never left his pockets. We like that model: half-in and half-not-yet.
A keen distrust for mobile electronic health records
Do you know what rationalization we technology-averse physicians use the most, apart from “I’m close to retirement therefore I don’t have to”? It’s, “why should I learn all about this device when it will soon become obsolete and replaced?”
But give us a break, for it’s not all about our shortcomings.
For starters, there is a ton of devices and software, such as electronic health records (EHRs) software, vying for the doctor’s attention –and much of it redundant and of such poor quality that techies and skeptics alike are driven to throw their arms up in the air and passionately loathe it.
In addition, no one could tell health IT from good health IT, and the difference can be terribly frustrating for any physician, let alone those with a heavy schedule.
One example that is frequently cited is that not many electronic health records enable transmission between portals or systems, and when they do, patient data comes through but in a way that it is not usable for fast-paced patient care.
Many physicians, particularly those who work in ERs and ICUs, also frequently mention that the vital data needed tends to get scattered throughout the system, leaving it up to the user to conduct an exasperating treasure hunt.
Even stalwart physicians who are by no means evading the change-over to implementing electronic health records talk about a dysfunctional workflow brought about by the software. They prefer to wait and bide their time -thankfully.
Technophobes ushering some technologies in
Witnessing some of the eye-popping advances made on tablets and “connected” cars, many of us technophobes are nevertheless impressed with how fast the voice-activated technology has come along.
In fact, we are anticipating the further development of Clinical Language Understanding (CLU) and the many solutions that it will bring about.
We’re actually looking forward to the day this technology will enable the computers in our offices to transfer unstructured (frequently dictated) medical jargon to structured and actionable information.
We see the day coming soon when anyone of us skeptics can have an easy way to talk to the Electronic Health Records (EHRs) and navigate the digital record with the use of our voice.
It’s truly exciting the number of routine digital issues we could resolve like that, not to mention the countless saved hours coders spend in translating codes from the ICD-9 to the ICD-10 system and interpreting, in structured language, what the physicians are doing.
Instead, physicians can dictate into the electronic medical records the outcome of a patient visit and then simply hit the Save button. The software would then prompt the physician to choose from offered details until, in quick real-time, the system captures the diagnosis and prescribed treatment in the desired format.
This can’t come in more timely fashion for myself as well as for many of my peers, for the squeeze has been on us over the last couple of years, and we sure could use a break.
As we all know, we are being asked to capture a far greater amount of data in the patient record and simultaneously deal with the change-over from paper to digital –all at a time when it is impossible for us to throw additional resources at the problems as our budgets are already bursting at the seams.
So for now, we can rejoice at the fact that even us technophobes are ushering some technologies in.
The way forward
When car manufacturers plan the next year’s models, they conduct extensive research and then keep their prospective buyers’ whims highlighted in big lettering on their drawing boards.
The manufacturers of innovative tools and processes for the health industry could benefit from emulating that sequence, starting with acquiring a meaningful understanding of their clients’ needs.
Instead, they seem to be outdoing one another in producing and marketing new wares on the market.
While no one really disputes the quantum leap forward that innovation will ultimately deliver, there is currently an imbalance in the marketplace, with physicians being squeezed from more than one direction.
An in-depth market analysis of physicians would firstly reveal that many of us have vested financial interests in our current setups and alliances, interests that we are being asked to dump for the sake of “change”.
This at a time when we are still deciphering the impact of the Affordable Care Act, and at a time when half of us are emotionally pressured and with fundamental technophobic constitutions.
In the end though, no one challenges the notion that the entire industry will make significant technological strides, and at a fast clip.
That train has already left the station, and if the lead locomotive seems to be sputtering and heaving, physicians and tool developers could fix it by taking deep breaths and entering into a period of more serious engagement.
¹ Study in JAMA, titled “Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population”, Article by Tait D. Shanafelt, MD and several co-authors.