By Mark A. Koppel, MD, Chief Medical Officer
Recently, I felt compelled to comment on a thoughtful article. In 3 Ways to Make Electronic Health Records Less Time-Consuming for Physicians, published in the Harvard Business Review, Derek A. Haas, John D. Halamka, and Michael Suk make astute observations and offer practical ideas on what’s become a touchy subject: physician requirements in the Electronic Health Record (EHR).
Like I said, I felt compelled to comment. So, I began writing…
And, before I knew it, I was working on more than just another comment. I hope this compels you to comment as well and become part of the solution.
The Worst Kept Secret in Healthcare
It’s truly the worst kept secret in healthcare. Our physicians can spend up to half their time using EHRs…recording information rather than treating patients. What’s even more mind-boggling is the financial cost—$365 billion annually.
Physician frustration is leading to levels of burnout leading to a real crisis in healthcare. We know burnout has negative financial, operational, and clinical consequences for our healthcare institutions and patients. We are seeing a real supply and demand problem that continues to develop today. Do we have enough clinicians to take care of an aging population? A population that is presenting with higher acuity problems?
It’s not hyperbole to call this a crisis, and we all need to pay attention to this now.
What’s the real problem?
At the same time, calling out the EHR as the problem is inadequate. We need to be more thoughtful than that. This is a multifactorial challenge and a multifactorial problem.
It’s not the EHR alone. And we have to recognize that. Rather, we have a complex regulatory, medical- legal, and reimbursement environment that contributes to this challenge. To start addressing this monumental challenge, Mr. Haas, Dr. Halamka, and Dr. Suk pose excellent points.
This is more than just a physician challenge.
It’s more than a technology issue.
We’re talking about a macro level-problem that will take engagement on multiple levels to solve.
Following are the authors’ proposed high-level solutions with some commentary.
Standardize and reduce payer-imposed requirements
The literature suggests that US providers document significantly more when compared with international providers.
Why? Because we have a unique reimbursement system that requires what amounts to exponentially more effort to be properly compensated or reimbursed.
Why is it that way? How can we work with payers to make that process more streamlined? This is exactly the path the authors suggest. Standardization can help immensely…but it can’t work alone. This truly is a massive challenge, so we should start where we can have the most impact……
Continuously improve EHR workflows
Technology without proper workflow consideration typically leads to failure of the technology. If the process is inefficient to begin with, adding technology will magnify that 100 times out of 100.
We all must consider a new paradigm in the way we care for patients and how we document care. So…
- Let's think about how we have our workflow structured.
- Let's continuously improve those workflows.
- Let's continuously look at the way we interact with the EHR.
- And, let’s continuously revisit what we're doing so we're reducing that burden!
When big change happens—even over long periods of time—you adapt. We must adapt the way we care for patients…improve workflows continually so we can adapt to the changes now and ahead.
It leads to the obvious questions:
- What’s the biggest barrier to changing workflow?
- How do we make it stick moving forward?
How many things are being done within the EHR that don’t need to be done in the EHR? Or, how many could be done by other team members?
This leads us to the authors’ final suggestion:
What innovation is out there that can help maximize the use of the EHR or minimize the excessive multi-click process?
The authors make an interesting point in their third recommendation. There are a number of solutions out there around voice recognition, scribes, and connected devices that are actually already automating processes. The one big aspect that perhaps hasn't been fully addressed? The clinician end-user experience. That's where there's ample opportunity for the industry and end-users to collaborate on real improvement.
Look…there are a number of different elements out there that can be added to the EHR. And—full disclosure—Excel Medical happens to be one of those. But, no one vendor can address things on an island. We're not going to be able to sit here in an echo chamber and come up with something that can be a real fix for this massive problem. No one vendor can! This calls for partnerships between vendors and providers and systems, working hand-in-hand to address the burgeoning crisis.
Mr. Haas’, Dr. Halamka’s, and Dr. Suk’s article is a thought-provoking read. The issues they've highlighted are significant, and at a high level, their suggested solutions make sense.
We can’t get distracted by the size of the challenge. Streamlining our reimbursement system is a massive topic.
But suggestion number two is, “Hey, there are practical things we can be doing as end-users to enhance our workflows each and every day.” That's a tactical thing that can be addressed starting NOW.
And then third, let's converge the healthcare ecosystem—providers, health systems, and (yes) vendors to not only think deeply about how we can improve this process…but to make a real impact through innovation. I’d love to see a coordinated effort between providers and vendors to consider how we can further realize the benefit of the EHR.
It’s a tricky thing in a world where the laws of supply and demand are real…where providers and institutions are focused on taking care of patients every day. And yet, it would make a massive difference for the future of healthcare in this country.
I know I want to be a part of the solution. And, from a vendor perspective, I know Excel Medical wants to be a part of the solution, too. It’s why I am writing this.
And it’s why I hope you’ll share your own thoughts. Let’s be a part of the solution…together.
I mean it! How can we be a benefit? How can we help solve this problem?
Leave a comment here, and also…give me a call or send me an email. All of us at Excel Medical are here, we're open, and we're willing.
A groundswell starts with open conversation. Let’s make it happen.
Mark Koppel, MD is the Chief Medical Officer at Excel Medical.