I began practicing medicine in the 1990s as a hospitalist. On an average day, I’d see 10 to 12 patients. I would spend any downtime on notes and billing. More importantly, I had time to revisit interesting cases, converse with colleagues and chat with patients and their families.
In 2018, that’s no longer what a day in the life of a physician looks like. I’m required to see more patients per shift, and my administrative tasks are much more time-consuming, due to a combination of regulations and technology. As physician satisfaction data will attest, medical practice is more stressful, frustrating and dissatisfying than it need be.
Physicians are not averse to working hard, of course; that’s part of what we signed up for. But now there are some compounding factors:
1. Medical knowledge is growing exponentially
Physician education and training are notorious for being one of the most grueling and time-consuming disciplines, and as new innovations and this body of knowledge continue to grow, the volume of information that physicians need to master is exploding. It has been estimated that, in 2010, medical knowledge doubled every 3.5 years; in 2020, projections are it will be doubling every 73 days, far beyond the human capacity to process it all.
2. Patient acuity and provider census have increased
People in the U.S. are living longer, which means physicians are treating more patients with more chronic conditions and complex medical situations – a trend that will only accelerate as more baby boomers enter their Golden Years, and the looming physician shortage manifests itself.
3. IT is more prevalent and confounding
The difficulty for physicians of using most electronic health records (EHR) systems is well-documented. As renowned health IT and patient safety advocate Dr. Robert Wachter of UC San Francisco has written, “EHRs contribute to burnout by turning physicians into unhappy data-entry clerks.”
All three of these issues are thorny to be sure. The first two are problems that IT potentially can help to address in time. The third is a problem with IT itself, which ought to be the most straightforward to address because health IT is advancing rapidly. In other words, IT is on the cusp of becoming a key part of the solution instead of the problem.
Over the past decade, an influx of health IT at hospitals and medical practices has left doctors struggling to learn an array of convoluted systems that impose unfamiliar workflows through non-intuitive user interfaces. EHRs essentially has become an additional hurdle for physicians to overcome as they try to do the already difficult job for which they trained. Ironically, we added technology and reduced the productivity of healthcare’s most precious human resources – perhaps the only industry to have gotten it so wrong.
Prior to EHRs, a physician’s most vexing information-related challenge was not having ready access to enough patient data. Patient information was siloed, typically in dusty paper charts buried in the basement or off-site storage. It was difficult, if not impossible, for a physician to garner a comprehensive view of the patient. With the introduction of EHRs, the pendulum swung in the other direction: doctors were inundated with information – too much, in fact, so that actually finding the right pieces of patient information became nearly as challenging as finding the sheets of paper in those dusty boxes.
The solution to this current dilemma obviously is not to go back to paper. Rather, we must build on and optimize the informational foundation that EHRs laid, with an eye particularly toward improving the physician experience. What does that mean? Physicians want to access and act on patient information with ease. They want data presented in a manner that is consistent with each physician’s unique thought process and workflow, and that allows them to intuitively synthesize and act on that information on the fly. So that technology helps each provider be a little sharper and more efficient and allows them to interact more (and more meaningfully) with patients.
For example, as a hospitalist, the first thing I do in the morning is pre-round, which can easily take up to an hour. I would welcome a computer system that helps streamline pre-rounding by highlighting the critical changes overnight and prioritizes tasks for the day, intelligently and in a manner that is consistent with how I practice. For me, the optimal system would provide a comprehensive view of the patient, including vitals, labs, and alerts, and let me easily scroll from patient to patient. It would unobtrusively incorporate clinical decision support and offer smart notifications, sending me updates specifically on information that I request. Another big plus for me would be automated note construction that I could begin during my pre-rounds.
A system like this – ideally available as a mobile app integrated with a web-based version — would get me on the floor sooner, and to the patient’s bedside earlier. And, of course, I’d want it not to require extensive training or adjustment to my familiar workflow.
Regardless of how much a typical day in the life of a physician has changed, our primary responsibility – to care for and improve the lives of patients – has not. I like computers; they’re great tools. But health IT must support, not impede, patient care. I look forward to the day when my laptop and mobile device are as indispensable to delivering patient care (and as intuitive to use) as my stethoscope. I believe it’s coming soon.
Christopher Maiona, M.D., is PatientKeeper’s Chief Medical Officer, responsible for providing clinical leadership across the company. Maiona helps guide PatientKeeper customers in how they can improve their physician experience and clinical outcomes utilizing PatientKeeper products, and brings a clinical voice to the product design and implementation processes.