Using technology to completely rethink the patient encounter

It’s time that we rethink the doctor’s office encounter.  It’s inefficient for doctor and patient, and doesn’t optimize care for those that need it most.  Everyone is treated the same, even though not every illness or medical need has the same urgency.

To get to see a doctor I have to make an appointment days or even weeks in advance.  I have to drive over to the complex, find parking or risk a parking ticket, go into a waiting room and wait until the nurse calls me while being exposed to ‘who knows what’ kind of germ, viruses and bacteria from other sick patients.  I then go into a patient encounter room where a nurse takes my temperature and my blood pressure.  Then I wait some more.  If everything goes well, the wait inside the doctor’s office averages about 20 minutes.  The doctor comes into the office, asks a few questions, looks at the chart, looks at the information the nurse documented and decides what should be done.  From the moment I left my house until I’m back at home, it could be as little as an hour, but averages about 2 hours.

Let’s look at how this plays out for a chronic condition such as high blood pressure.  The doctor issues prescriptions for 6 months at a time.  The doctor is monitoring the BP to make sure that the patient hasn’t developed tolerances and everything is remains under control.  Every six months, the patient must return to have their BP read, then an new prescription is issue.  Every six months the patient must put their life on hold while they return to the doctor’s office to another prescription, even if everything is working fine.

I propose using technology to completely rethink the patient encounter.  Instead of using technology to augment the ‘time inefficient’ traditional appointment model, let’s break down the entire process and figure out how to replace it with a more efficient model that saves time for the patient and the doctor while providing the best patient care possible.

I envision a system where the patient at their computer calls the doctors office on a video call.  The patient punches in their account number.  The computer on the doctor’s end automatically recognizes the patient’s medical record number, goes to the medical records data base, and provides the patients medical record to the triage nurse.  (This is standard call center technology done currently when you call customer service organizations where they ask you to enter your customer number.)  The triage nurse identifies the immediacy of the patient need and schedules them accordingly.   If the patient needs are critical, the patient is directed to the nearest ER.  If the patient needs a specialist, they are referred to the specialist immediately.  The electronic order for the referral is done immediately and the patient’s next call is to the specialists office.  Other’s are scheduled according to needs and available openings.

Think about how the BP encounter would work, using technology.  The doctor’s office is called.  The patient enters their patient ID number and a message is left that the patient wants to renew a particular prescription.  The doctor’s office, upon getting the message, has the doctor review the video of the call to verify that everything looks good and there are no signs of obvious distress.  The doctor issues a conditional prescription to the pharmacy.  During the course of the day the patient stops at the local pharmacy and has their BP taken at the local machine.  The patient hands the printed read out to the pharmacist who checks it against the conditions of the prescription.  If everything matches, the medication is handed out.  If there is a discrepancy, the patient is referred back to the doctor for a visit.   The entire process takes the patient only 15 minutes and very little deviation from daily life.  It can be handled by the doctor is less than a minute.   No medical transcription of the event is necessary because the entire encounter between the doctor and patient is recorded and becomes a part of the electronic health record.

To be fair, pharmacies will call doctor’s offices for new scripts to renew them.  However, at some point, the patient is forced into the doctor’s office.  That is the visit that this method will be ideal to replace.  For those patients who feel more comfortable with the traditional doctor’s office visit or they have more serious issues, they can continue with the same method of visiting the doctor’s office.   However, there is no reason that we should be using technology to emulate old encounters instead of rethinking and streamlining the entire thing so that everybody wins.

Gary Patterson is the founder and CEO of Pearce, Patterson and Associates, Inc.

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