Surprise! Health care can learn a lot from the DMV

Three years ago, I received a letter in the mail informing me that my driver’s license would be expiring. Almost immediately, I felt a sense of dread because I knew I would have to go to the DMV to renew my license. As a full-time, practicing orthopedic surgeon, running daytime errands isn’t exactly something I like to do, or better yet, have the time to do.

However, along with the DMV letter, there was a form requesting demographic information. The letter stated that I should complete the form at my convenience and return it with the appropriate payment. The DMV would then process the information and send me a confirmation form that I would take with me to get my new license.

So, in the comfort of my own home, I completed the form, attached my payment and mailed it to the DMV. About two weeks later, I received a letter. The letter confirmed that the DMV had received my information and payment. I was instructed to bring the confirmation statement with me when I went to renew my license. Upon arrival at the DMV, I would then get my picture taken and leave with my brand new license. Easy, right? I must say, I was skeptical about the whole thing, but that’s exactly how it played out. Having completed the necessary paperwork with payment ahead of time, all I needed to do was to get my picture taken.

When I actually arrived at the DMV, it looked like it always looks: crowded, slow and full of impatient people with various motor-vehicle related complaints. To my surprise, there was a special line for people who were “pre-registered” and just needed to have a picture taken. Even more astonishing, there was no one in the line when I arrived. Once I had my picture taken and received my new license, I looked at my watch. I couldn’t believe it! Just 8 minutes had elapsed from the time I entered the facility. In my previous 20 or so years as a driver, I had never spent less than 60 minutes at the DMV. From start to finish, it was a great experience.

Imagine a world, where the health care you need could be expedited and streamlined in a similar fashion. After years of training and clinical practice, I can diagnose a patient with most musculoskeletal complaints and develop a treatment plan in about 10 minutes. In order to provide a diagnosis, I need background information, the ability to perform a brief physical exam and possibly, interpret some imaging. Without question, the information-gathering portion of the visit is, by far, the most time-consuming part of the patient’s clinical visit. What if there was an effective, accurate, HIPAA-secure way to obtain the necessary information, patients and providers alike would benefit?

Consider this: as a patient, you could spend a lot of time telling your story and sharing the details that you think are relevant. Since this isn’t simple demographic data like what was required at the DMV, there would likely need to be a clinical person gathering the information. Ideally, there would be a physician assistant, nurse practitioner or potentially AI-enabled platform that would take whatever the patient said and put it into a concise, five-to-ten sentence summary. With current technology, this interaction could take place anytime, 24/7, via phone or even videoconference prior to the patient’s visit.

As a physician, did you ever wonder why you can take a medical licensing exam or standardized test and complete 200-300 questions in around six hours? It would probably take 10 days to see that many patients depending on your specialty. The answer: when all of the information is available in a format that’s easily accessible, you can make decisions very quickly. Information, such as a patient’s history, description of injury and interpretation of imaging could be captured in the patient’s chart and reviewed prior to the patient arriving. In this way, the patient’s visit could be focused on diagnosis, discussion, and counseling about how to manage their problem.

From a physician perspective, it would be great to have your patient pre-screened prior to their arrival. The visit could then be tailored to their specific situation, complaints, and clinical problem. They could even be triaged to see another provider if necessary, sent for imaging or lab tests ahead of time or coached or counseled about the upcoming visit to set reasonable expectations. In addition, portions of the clinic note could be completed in advance which could help minimize the administrative burden and documentation by the provider.

From a patient perspective, being pre-screened could enhance their experience by shifting the focus of the visit towards the assessment and treatment plan and away from redundant information transfer. In our clinic, we recently performed a three-month pilot pre-screening our new, knee-pain patients and found significant decreases in visit and wait times as well as increased one-on-one time with the provider.

Having this sort of operational workflow, will probably take several years for most health systems, but given today’s technological advances with telemedicine, automation, and artificial intelligence, there is no reason why we can’t start having that conversation now. There is no substitute for extracting necessary background information from our patients. I’m just advocating for improved efficiency as to when and how we get that information.

Alfred Atanda is a pediatric orthopedic surgeon.

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