Anyone who has spent any time on the internet knows better than to spend much time on the comments from an opinion piece. The comments section, even one on a site as reputable and respected as the New York Times, is often a minefield of trolls, contrarians, and conspiracy theorists.
But after reading “The American Medical System Is One Giant Workaround” by Theresa Brown, I couldn’t resist. Among the predictable stories from overcharged and disgruntled patients were some thoughtful, if unsurprising, comments from newly retired physicians blaming EHRs for pushing them out of medicine; ER doctors and nurses who were unable to provide care to patients in dire need of it until the patient was registered in the system or the emesis basin barcode was properly scanned; and health care IT staff who are just as frustrated as everyone else by the slew of Band-aid style of “fixes” that have contributed to increasingly poor usability.
As a physician, I’m all too familiar with the workarounds clinicians have devised to ensure they are providing the best care for patients. When you’re caring for a patient who is clearly in need, while navigating a system filled with frustration and inefficiency, it’s nearly impossible not to choose the workaround path. It’s also easy to get frustrated and tempting to look for who’s at fault. There is plenty of blame to go around, but finding scapegoats doesn’t get us any closer to fixing the problem.
Technology was supposed to make health care easier to deliver, access, and pay for. But EHRs are not smart technology. More often than not, they slow things down and add to the noise rather than tamp it down. The health care industry asked for EMRs that optimized billing, and that’s exactly what we got. Unfortunately, it came at a non-trivial cost. Unlike the positive impact that digitization has had on every other industry, in health care, digitization has reduced productivity by nearly 20 percent.
The bad (and unsurprising) news: no one is coming to save us from the “health care non-system.” No presidential candidate, altruistic health system or insurance company executive, or Avengers-style army is going to blow up the whole system and make us a perfect, new one from scratch.
The good news: Smart technology can help ease the problem. A great place to start is with an idea that has saved other industries billions of dollars and created exponential productivity. Instead of thinking “digitization,” we should be thinking about “automation.”
As in other industries, health care automation lets people do the things they are good at and lets machines do the rest. In health care, that looks like this:
1. Doctors and patients discuss health history and current symptoms while voice-recognition software collects data and updates patient records.
2. AI “learns” how to rapidly and accurately pre-read basic CT scans, so radiologists can help patients get quicker and more actionable results.
3. Primary care and urgent care clinics hand patients an iPad with a conversational AI app that guides the patient through a dynamic medical interview. When the patient then sees the clinician, their medical record is up to date, and the visit is face-to-face rather than “face-to-screen-to-face-to-screen.”
4. AI-driven virtual care triages patients and directs them to the most appropriate venue for care delivery.
In each of the examples above, the clinician is delivering care. They interact with their patient as needed and use their medical expertise, experience, and evidence-based practices to chart the right course for patient health. What they aren’t doing is data entry, checking boxes, or scanning bar codes.
These kinds of interactions improve health outcomes for patients as well as allow clinicians to be much more efficient. Let’s say the patient in the fourth example (receiving AI-driven triage) was experiencing UTI symptoms. Once they had answered all of the questions in the virtual exam, the results were sent to a clinician who was able to quickly determine the patient did, indeed, have a recurrent bladder infection. Because there’s no need for the patient to have an in-person visit, the clinician can respond to the patient with their diagnosis and recommend or prescribe appropriate medications. If the virtual care software is integrated into the provider’s EMR system, the patient’s medical record is automatically updated—no need for the clinician to enter that data.
If the patient’s symptoms had been more complex, the virtual care platform would direct them to a higher modality of care, with a urinalysis and culture already ordered by the reviewing provider. The information gathered during the online interview will be available to the clinician seeing them in person, and the results from the lab test would already be available, saving both the patient and provider time.
It’s going to take every ounce of our collective creativity, ingenuity, and innovation to right the health care ship for all stakeholders. Clinicians want to deliver the best care possible to every one of their patients without being unduly burdened by the tools they use to provide that care. Patients want high-quality, affordable care in a reasonable time frame. Health systems want to be able to serve their patient populations, keeping them healthy, safe, and delighted. By taking a lesson from other sectors of the economy, health care can use smart technology to build real solutions, rather than place Band-aids and workarounds on the issue.
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