When my doctor walks into the exam room, I want her to pay attention to me, not the computer. Not only is that what all patients want, but it’s what doctors want, too. Yet doctors today are under pressure to feed the digital beasts.
Health care’s latest best-selling M.D. author, Bob Watcher, says that in a 10-hour shift a single doctor might record 4,000 clicks. Worse, much of this activity is routine census taking, driven by insurers and regulators who assume digitization makes it easy to gather statistical data, regardless of whether it contributes to the quality of care.
Doctors are not Luddites. Many were initially enthusiastic at the thought of automating their practices, expecting the same kind of usability and productivity they enjoyed with, say, the software they use to do their taxes. The expectation was that software for medical professionals would at least be that good. The reality is that the more “digital” physicians go, and the longer they use software, the less satisfied they become.
That’s the kicker: Health care is the only industry that has managed to lose productivity while going digital.
The typical electronic medical records software is a maze of tabs and dialog boxes that doctors must navigate to record the same information they used to be able to handle with a few notes in a file folder. And what do they get back for their effort? Sadly, consumer apps are much better at volunteering helpful information and unexpected insights.
Health care’s software problem will not be solved with a user interface overhaul – EMRs need to be smarter, not just prettier. Think networks, not software alone. We need to bring together the intelligence of doctors, nurses, patients, hospitals, laboratories, insurers and everyone else who contributes to the continuum of care.
Too many doctors document care in disconnected software that doesn’t know if a patient had an adverse reaction to a medicine, saw a different doctor down the road last week for a related aliment, or has had countless tests done over the years for similar symptoms. Expecting that intelligence from an isolated EMR would be like hoping your CD player will start to play Isaac Hayes because you like James Brown. Unlike your favorite digital music service, it just isn’t wired that way.
For the past four years, my company, athenahealth, has been working to reimagine the EMR. We want to take the hassle out of technology, making it useful for the physician and seamless for the patient. We’re not done, but we’re making progress. Ultimately, we are focused on delivering EMRs that provide rich clinical information, while still allowing doctors to be fully present at meaningful moments of care. In other words, we believe technology must let doctors be doctors.
In our quest to make the EMR smarter, one of our primary tactics is to simplify every process where clinicians are presented with an overwhelming number of choices. Because we operate a network that more than 67,000 providers, serving more than 69 million patients, are plugged into, we can aggregate what we learn from every interaction. That’s on the order of 330 million data exchanges per month. We’re studying health care in the wild, as well as listening to doctors and care staffs.
Complexity is the enemy. Medicine is necessarily complex, but the administrative complexity surrounding it can be reduced. For more than 15 years, we have managed the byzantine world of reimbursement to help providers get paid faster. More recently, we’ve been applying the same discipline to making electronic health records more useful. Our goal is to prompt providers to gather the data they need to gather in the least intrusive way.
Wherever possible, delegation should happen from doctors to nurses and administrative staff, and even to patients. Instead of patients answering a whole series of routine questions with their knickers down in the exam room, let them do it on a mobile app from home the night before. If a doctor is prescribing a prescription for a diabetes patient, rather than being presented with all possible medications, why can’t the EMR surface those most likely to be appropriate based on a doctor’s past choices, but also based on what’s trending and in use across the network?
If we expect information technology to help us achieve a more efficient, more effective, higher quality health care system, we not only need to gather data efficiently but make sure we learn from it and translate it into meaningful moments of care.
We need make EMRs serve providers, rather than the other way around.
That’s why we’re launching the social engagement campaign let doctors be doctors. We are hopeful that all in the provider community that similarly believe there is a better way, share their EMR stories and recommendations at letdoctorsbedoctors.com. We will bring that feedback to Washington to help influence developing Health IT policy initiatives, including legislative efforts currently underway to improve the interoperability and usability of EMRs.