By Mark A. Kelley, MD |11/10/17
Founder, HealthWeb Navigator
According to published reports, over 50% of doctors are burned out. The reason? They are overwhelmed by payment and quality rules as well as poor information technology.
It’s no secret that physicians spend long hours seeing patients. But as financial pressures have mounted within hospitals, doctors are forced to perform more administrative tasks. In fact, administrative tasks account for nearly a quarter of the average doctor’s schedule. That’s all time diverted away from patient care.
Many physicians feel a loss of autonomy, a major factor in burnout. The National Academy of Science now sees burnout as a major threat to maintaining our physician workforce.
The key issue is how we want healthcare professionals to spend their time. Instead of asking them to do more, we should ask, “Do more of what …and why?”
Our current system is based on assumptions and technologies that are outdated and interfere with the delivery of modern health care. Three problems are clear:
• Physicians in the United States must provide exhaustive documentation to justify their services. No other health system in the world imposes such onerous rules.
• Health IT systems are designed primarily to support tedious billing documentation rather than clinical care. For practicing physicians, this issue tops the list of frustrations.
• Payers and other advocates have promoted different measures and incentives, leaving both physicians and patients searching for a single, meaningful quality agenda. That goal remains elusive, trapping physicians in many time-consuming quality tasks of dubious value.
These three problems have forced physicians to perform more tasks that take time away from patient contact. The result is the “ten-minute patient encounter,” during which the physician spends most of the time on a computer to document and bill for the visit.
This contrasts with how other professionals spend their time. Imagine if we expected airline pilots to sell tickets, load the baggage, and fill the fuel tank before flying the plane!
Several innovations would help solve these problems.
1. Modernize healthcare transactions to be efficient and understandable. Documentation has devoured clinical practice. Originally designed to curb costs and prevent fraud, the current system is an obsolete instrument. In businesses such as the credit card industry, electronic algorithms and analytics detect fraudulent behavior. Such technology should replace arcane documentation rules and their toxic effects on clinical practice.
Beyond the documentation problem, the healthcare industry operates an economic system that bewilders patients, providers, and most business experts. Private insurance rules vary widely by plan, location, facility, and provider. If health care were a consumer-based business, it would have been “out of business” long ago.
2. Focus IT on healthcare analytics. The depth and breadth of medical information is growing exponentially. To serve their patients, physicians must process complex data and perform multiple tasks rapidly. Well-designed informatics can save time, reduce errors, and distill information. Sadly, we are far from reaching that goal.
The current health IT systems are heavy on billing and documentation, and light on usability and analytics. While medicine has aspirations for using “Big Data” in patient care, its information systems are poorly prepared to do anything more than print reports and bills. The healthcare industry needs “smart systems” that make medical practice highly reliable, safe, and more efficient.
Outside of health care, new IT solutions are thriving. Patients can purchase a $50 voice recognition device to browse the internet, play music or news, and perform calculations. However, their doctors and hospitals are stuck with expensive billing systems that are clumsy at retrieving and organizing patient information. That embarrassment would end if healthcare IT focused more on patient care instead of billing.
3. Prioritize national quality goals that matter. Our nation needs to justify the assignments it imposes on physicians. The major advances in healthcare quality have been successful because both patients and physicians understood their importance. These advances, such as cardiac prevention, were planned and tested to blend into practice. Physicians will support important quality programs that meet these standards…but not low-impact measures designed in a conference room.
Medicine is the ultimate human service, whose value to the patient is quality time—time spent with the physician. That bond should not be threatened by putting “business” processes ahead of patient care.
If we lose that battle, both patients and their physicians will be casualties in the war to save medical professionalism.