Primary Care and Technology: Striking a Balance in Healthcare
Many well-established medical practices are feeling pinched by reforms that have incentivized the adoption of Electronic Medical Record (EMR) systems.
EMR suites are costly for any organization to buy and customize, and for many smaller practices, no matter how well-established, the initial expenditures and hassle of buying a system, training a staff and converting years or decades of paper records simply aren't worth potential returns. As a result, we've already seen many private practices across the nation allowing themselves to be gobbled up by large groups and hospital systems.
Worse, some physicians are retiring outright rather than adapt to new systems. With the expense of medical school, falling reimbursement rates and perceptions of worsening job satisfaction, there aren't always enough new graduates trained and ready to replace them, which exacerbates what is already in some areas an acute provider shortage.
Gains in efficiency realized from EMR implementation are often offset in other areas.
For all the potential benefits of EMRs, we realize that there are pitfalls.
The efficiencies that can be gained by the ability to look back, in an instant, through a chart and see a trend can be offset by non-intuitive layouts, glitches, incomplete conversions of old data and incompatibility of different EMR platforms that various providers may use.
EMR systems aren't always user-friendly, or even particularly well-suited to every medical practice environment — particularly in those areas where data entry during the patient encounter might take away from a physician's ability to give critical, hands-on care, such as that provided in an emergency ward, ICU, or operating room.
Crucial details of medical history can be lost when providers have their heads buried in a screen, trying to find ill-placed checkboxes. And older physicians who are less comfortable with computer systems than younger counterparts must take time away from patient care to hunt, peck and sweat over a keyboard.
Moreover, time spent recording information is time directed away from cementing or strengthening a relationship with the patient. Communication and empathy build trust, and many patients resent a physician who doesn’t speak with them eye-to-eye and clearly seek to understand their experience.
Data from the 2013 c2b Consumer Diagnostic underscore this issue: over half of respondents believe a personal relationship with their primary care physician is Very/Extremely Important. In the hurried exams of today’s office visits, less physician/patient interaction translates to less patient satisfaction.
Some of the benefits can even be detriments in and of themselves.
The ease with which a record might be transferred electronically from one institution to another could result in liability when it’s as simple as copying a file and clicking send on an e-mail. A paper system does provide more time to process which means more checks and balances in place.
Many EMRs like EPIC allow users to create auto-fill templates, which then ostensibly save physicians charting time. Unfortunately, the very ease of using templates can also contribute to mistakes when a physician or scribe hasn’t remembered to un-tick unrelated checkboxes that have been autofilled.
The result can be dissatisfaction and reduced productivity among your most experienced (you might read skilled,here providers.
Providers' wishes and EMR challenges aren't your only considerations, though.
But there's another side to this, too — many younger patients want, even expect, their encounters to be more digital.
Writing in The Atlantic, Olga Kazan bemoans (albeit with perhaps a generous dose of hyperbole in places) her doctors' struggles, or refusals, to become more tech-friendly.
She cites the discomfort she feels when scheduling by phone — from her desk in an open-plan, reduced privacy office — a gynecology appointment. She expresses her wish that she could simply e-mail her appointment request and quietly type out her chief complaint, instead of being forced to risk coworkers overhearing her private business.
Kazan makes some valid points.
Why shouldn't a patient be able simply to e-mail or text appointment requests and questions to the doctor? Potential breaches in medical privacy could be avoided, so too could confusing games of phone tag between the patient, doctor's staff and the provider.
In the author's case, many of her provider choices are predicated on a practice's tech-friendliness.
Granted, a system in which patients can directly e-mail providers might be somewhat problematic. You will always have a certain portion of high-usage, high-demand patients who will monopolize a doctor's time. And how can one charge a proper consult fee for time spent e-mailing?
There probably needs to be a balance. Kazan isn't far off the mark when she asserts that tech-savviness is a sales attribute for many younger healthcare consumers.
This will likely not seem like so much of a problem in 10-20 years. As older, less-savvy providers retire and leave the market, younger doctors — who grew up entirely within the Age of the Personal Computer — will make up the majority.
In the meantime, health care organizations must find ways to strike a balance between doctors' desires, consumer demands, economic realities and legal requirements.