Providing Meaningful Care: Leverage Technology and Optimize Workflows to Help Physicians and Patients
In practice, health care is warm and compassionate. Healing and helping are at its heart.
As a business, health care is cold and detached. Reimbursements and incentives are tied to revenues and adoption rates.
Patient-centric physicians often must provide care in accordance with policies set by policymakers far removed from clinical settings though, if they and their organization are to be properly compensated.
Perhaps it is no wonder then that many physicians have come to resent what they see as an intrusion of a values set that emphasizes money over care.
One of the 13,575 physicians who responded to The Physician Foundation’s 2012 Biennial Survey of America’s Physicians included this comment:
“I was told once by a healthcare administrator, and have heard this ‘mantra’ from several more: ‘Healthcare would be a great business if it weren’t for patients and doctors...who keep interfering with the business.’ … The focus of healthcare has sadly and dramatically changed: It no longer is patient care or the quality of care that is important. It is all about the money.”¹
Physicians’ disillusionment often extends to Electronic Medical Records (EMRs), which many see as a burden rather than boon when it comes to patient care.
Though more than 69 percent of the physicians who responded to The Physician Foundation’s 2012 survey had implemented electronic medical records into their practices, only 46 percent said that EMRs had improved or would improve care. Four percent indicated that EMRs had decreased quality of care but would improve it eventually, while more than 31 percent responded that they had no effect on quality or had not improved care, and that they would not do so. More than 10 percent replied that EMRs had decreased quality outright. Eight percent said EMRs may improve quality but not were not worth the investment.
Change-resistant physicians are pushing back, thereby slowing the adoption of meaningful use provisions.
As of Aug. 25, 2014, only 3,152 eligible professionals and just 143 eligible hospitals had attested to Stage 2 meaningful use, according to statistics from the Centers for Medicare and Medicaid Services, cited by Health Data Management.²
“The numbers are very low, particularly for Stage 2 attestation. I mean they are like 4 percent of [providers] that should be currently going for Stage 2,” Health IT Policy Committee (HITPC) member and Intermountain Healthcare CIO Marc Probst said of the numbers, according to a Health Data Management story about the HITPC meeting in which the data were released.
The next phase of optimization is to move from meaningful use to meaningful care, in which workflows, processes and best practices are refined so as to use EMRs to produce the best clinical outcomes.
Here are five ways your organization can improve patient care by transitioning from meaningful use to meaningful care.
1) Focus On Care
Clinicians have been marginalized from the beginning of the movement to EMRs. The term “electronic medical record” conveys nothing about care but speaks volumes about IT. Rather than portraying an EMR as another tool to improve care, the term speaks to a “record” as the end product. “Electronic” also implies laborious and burdensome—read obstacle to effective care. A more patient-centric term like “collaborative health records” may have ameliorated physicians’ concerns about the records’ intended use long before now.
It may be too late to relabel EMR industry wide, but you can communicate their benefits to physicians and other care providers in care-focused medical terms, rather than IT and project management terminology. Clinicians relate more easily to terms such as “symptoms” and “diagnosis” than “discovery” and “finding,” for example. Showing that you care about patients will help increase physician adoption rates.
2) Integrate IT Into Your Workflow
If you were to get a new MRI unit, not everyone would have to be trained in its usage. But everyone is required to learn your new EMR system, and physicians often do not get adequate training. Clinicians and physicians require deliberate orientation. You should also redesign their workflows and processes to accommodate for their learning and usage. They need to know more than what buttons to push. They need to know how to put the system to work on behalf of their patients.
3) Use Data to Optimize Care
Collectively, we have erected a suitable framework for using data to improve patient care. But it is as if we have built a house, topped it with a roof and put up the drywall. It is not yet a home. We must enclose the walls and do more work before it is livable.
Your organization should integrate its systems to allow cross departmental communication and collaboration, regardless of vendor type or clinical setting. This allows you to care for patients holistically. You should also customize your systems clinically. The same alarm should not ring in pediatrics as obstetrics, for instance. Your EMR system should serve providers, not the other way around.
4) Prioritize Efficiency
Ensure that your health IT professionals focus on process improvement rather than data entry. Too often, clinicians and others go into HIT with the expectation that they will be working a 9-5 desk job with a limited scope of responsibilities. In actuality, they should be walking the workflow to determine how you can leverage EMRs to improve patient care. Emphasize efficiency in recruiting and training your HIT staff accordingly.
5) Advocate for Broader Change
One organization alone cannot move the industry from meaningful use to meaningful care. A wider dialogue and bigger push is needed. Hold policymakers accountable for provisions that could—or should—affect patient care. As well intentioned as they may be, some policymakers may lack the proper experience or perspective to see how a decision they make based on business criteria will ultimately affect patients. Share your opinions publicly and through targeted advocacy for patient care.
Urge vendors to be responsive to physicians’ needs and data integration issues as well. It is not enough to say, “We will wait for the next generation of systems.” Those systems may never come or could be a long time in coming. Physicians have embraced technology inside and outside of hospitals. They are capable of using, and worthy of having, enhanced EMR systems that can be customized to improve patient care. Include external physician groups in outreach, for they too can generate efficiencies by integrating with your EMR system.
Pain is inevitable when thousands of organizations and hundreds of thousands of providers have to migrate to EMRs. But focusing on transitioning from meaningful use to meaningful care industry wide would drive up physician adoption and attestation rates, thereby accelerating the movement to Phase 2 and then Phase 3.
You can push through the pain to achieve real, meaningful integration of IT systems into your healthcare system, if you focus on how EMRs affect patient care. Assess how systems hinder or help your physicians as you prepare for implementation or optimize afterward. Learn from the experiences of other organizations that have overcome similar problems. Engage outside experts to provide the resources and knowledge to improve physician adoption and patient care as needed.
Meaningful data may be enough to collect money. But meaningful care is what your physicians demand—and what their patients deserve.
1. Slabodkin, Greg. “Stage 2 MU Attestation Rate Remains Sluggish.” Health Data Management. Sept. 5, 2014. http://www.healthdatamanagement.com/news/MU-Attestation-Rate-Remains-Sluggish-48753-1.html?utm_campaign=daily-sep%206%202014&utm_medium=email&utm_source=newsletter&ET=healthdatamanagement%3Ae3032696%3A2492226a%3A&st=email
2. The Physician’s Foundation. “A Survey of America’s Physicians.” Completed September, 2012. http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf
3. Health IT Policy Committee. “MU Listening Sessions. May 20, 2014 and May 27, 2014.” June 2014.