As we all know, healthcare is a well regulated and process-driven industry. The current timeline for new research and techniques to be adopted by half of all physicians in the United States of America is around 17 years. While many of these regulations and policies are created with the best of intentions, they are often designed by criteria that doesn’t have the patient in mind, but play more to the needs of our billing needs, reimbursements, and being efficient as organizations. Rarely do we see these being designed with the experience and interactions with a patient.
The challenge for technology at the moment, especially for the physician, is how to move beyond the meaningful use criteria that the federal government has adopted.
Outdated record rules
We are currently working with medical record rules and criteria that are 20 years old, and trying to adapt and apply them to our electronic records. The medical records have become a repository of large amounts of waste of words and phrases that have little meaning to the physician/patient interaction. For me to wade through a medical record (because of the meaningful use criteria and structure of medical records) it is very difficult to find relevant information.
As a person involved in quality review, what I find more and more in electronic records is that it’s very easy to potentiate mistakes and errors. One part of the whole system that I find uncontainable is to have the physician, who is one of the most costly members of the team, take time to ostensibly be a clerk, or scribe, and take time to fill out the required records.
The problem that we can identify with all of this, at least in the office visit portion, is that it disrupts the visit with the patient. It focuses the conversation to adhere to getting the clerical tasks necessary for meaningful use criteria completed. And to me, there’s nothing more oppressive in this interaction than to doing this clerical work, than when it’s done electronically, and getting worse.
So if we look at this situation from the perspective of people (both the patient and physician), and how we can use electronic tools, we could rapidly be liberated from the oppression of regulatory interactions. It would be so easy, right now, to capture patient’s activities and health to create a historical archive. This could be created in some template using video and audio technologies, and language dictation software that could give the physician much more content about what is going on.
I say this after visiting the Center for Innovation team at the Mayo Clinic Scottsdale location, where they are conducting a wearables experiment, on which the provider is wearing Google Glass when at an office visit with a patient.
The experiment had a scribe in another room observing and recording the interaction through the Glass feed, both video and audio, to capture the visit and create the medical record. As I looked through the note that was put together, it was a good note. It met the requirements for the bureaucrats, but it missed the richness of the visit that I observed, and it missed what the patient needed. It missed the steps and instructions that the physician covered with the patient. There is no place to record this in the current set up.
Easy review access
Just think if that interaction was available, through a HIPAA compliant portal, for the patient and provider to access. When the patient goes home, and a few days later asks, “What did my doctor cover during my visit,” they would be able to watch and hear the conversation right there. They might have brochures and literature that was given to them, but imagine if they had access to that video and audio to replay and watch again.
It seems to me that we have the technology at hand to make this a viable reality.
The biggest challenge here is to convince certain parties, like the Federal Government and Medicare, that there is a better way to do this, and that these are more meaningful ways. Recalling who the decision makers are that designed these processes and regulations, we must work to change the design criteria from that of a compliance perspective, to one where the needs of the patient come first.
That’s where I think we have the great opportunities and great challenges to turn this around. If we think for a minute, and decide to do away with all this useless meaningful criteria, and instead say, “Let’s go back and think how we can make the experience better for the patient,” and leverage technologies to do just that, we would be much better off.
What questions do you have?
Dr. Douglas Wood is a practicing cardiologist and the Medical Director for the Mayo Clinic’s Center for Innovation.