There’s an awful lot going on these days.
Increasing awareness of the plight of American Medicine. Costs way up, access questionable, uninsured numbers growing. Primary care disappearing, and inverted in proportion to specialist:PCP ratios in other countries. The Graying of America. Talk about universal health care. Healthcare costs as being the #1 cause of personal bankruptcy in this country. Mid-level provider extenders.
Retail clinics.
Defensive medicine, and the over-utilization of expensive tests.
Just defining the scope of the problem is enough of a challenge, and lies outside the scope of this medical record blog.
But whenever I’ve read about strategies to fix the system, all of the serious ones involve EMR’s.
It Wasn’t Us, Honest
Although EMR’s have been guilty of many things in their short time on the planet, tanking the American healthcare system isn’t one of them. We were doing a fine job of opening the vents long before they came on the scene a decade ago (and even now, nearly 90% of physicians still don’t use them).
None of the issues at the beginning of this post have any kind of genesis with electronic medical records. And before you want to file EMR’s under “costs way up,” think about that $1500 MRI you ordered last week, or how a PCP after 40 minutes of coordinating care and counseling, earns 1/4th of what specialist can in 5 minutes.
A handful of those ka-chings, and you could pay for a high-end EMR for a year.
Think About Losing Weight
Consider it from another angle: What do you do when presented with a supposedly insurmountable problem?
If possible, you start by comparing it to something similar that you know how fix. The Weather may be way too complex — I only quote Chaos Theory, I don’t actually study it — but obesity is about right: it’s all around us, it’s a big problem, and very resistant to change.
And what’s the first thing you tell patients who want to lose weight? The thing that people who have successfully lost tons of weight – 80, 90, 100+ pounds tell you?
You’ve got to write everything down.
Put it down in black and white, all the stuff that pertains to your weight: nutrition, exercise, morning scale weight, etc. Count those calories. “I think I ate properly this week” is notoriously imprecise and generally wrong. What did the numbers actually show?
If you don’t measure it, you can’t correct it.
And there are an awful lot of administrators, public policy makers, and economists looking very closely at correcting the course of the USS Healthcare.
Lesson #1: At least for the clinical end of the stick, we aren’t going anywhere nationally, without EMR’s to record and measure what we’re actually doing, and to give us real data to work with.
Gathering said data with paper? With the expansion of the patient population? Then extracting, mining, and otherwise analyzing the info? Forget it.
But We’re Doctors, Not Statisticians Or Politicians!
Does the phrase “data mining” set your teeth on edge?
Or how about the thought of actually manipulating something with those numbers, like changing how you order certain meds, or whether someone needs to be called on the carpet because of a patient satisfaction survey? Don’t you just hate that?
It’s time to get over ourselves.
Our aversion to doing exactly that may well be a major factor in the ailing American healthcare system. An unexamined healthcare spending life may or may not be worth living, but we’re all sure paying for it. And it doesn’t need to be that way.
As medical providers, what our politics and numerical analyses often tell us, is that Doing What’s Best For The Patient is the overarching Rule Of Gold. Not realpolitik, and not zero sum game theory.
What works best in our daily slog through the mud, is what helps the patient get or stay healthier. This is less of a theory, than an observation — and if we disagree on this one, the whole rest of the argument falls to pieces.
Physicians who are policy makers and number crunchers may disagree on economic theory, but find it hard to argue this fundamental premise of medicine. When the numbers don’t add up at the end of the day, it’s sometimes the one thing that lets you sleep at night.
Lesson #2: There IS a lodestone, and that’s Taking Care Of Your Patients.
The problem, of course, is that it’s not always obvious what the best way is to do that. Especially across multiple practices, regions, disciplines, and regulatory bodies.
But That’s What Evidence Based Medicine Is For, Isn’t It?
Yes.
Forget about the legal hole you’d be in, if you did medical therapy instead of an angioplasty and your patient died — science itself, much less medical science, exists precisely because What Is Obvious Ain’t Necessarily So, and Common Sense Is Not So Common.
If a treatment works, it should hold up to scrutiny; if not, it’s time to revise our understanding of the problem, not cling to shadows. Evidence based medicine is the scientific method, writ large on the page of healthcare, and most of us understand the need for it.
So where does EMR come into this?
Evidence based medicine changes patient care patterns among clinicians, using analysis of hundreds or thousands of patient cases at a time.
But front line clinicians are only one part of the healthcare system. Just like documenting a patient care visit is only a small part of the benefit of an integrated EMR/EPM system, there are many, non-clinician aspects to the healthcare system that can be tweaked.
- What would you need to change not only patient care patterns, but also marketing patterns among medical groups?
- How would you analyze what went into setting the price point for a service, involving physicians, therapists, office and hospital stocking practices, and suppliers?
- How would you track waiting time trends, or the time needed to get a first appointment?
- How could you compare long term outcomes data for subsets of patients, not only weeks after a procedure, but months or years after?
How, in other words, would you track everything else in the healthcare system beside what the doctors do?
It all begins with an integrated EMR system.
If we can track it, we can kill and eat it.
But without the capability to analyze and optimize all aspects of the healthcare system, we’ll be forever stuck in our corners, trying to grab whatever fast moving targets flit by that day.
And the system’s problem isn’t a grab bag of small, quick, elusive targets. It’s a big, leggy Kraken that’s gotten used to waving its limbs around pretty much whatever way it wants to.
But then again, so are most medical practices, pre-integrated EMR’s (medical records, medication lists, chronic conditions, scheduling and appointment management, consultant coordination, follow-up tracking, etc). And though I defy any integrated EMR practice to precisely corral The Slimy Beast, taming it is, we’d all agree, both possible and pretty commonly doable.
But the first step is to track it. And for the magnitude of what we’re facing system-wide, nothing less than widely adopting EMR systems will do.
