Tuesday, September 13, 2016

Accelerating IT Adoption Among Clinicians: The Fundamentals
Two New England Journal of Medicine articles inspire this blog.
·         “Counting Better – The Limits and Future of Quality-Based Compensation, “ by Christopher Dale, MD, Michael Myint, MD, and Amy Compton-Phillips, MD, of Swedish Health Services, in Seattle., August 18, 2006.  The authors speak for the Swedish Medical Group, a 1200 multispecialty group, which is having troubles redesigned a compensation package  that does not rob “clinicians from the joy and meaning of partnering with patients to create health ‘ by relying too much on performance metrics.

·         “Accelerating Innovation in Health IT,” by Robert Rud, PhD, David Bates, MD, and  Calum MacRae, PhD, or RAND and various Harvard-based Harvard organization, September 1, 2016.   The authors comment on lag in health IT, on physician dissatisfaction with EHRs, on the disconnect between IT developers and clinicians,  and how to bridge the disconnect – involvement of multidisciplinary teams, focusing on users’ needs,  redesigning care processes,  having the freedom to experiment and fail quickly.= 

Accelerating Adoption may be even more fundamental than that,  by asking what clinicians need and  are already  doing. 
What every clinician needs – 1)  the patient’s demographics and chief complaint and medical history; and 2) what most clinicians already collects – the patient’s weight  and height, vital signs, and basic laboratory information.
Computer Interview
The former could be provided by the patient in computer interview  conducted at the patient’s home computer or in a waiting room  and processed by an existing clinical algorithm ( the commercially available “The Instant Medical History” is an example), and this could be combined with the vital signs, to produce a narrative history and rudimentary differential diagnostic summary available when the patient enters the examination or interview room.     This can save the doctor as many as 6 to 7 minutes for each patient encounter.
Merits of Computer Interview

This approach has these merits; 1)  the patient’s time, not the clinician’s time,  is involved in producing the basic information; 2)  the clinicians can quickly focus on the basic clinical problem,  giving the  clinician extra time to see more patients;  3) the relevant information can be used to generate a proper code and to use in case a referral letter is required.
Insatiable Demand for User-Friendly IT Functionality
As the authors comment, “There is an insatiable demand for new, useful, user-friendly IT functionality.”   Current electronic heath record models for the most part are not-user friendly and are often developed by soft-war experts who have never set foot in a busy doctor’s office who is struggling to make ends meet.  “Emerging provider-payment models must “seek tools to help reduce costs and improve quality.’  Only then will “IT-enabled transformations… might finally come to health care.”
1.        Friedberg, et;  “Factors Affecting Physician Performance Satisfaction  and Their Implications for Patient Care, Health Systems, and Health Policy,” Santa Monica, CA, RAND,  2013.

2.      Ratwani, RM, et al:  “ Electronic Health Record Usability; Analysis of Use-Centered Design Processes of Eleven Health Record Vendors, J Am Med Inform Assoc, 2015:22:1179-1182.

3.      Jones, SS, et al: “Unraveling the IT Productivity Paradox: Lessons for Health Care,” N Engl J Medicine,  2012: 366:223-5.

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