I remember hearing a radio commercial a few years ago from TJMaxx about “the thrill of the hunt.” Every time I heard the jingle–“It’s the thrill of the hunt!”–a tiny shiver of terror went down my spine. While some retail shopping is driven by the pursuit of sales and the quest for the best deal, I was raised by someone who talked about how many billable hours one could lose in trying to save five dollars. In terms of healthcare data, it isn’t about the thrill of the hunt for a bargain–it’s about quickly surfacing everything possible about the patient in order to facilitate great care.
Over the past few years, things in healthcare data have gotten bigger. And bigger. And bigger. It is estimated that 2.5 quintillion bytes of data are created every day. Currently, from our step tracking and wearables to personal genome, we actually have too much data to be useful at the point of care. Physician job satisfaction, on the other hand, does not seem to be growing, and on a fundamental level, we are still trying to get the information and tools we need to deliver great care. What has been lacking is usable data that has a positive impact on physician workflow at the point of care.
People are always complaining about herding cats, saying it is difficult to manage physicians. However, given the sea of data and the sheer number of physicians who are dissatisfied with their increased burden, it shouldn’t be that difficult–it’s a matter of finding meaningful information and enabling that information towards useful goals:
- Helping physicians to understand that you have their best interest at heart.
- Giving them information about how they are performing, about their outcomes, etc.
- Giving incentives to drive value instead of volume.
- Giving them influence with that information so they can be organized and governed into an effective network.
The data is not necessarily the problem. We are swimming in data. We need to tell people what to do with it. Contextual awareness during every interaction matters. Healthcare IT Company, Holon, saves physicians five minutes per encounter simply by allowing physicians to see relevant insights in the workflow. This matters especially in risk-based populations, where we need to know the attribution. Patients that are identified as “at risk,” such as those with type 2 diabetes, need to have proactive care and data insights at the point of care to facilitate health improvement. When you are at risk or have a diagnosis that indicates certain care, it will show.
One of the foundations of the future of interoperability will be to recognize that physicians are not lazy. No one involved in the process is lazy. Physicians want to give the best care to their patients, and that means transforming data from a series of clicks to something that helps physicians and improves outcomes. If an electronic health record adds another drop down menu to remind clinicians to check patient health history, it further separates them from patients. The average clinician-to-patient encounter takes 15 minutes, and one study found that providers are forced to interrupt what patients have to say within 18 to 23 seconds of asking how they are doing. Accessible data would help inform providers with the knowledge they need from the beginning of the patient’s visit.
We need to ask ourselves- are physician’s being buried in the data and regulatory explosion? Now they have to be good at feelings, at medicine, and at data entry. I still remember over four years ago asking Kathy Nieder, MD, what she thought was key to attracting physicians to a data product. She said, “I don’t want another sign on. I want better tools at the point of care within my existing EHR.”
This desire is still valid. People want to make the workflow that they have useful. User experience is starting to dominate conversations surrounding electronic health records.
Do EHRs lead to burnout? That is debated, with Judy Faulkner recently citing KLAS data showing that well-personalized health records are not a major contributor to physician burnout–but that records with poor workflow are. While not everyone agrees on the quality of our records, and how much these records detract from workflow, everyone seems to agree that adding meaningful insights into a natural workflow will help.
In contrast with Faulkner’s response was what Betty Rabinowitz, from NextGen, told me when I asked about their technology advances:
Here at NextGen, we have been focused on reducing physician burnout in several ways. We now provide a state of the art integrated mobile platform that allows the physician to interact with the EHR using mobile devices with an elegant and effective user interface, with natural and easy use of voice for documentation, which we have shown to save physicians several hours a week of computer time. With our recent partnership with Holon, the NextGen Population Health Platform is now serving up multi-sourced data at the point of care in ways that fit and adapt to physician and care team workflows, by averting the need for them to log on to multiple systems in order to see a full view of the patients’ data and information. Within the EHR many workflow accelerators are allowing automation and streamlining of repetitive tasks. When it comes to physician burnout these innovative platforms are no longer part of the problem, they are the solution!”
What is the difference? The difference will be found in what physicians can do at the point of care, and how data accessibility and usability is improved. The measure of success will be in technology that creates more autonomy and lifts the administrative burden.
Robert Groves, MD, CMO of Banner|Aetna commented on usable data motivating physicians to improve care. Autonomy and information help physicians who are already motivated.
“Less administrative burden will be necessary. I will work really hard if I feel like I have control over my life. I will work really hard if I’m driving me instead of somebody else,” Groves says.
“What I mean by influence is that you allow me as a professional to organize and drive the governance of the team with which I work and organize my day–I don’t want to feel like I am punching the clock. I want to feel like I am listened to. Like my views are respected.”
A small ribbon with contextual awareness to the EHR can act as a nervous system for delivering usable insights to physicians at the point of care. And, systems need to alleviate the need for a physician to sign on again every time a patient is with them so they can go look for usable information. Rather than adding more clicks, the best tools surface the information that health systems have spent money on–analytics to deliver to physicians at the point of care. Holon Solutions, for example, is able to add context without additional logins. This seems like a simple adjustment, but the reality is that it has been an elusive fix for many data systems.
Conversely, giving physicians a portal with low adoption means the work of population health and value based programs will have little or no impact at the point of care. For example, if a patient is overdue on a wellness visit, and the physician doesn’t notice that within the limited time the patient is present for a sick visit, the physician might not realize what the patient needs. Patients historically have been shown to be unaware of how much care they should have to facilitate their best health.
“Before Holon came along, negative and positive deviance were invisible–you didn’t know how anyone else was doing- so they kept their noses down and did what they had always been doing. They didn’t know and didn’t get recognition for it. Those doing poorly complain how life sucks and they don’t know why. If we create a clinically integrated network that allows us to share information with doctors and provide services for improvement, physicians will improve things themselves.”
Dr. Groves adds, “Everything flows from having the right information. You can’t direct the incentives unless you have the right information. Information has to be the foundation.”
Data changes that seem simple, like having patient data at the point of care, are increasingly complex; our volume of data has reached the point where it requires more than half of a physician-patient encounter to log in, sort through information, and click on boxes to potentially reach useful data. As technology advances to connect these insights to actual physician care, we can finally make that information usable, yielding greater physician satisfaction and better patient care.