“Because the physician role includes legal and regulatory authority, a lot of tasks that used to belong to the medical assistant, nurse, or resident—lab requests, lab results, prescription refills, patient calls—get lumped under the physician's control,” said Vic Arnold, managing director at Huron Healthcare. “Health systems spend a significant amount of time post-EHR implementation trying to filter out what the physician should really be touching.”
Despite the hassles around implementation, experts say technology in healthcare has the potential to save time, raise productivity and reduce errors. While the current transition period places a heavy burden on doctors, the hope is that eventually EHRs and other digital tools will serve clinicians in ways that are beneficial while offsetting the increasing demand for care.
In addition, if such tools can be implemented on a widespread scale, they could help relieve the looming problem of physician shortages that many are predicting for the future.
Linda V. Green, a professor of healthcare management at Columbia University, had seen reports predicting a shortage of primary care physicians due to expanding insurance coverage and an aging population. Most had been based on simple ratios, such as one physician per 2,500 patients. Finding the estimates quite superficial, Green decided to use her background in quantitative modeling and queuing systems to determine whether a shortage would indeed occur.
“The whole idea is to provide timely access to care, so that's the question to answer: Are there enough physicians to provide access to care in a timely fashion for those who are demanding it?” she said.
Green and her colleagues used data from the National Ambulatory Medical Care Survey and the Medical Expenditure Panel Survey to estimate patient demand probabilities.
Their analysis, published in 2013 by Health Affairs, showed that the use of primary care physician pools supported by non-physician professionals and EHRs can increase efficiency and the ability to handle larger patient panel sizes.
“There are so many factors that to me seem to indicate that we can reduce our dependency on physicians quite a bit and leverage other resources,” said Green. “Studies show that a significant proportion of primary care office visits can be handled by another person or another technology.”
For instance, a recent report by the National Institute of Standards and Technology looked at how human factors modeling methods can improve EHR workflow integration into the overall clinical workflow. The authors recommend EHR developers find ways to increase efficiency for bottleneck tasks such as drafting pre-populated orders to be formally executed later and the ability to document care with shorthand.
Operational changes involving EHR-based technology could offset the increased demand for care that looms around the corner. And after an initial learning curve, more health systems and private practices can begin to harness the power of this new electronic environment.
“A hundred or more years of paper-based process have moved into an electronic workflow, which has a huge impact on the physician,” said Arnold. “Success in this transition period means understanding the various wrinkles in the system and making sure all the plumbing is properly thought through.”
Next week in Part 2 of Automating Clinical Tasks, Scripps Health searches for a solution that will relieve physicians of the need to respond to routine prescription refill requests.
Meeri Kim is a freelance writer based in Los Angeles.