Comment by jcowdy
7 years ago
The problem with this article is that Dr Gawande is too quick to point the finger at the EHR vendors for increasing the amount of non-clinical work that physicians are responsible for today. The EHR has become the face for arcane and archaic billing, regulatory, and compliance requirements which, when enforced through the software of the EHR, cause additional work to be shifted to the physician. Those questions that you get when you place a radiology order have typically not been added by the EHR vendor. More than likely they were added at the advice of legal / compliance.
Unfortunately the problem isn't as simple as getting more competent EHR designers and developers (although that certainly wouldn't hurt), but rather a deeper look into each aspect of increased work for physicians and analysis of why it is in the workflow (5 whys application would be great). At that point, organizations and physicians will better understand the reason work is on the physicians' plate and have a chance to weigh the pros and cons of either removing that work or shifting it to another person.
The other side of this that most don't see is that EHR vendors are also being held back by these same billing and compliance pressures. Here's a secret - EHR vendors actually want to help physicians be as efficient as possible and would love to automate work off of their plate. Unfortunately the environment created by compliance departments who are afraid of being sued and hospitals who would like to get paid has handcuffed the more innovative development from EHR vendors. If a system reviews incoming medication refill requests from patients, evaluates protocols, and determines that a refill should be approved who does is listed as the authorizing provider for the purpose of the pharmacy and the patient's insurance?
EHR vendors and clinicians need to find a way to come together to both design software that will make clinicians lives easier, but also to change any billing/legal/compliance hurdles that are in the way of putting this technology in clinics. If someone can put all of these pieces together we could see some powerful changes. Perhaps Dr Gawande's new venture with Amazon, Berkshire Hathaway and JPMorgan will give him a chance to control both sizes of this puzzle and create a better environment for clinicians and patients.
> If a system reviews incoming medication refill requests from patients, evaluates protocols, and determines that a refill should be approved who does is listed as the authorizing provider for the purpose of the pharmacy and the patient's insurance?
If this system has really done all this work that presumably would have otherwise been done by a provider, what's the harm in presenting the recommendation to a doctor or pharmacist for final approval?
I'd think that it's important to get a trained professional to apply their experience to the final decision, which is perhaps why there is an "authorizing provider" field in the first place.
Yes, definitely an option although eventually the volume of "final approval" items will stack up. Another option could be to allow items that pass protocols for non-controlled substances to be approved by nursing staff. Conversations like this are exactly what need to take place for each item on the provider's plate.