by Neil Kudler, CMO
When folks ask me what I do these days, I always say that I’m a physician – but that’s not exactly true. After 15 years of clinical practice, I left primary care internal medicine 15 years ago with hopes of improving care delivery as a physician administrator.
For me, this career change was unintended and, once upon a time, unthinkable. The break for me came when hospital medicine rose to prominence and abrogated the role of the primary care internist. No longer would I be able, not to mention be allowed, to care for hospitalized patients. This was only made worse by the increased demands on my office-based productivity in order to maintain revenue.
Around the same time that I made my escape, the physician burnout epidemic began to mount nationally in the 2010s with the institution of electronic health records (EHRs). I don’t think EHRs single-handedly caused burnout rates to skyrocket, but they did trigger a much broader conversation about time management and its impact on physician well-being. As a system chief medical information officer, I made it my primary responsibility to alleviate the burden presented by “electronic solutions.”
Fast forward to 2022 – the digital age of medicine. I’ve left the provider side and now deliver support in the form of IT consulting to health systems across the country as Pixel Health’s chief medical officer. As a physician-consultant, I play the role of interpreter, sometimes mediator, between the IT and clinical enterprises. My primary goal is to help empower IT professionals to understand their critical role at the bedside. Further, I work with my clinician colleagues to help them understand the opportunity for collegiality with their IT counterparts to provide more efficient and effective patient care. I emphasize the provider experience as vigorously as the patient experience. I’ve learned from my own journey that physicians and nurses need to be front of mind as we design the efficiencies and features of digital transformation.
The ‘time suck’ of excessive and overcomplicated documentation
A recent report in Journal of General Internal Medicine found that it is “infeasible” for primary care physicians to meet all of the expectations for high-quality preventive, chronic, and acute office-based care. Much of the reason is that documentation and inbox management currently take physicians longer than 3 hours per day, according to the study. This massive proportion of time is only exacerbated by electronic inefficiencies.
Less discussed is the “time-suck” created by needless documentation requirements set forth by public and private payers. These requirements breed poor communication, failing handoffs, and copy/paste fraud. Time management strategies offered by electronic tools are not yet meeting their promise.
It is time for change, but the big questions is: What is the change that needs to happen? In part, documentation reform is essential. Reimbursement should not be tied to the length and quantity of information in a clinical note. Team-based care, a concept spoken of for at least two decades, holds potential, but may not fit the physician personality. We are trained from the outset, even before medical school, to tough it out and go it alone. Technologies that are currently available need to be right-sized, right-fitted, and at the service of care providers. The more passive that electronic solutions are, the better the adoption of new methods of care.
We can transform care with the thoughtful implementation of electronic solutions. These solutions need not disrupt the crux of clinical care – human-to-human interaction. Solutions should be running in the background and provide service passively. From evaluation and management to documentation and handoff, we owe this to our providers for the sake of our patients.