Friday, October 14, 2016

What can the healthcare system really learn from Uber and Lyft: Increased Automation and Smarter Regulations can go a LONG way!

A new Study found that doctors believe EMRs may help with reporting, but that they do NOT help with outcomes. Furthermore, they note the downsides of EMRs include increased costs and distracting from direct patient care. 

However, I think an equally guilty culprit is the over-regulation of our medical system- including 
(1) The amount and detail in which everything needs to be documented, and 
(2) The amount of extra work that doctors now need to "review and sign off on". 

On one hand, EMRs actually may help with doing some of this documentation (if we were still on paper, there is no way docs could do all the documentation required these days!). On the other hand, EMRs have also caused extra work due to their inflexible design requiring both multiple clicks to find or complete tasks, as well as enforcing a "top of license" mentality that means a doctor has to be involved with EVERYTHING.

Meanwhile, both state and federal regulations make it incredibly hard to automate or delegate even routine primary care... we are so behind other industries, and even behind other areas of healthcare! For exampe, we somehow allow AUTONOMOUS CARS and SURGICAL ROBOTS, but we have regulations that don't allow a computer to automatically handle refill requests, order labs or manage minor medication changes?!?  We think making a well trained and time-strapped primary care doctor scour an EMR and do refills at the end of the day is better than using automation to handle this type of work?  

Fortunately, there are companies like healthfinch building out tools to work within EMRs to delegate this type of routine clinical work - meaning they automate everything to the last foot... but still have to hand it off to a nurse or similar professional to click on the final button.  The result is that: 
1. It takes work off the doctor's plate (the Swoop Refill Product alone saves them 20-30 minutes a day). 
2. It makes the delegation process to nurses much more efficient (usually 3-4X more efficient, which means you only need 3 nurses to support a task vs. 12 nurses... saving millions a year, and allowing you to deploy those nurses elsewhere)
3. It improves the quality of care for the patient... both in making the turn-around time faster, and in ensuring that evidence based rules are used to make a decision

But ideally- we really need to see a regulatory system that allows us to automate the process fully!  Then instead of complaining about EMRs - docs and nurses will actually love how it make their lives easier (while also improving patient care in a variety of ways), rather than feel like the EMR is the hammer bringing down the pain on them!

I was pleased to see the recent CMS announcement that they are lauching a pilot initiative with the goal to "reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction".  Amen!

The other, potentially simpler, idea I would recommend is simply to provide more guidance on current regulations around licensure. For example, every state has regulations about who can do what in a healthcare setting - often convoluted language that makes it unclear if a nurse or medical assistant can do nothing, something or many things based on protocols and standing orders.

Unfortunately, every hospital system has a cache of lawyers who may interpret the laws differently because there is no "case law" they can point to for a definitive understanding.  The result may be wild swings in how one healthcare system allows work to be shared across a team.  In a world in which we need more team based care, these types of "legal traps" make it much harder to try to use everyone to the "top of their license" when that very definition is confusing.

What if a state could provide specific examples with their regulations - for example, making it clear if an MA could sign for a refill based on an automated protocol vs. requiring it to be an RN, pharm tech, or in some systems- insisting only the doctor has the power to do that final touch.  As I've often said, we don't have a shortage of physicians, just a shortage of using them efficiently... and this is a big case in point.  Doing this right allows us to share the care across the team... doing it wrong means burdening the doctor with routine care that overwhelms and burns them out.

Hmmm... Maybe Uber and Lyft should take over healthcare - as they certainly have figured a way to work around "regulatory hurdles" that allowed them to use technology to make life much easier, cheaper and better for so many! 

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