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May
15, 2006
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Straightforward Solution A software CEO says document management trumps complicated technology and allows physicians to maintain a personal touch with patients. The symbiotic relationship between healthcare and technology is well established: Both entities feed upon and benefit from each other’s assets. However, many industry stakeholders are questioning why this seemingly productive relationship is conflicted with so many problems and why the adoption of electronic health records (EHRs) is proceeding so slowly. Many people suggest that the high cost or fear of technology is keeping physicians from adopting EHRs. But like the hall of mirrors at a carnival, such explanations just lead to additional questions. For instance, is lackluster EHR adoption directly related to healthcare providers themselves, or does the problem stem from the limitations of technology when applied to healthcare? This question merits both the time and effort of close examination to identify where the real problems exist. It may simply be a case of complex technology trying to make a square peg fit in a round hole. The
Big Picture Compounding this situation is the fact that everyone assumes the answer to every problem is better and more complex technology, which is equally difficult to implement. Interpreting thoughts, pain, and emotions is what physicians focus on when hoping to understand a patient’s illness. They apply science and methodology to the “art” of medicine, but at the core of their approach is interpretation, intuition, and experience. Applying rigid technology rules to a free-flowing and organic workflow is akin to asking Renoir to create a masterpiece using graphic design software. By forcing physicians to adhere to strict and rigid computer logic trees, both government and private entities restrict the flow of free thinking. People have become so dependent on technology that they often limit their ability to solve problems. So, when the computer doesn’t provide an option for a set of problems, users tend to try and make it fit into the closest category. This may be satisfactory when the clerk at the supermarket check-out counter enters “Roma tomatoes” as “vine ripe,” but it’s dangerous when applying the same logic to healthcare. Physicians
Are Human Technology has not matured sufficiently to process as much information as the human brain can process in tenths of a second. Technology’s ultimate goal should be to adapt to the user’s preferences and interpret what the user is thinking and feeling—not to force the end user to adapt to the limitations of technology. Computers are inanimate, cold objects that use ones and zeros to calculate true or false values. Essentially, computers see the world as black and white while the human thought process consists of millions of shades of colors. When physicians focus on technology in the exam room, they are effectively diminishing their ability to interpret, understand, and diagnose. Consider
the “Blink Theory” Doctors are dealing with a multitude of challenges that span lower reimbursements and higher malpractice insurance rates, as well as escalating rent, salaries, and overhead. It is becoming a widely accepted fact that doctors have to see nearly twice the number of patients today than they did in the past to generate the same income. The common perception is that doctors are “in it for the money” and that they are all getting rich. If one accepts this misconception and then magnifies the notion with diminished bedside manner, the result, over time, might well be an increase in the number and scope of malpractice cases. In the book Blink: The Power of Thinking Without Thinking, author Malcolm Gladwell describes documented cases of patients wanting to sue their doctors based on the relationship, not the level of care provided. One chapter explains that patients are reticent to file a lawsuit against a doctor with whom they feel connected and really like. Even when the primary physician was clearly at fault, patients have opted to sue the specialist because they didn’t believe the specialist spent adequate time discussing individual problems or understanding personal concerns. Include disruptive technology, such as the EHR, and the situation worsens. If physicians focus on templates and navigating extensive menus and screens, they will further alienate patients and may develop additional lawsuits. Physicians may be clearly right and well-founded in their diagnoses or recommendations, but it is the patient’s interpretation of the doctor’s bedside manner that can prompt the decision of whether to sue. Another factor is the impact of consumer-driven healthcare. With the rising costs of insurance today, more and more patients are being encouraged by their employers to choose health savings accounts with high-deductible health plans. This new era empowers consumers to make their own choices regarding providers and service options. Increasingly, consumers will be spending “their own money” when paying for healthcare services. If a practice appears disorganized or the physician appears disinterested in the individual, the patient is more likely to choose another practice. In a brave new world of consumer-centric healthcare, when it’s the patient’s money, not the insurance company’s dollars being spent, consumers may find it easier to go to a different provider to get the level of service they require. This will be an important departure from the way healthcare has been delivered in the past when patients would continue to see the same doctor because of insurance reimbursement and to avoid the hassle of finding and choosing another one. Going forward, patients will make more informed choices. Technology requiring physicians to spend their time typing or entering data into a computer—rather than interacting with the patient—may produce a negative outcome for the doctor’s practice. Patients will feel unimportant and may long for the days when the physician was dealing with paper charts and paying more attention to them as individuals. If given this choice, would patients prefer a high-tech doctor who is entering data on a screen and printing prescriptions, or a physician who looks the patient in the eye, engages in conversation, and then goes to a quiet area after the exam to dictate his note? It will be important to take into consideration each patient’s communication preference. Patients who appreciate the use of an EHR may also prefer e-mail to a phone call. Other patients will resent the time the physician takes to interact with the computer and prefer a personal phone call and increased customer service. So how does a practice offer both the superior customer service and benefit from technology efficiencies? The answer may lie in a simple solution. The
Solution: Occam’s Razor This same principle can be applied to healthcare technology. The healthcare industry as a whole—media, consultants, government, and vendors—is clamoring to respond to the healthcare crisis. Instead of putting efforts and energy toward solving today’s problems, they have lost focus and are trying to overcome the limitations of tomorrow’s technology. Collectively, we have lost sight of the real issues and the original dilemma. Technology should solve problems, not create a new set of limitations. Healthcare organizations need to adopt problem-solving solutions, not look to software products that present new sets of issues. This is why document management, which has been around for decades, is a viable alternative. Document management is proven, flexible, and can be easily used by everyone who knows how to read. It falls under the heading of solutions that address every problem … ones that find the least common denominator that everyone can adapt and use. If people can read, write, or speak, then they can use document management. As a parallel, paper and pen are the universal tools for every literate person. One problem facing technology in clinical settings is that there are too many variables. Data entry technology is useful when automating a limited set of values. As an example, a healthcare billing system spans the patient’s name, address, phone, date of birth, Social Security number, insurance company, insurance company ID, payment method, and an established set of codes for billing. However, the system cannot accommodate every possible variable when addressing a person’s health or emotional state. Document management provides access to all parties that need to view information, and allows each user the flexibility to enter data in the most accommodating fashion including dictation, handwriting, and typing. Document management presents the least common denominator that answers the immediate problem: It eliminates paper chart costs, increases revenue, allows access from anywhere, and eliminates a spate of current inefficiencies in healthcare. Document management is also the most natural extension of the practice management software that the office is using to address a multitude of daily operational issues. Physicians and staff depend on this software to run their practices more efficiently and facilitate scheduling appointments, receiving payments, submitting claims, and managing payor contracts. But there are deficits that are inherent to practice management software, leaving practices with inadequate solutions to untangle operational log jams caused by paper charts. This is where document management is a natural extension, representing an evolution in efficiency that extends beyond the functionality of practice management software systems. A versatile document management solution for healthcare represents an important step forward for medical enterprises to digitize charts and automate the entire workflow process. Document management complements existing practice management software to eliminate the following bottlenecks: • chart creation for new patient visits; • pulling/filing charts for follow-up patient visits; • physicians seeking information and locating items within charts; • patient calls/messages/correspondence; • prescription refill requests; • tests ordered; • test results received; • lab result inquiries from patients; • dictation received; • satellite office faxing; • billing staff looking for pertinent data; and • purging/archiving patient charts. Document management provides 24/7/365 access to charts in seconds and allows doctors to either handwrite or have the piece of paper scanned. The moment it is scanned, it’s available anywhere, anytime—or simply dictated and transcribed into a Word document that is routed seamlessly and automatically to the patient’s chart. This feature, unto itself, is a compelling attraction for doctors. The simplicity of document management translates into a fundamental freedom for physicians and their practices: Scanning a piece of paper now and having it available from anywhere, anytime in seconds is a quantum leap from the existing paper situation. Practices can finally free themselves of paper charts and their multitude of problems, including lost charts, storage, access to patient data, and other inefficiencies that weigh down the delivery of care. The move to document management is not only affordable, but it also exemplifies the Occam’s Razor principle. While there is continued pressure on physicians from government and private sectors to adopt new technology, the weight of purchasing and introducing more highly complex solutions holds back the majority of practices from making the investment. Document management is a different “best of breed” that more closely meets practice requirements. American healthcare may have to confront the fact that “simple is better.” Paper is likely to continue its reign as the most common denominator and preferred documentation method. But it is the document management of paper that is providing an uncomplicated, straightforward path to efficiency—and it won’t take decades to get physicians to climb aboard. — Evan
Steele is CEO of SRS Software, Inc. (www.srssoft.com).
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