Back in the 90’s, my cardiologist father once bemoaned that administration and accountability had replaced what he considered to be the fundamentals of medicine: the care and healing of patients, face to face. Thirty odd years later, the administrative requirements and documentation for medical practitioners have increased to an estimate 4 hours per working day. Now with the Affordable Care Act’s (ACA) increased accessibility driving greater patient loads and the emphasis on value based medical practice, many of our top specialists are caught in the crossfire trying to balance quality with quantity.
Turns out modern medicine also has its upside as many clinics discover the marvels of digital medical assistants, such as Phreesia, Seamless and Doctella – applications that are making lighter work of the administrative side of their jobs. But has the introduction of electronic medical record (EMR) systems, surgical coordination software, and other technological solutions actually helped or hindered the all-important doctor-patient relationship?
Face time with doctors at a premium
In 2013, a US poll of medical personnel found 73% believed that clinical documentation obligations were excessive and compromised patient care. They understood the necessity of administrative tasks for reasons of image, budgeting, quality assurance and performance assessment, yet they found this aspect of their work detracted too much from the direct contact between doctor and patient.
In fact, it’s estimated that 1 out of every 4 minutes spent on individual patients is dedicated to paperwork, and in hospitals only 23% of the time logged is spent interacting with patients directly. Comprehensive documentation has many advantages, but for some doctors in the US and around the world, the burden it creates is a major source of job dissatisfaction, and distracts more than it contributes to quality patient care coordination.
Technology vs. quality care: Where’s the conflict?
The obvious solution to the heavy burden of administrative paperwork has been to automate and embrace technological assistants. Since the ACA was passed in 2010, the adoption of EMRs has also been encouraged by US federal mandates. Questions have arisen, however, about whether the benefits of EMR and other information systems outweigh the drawbacks. Some studies cite that most medical professionals are insufficiently tech savvy, so it will take them longer to complete clinical documentation through an EMR than before. Other sources suggest that using software might encourage medical staff to be lazy and ‘copy-paste’ data, which could lead to a greater number of medical errors. In extreme cases, it has been speculated that too much focus on technology in medicine doesn’t improve the patient experience, but rather leads to a decline in bedside manner and poor doctor-patient communication.
Most of these issues come down to the ethics and technological capability of the individual professional, but one question that keeps persisting is whether surgeons and staff are capable of giving patients their undivided attention while tapping away on their keyboards. And how is using a technological assistant a greater distraction than using pen and paper to write notes and schedule further appointments?
Yet despite these concerns, the solution proposed in almost every study on the matter has not been to hold back the tide of technology in medical practices. Rather, researchers propose that the best solution is to update education models so that medical staff and students are taught how to master the technology and thereby balance their attention effectively between technology and their patients.
Has technology really had a negative affect on the doctor-patient relationship?
Despite widespread speculation that digital systems might degrade the patient experience, recent studies have confirmed the real life results are actually quite the opposite.
In a prominent study conducted by the University of Chicago, researchers determined that an astonishing 88% of patients reported receiving higher quality care and attention in facilities where EMR devices were in practice. They noted that the EMR improved the doctor-patient relationship, enriched interdisciplinary communication between medical professionals about the patient’s circumstances, and helped create a more comfortable and comprehensive patient experience overall.
In fact, only 8% of the patients reported that the EMR was disruptive and led to poor eye contact. Even in these cases, it was recognized that the problem lay with the medical professionals concerned. The primary solution recommended, therefore, was not to roll back to paper record keeping: it was to provide those individuals with additional training sessions to learn how to use their EMR platform better and divide their attention between their screen and their patient more effectively. Then they wouldn’t need to fiddle with the controls of the EMR and try to figure out how the software works while talking face to face with the patient. They would be trained to assess when a medical conversation required them to upload their notes and when to ignore the EMR and give the patient their full attention.
On the other hand, many medical providers have also reported significant improvements in the quality and quantity of patient care after introducing EMRs. In Canada, one clinic found that the number of scheduled visits more than doubled and walk-ins increased by 29% over four years with no decrease in patient satisfaction. Other benefits cited include more accurate record keeping, reduced risk of medical errors due to automated alerts, improved interdisciplinary communication and a whole lot less paperwork.
Good news for surgical coordination, too
Surgeons, PAs, and scheduling staff have noticed a significant improvement in care coordination and quality time spent with patients when they use a dedicated coordination platform. Kristen Hesketh from the University Orthopedic Center in Pennsylvania claimed that Surgimate enabled her staff to ‘have more time to talk to patients and answer their questions instead of handwriting paperwork while they wait for us.’ Darcy Parizek from Murphy Wainer Orthopedic Specialists in North Carolina agrees that introducing Surgimate into their clinical practice has ‘helped efficiency, reduced errors and increased patient satisfaction.’ And Katie Murray from Consulting Ophthalmologists PC in Connecticut attested she can now ‘spend more quality time talking with patients, since their demographic, insurance and appointment data is already integrated into Surgimate.’
Finding the right balance
Technological assistants, such as Surgimate and EMR platforms, have proven themselves beneficial to both patients and medical professionals on many levels. As mentioned, in the rare instances where pitfalls have arisen, it’s been recommended that the medical professional may need advice and additional training to understand how to divide their attention more effectively between their patient and their record keeping.
This advice includes:
When discussing sensitive or priority information, desist from entering information into the platform and make sure your focus is 100% on the patient. Your top priority should be to ensure your patient has confidence in your abilities and completely agrees with your prognosis and treatment plan. It’s also important that your patient feels that you have time for them and connect with them on a human level, not just as a clinical subject.
When you are using any kind of software in a patient session, explain and show what you are doing to the patient. When a surgeon is focused on a screen and not on the patient, the patient feels they are not giving them their full attention. The patient will assume the surgeon is distracted and will automatically speculate that they are checking on other patients or personal messages. Many successful surgeons include their patients in the data entry process and some even show the patients how the software is used to improve and help their treatment.
Familiarize yourself with the most commonly used functions before using any kind of software in a patient session. That will cut down on the time you detract from the patient in order to get the system to work properly.
The best advice, however, is the simplest one: choose an application that is more intuitive, customizable, and suited to your specific surgical workflow needs. There are dozens of technological assistants available; research the reviews online and ask colleagues or friends in the industry which ones work best for them. The right platform for your requirements cuts out the need for additional training and lets you focus entirely on the patient. That way, you won’t need additional training to work your surgical assistant: it will work for you.