The regime of growing requirements

Between this year’s roll-out of MACRA, MIPS and APMs, earlier programs like PQRS and VBMS, and the transition from FFS to VBPs, I fear we may be killing our doctors one alphabet letter at a time.

It’s a wonder that today’s doctors still have time to be doctors. Between ever-evolving government regulations, poorly designed clinical user interfaces, and inefficient hospital information systems (HIS), physicians can no longer focus solely on the delivery of quality patient care. Instead they are hampered by large HIS platforms that were originally designed to track patients and facilitate billing and reimbursement – and not to support the clinical thought process at the point of care. Clinically-focused solutions have always been an afterthought for HIS vendors, who are committed to enhancing their systems to facilitate billing processes so that providers can get paid. Meanwhile, clinicians continue to struggle to glean insights from existing patient data for the delivery of better care.

Traditional HIS not built for clinical users

Consider the organization of most traditional HIS systems. They typically follow a transaction-centric approach and arrange clinical data for each type of transaction into different “buckets,” such as active problems, laboratory results, medications, and orders. If a user wants to locate data relevant to a particular problem, he or she must click between different tabs, which disrupts the clinical thought process and can quickly lead to frustration.

On top of that, we are constantly asking physicians to adhere to the latest version of alphabet soup. Today’s flavor is MACRA, which includes 273 possible clinical quality measure (CQM) requirements, 190 of which require clinical decisions that are best made at the point of care. Unfortunately, few systems provide integration of CQMs at the point of care and within the physician’s clinical workflow. Instead, CQMs are treated as just another set of transactions that must be addressed to meet reporting requirements.

AI and machine learning are going to need better data

Leading HIS vendors are hoping that healthcare’s growing use of artificial intelligence (AI), cognitive computing and machine learning will make things easier for physicians. Ideally vendors would like for doctors to be able to dictate, have the dictation converted to free text, have the free text analyzed through natural language processing (NLP), and finally have AI and machine learning techniques applied to the data for clinical decision support and to ultimately improve the quality of care. Wow. That one long sentence involves a lot of “hoping” – and today those hopes are not backed up with a lot of reality.

Fortunately, realistic options do currently exist to make things easier for physicians by seamlessly integrating various alphabet soup requirements into clinical workflows so that physicians can focus on the delivery of quality patient care.

Enabling usability of clinical data at the point of care

Usability at the point of care is improved by taking today’s current systems and adding a clinical engine and a user interface that supports physician thought processes. Such a doctor-friendly user interface must include:

1.      A single workspace with an actionable patient summary showing all clinically relevant information for any problem. The workspace should be integrated with point of care documentation and quality measures should be part of the workflow and not as a separate task.

2.      A clinical data engine that supports problem-oriented views and documentation and automatically shows a physician what is new, different, or unchanged about the patient. A quality compliance engine should also determine potential care gaps for each patient at the point of care and for every encounter.

3.      The proven ability to see more patients in the same amount of time (or less), and allow users to complete all documentation and quality, compliance, and billing requirements at the time of the encounter.

Let doctors be doctors: give them what they need

We may have little control over the administrative programs that are killing physician productivity and disrupting their ability to deliver quality patient care; however, rather than allowing inefficient systems to stand in the way of doctors being doctors, organizations must consider proven technologies that actually enhance the ability of physicians to practice medicine.