The world of healthcare is changing especially so in the light of an estimated 30 million new patients that will be added to the healthcare system. Most of them will be tended to by Family Doctors (including internists and pediatricians). Primary care practices typically measure productivity according to the number of visits, which also drives payment (which is less than half the money earned by specialists).
Besides the low salaries, there is tons of work that does not involve a visit from a patient, is invisible to those who support and purchase primary care and is therefore uncompensated.
In a recent study documented, each internist handled 18 visits per day in addition to the following unpaid tasks:
- 24 telephone calls (80% handled directly by Physicians; 28% resulted in writing of prescription and 8% ended in ordering of new tests)
- 12 prescription refills processed
- 20 laboratory reports read - they frequently trigger a review or adjustment of a medication, which requires access to accurate, current medication lists with doses.
- 14 consultation reports from specialists examined
- 11 X-ray and other imaging reports reviewed which may require updating problem lists or further referrals
- 17 e-mail messages including interpreting test results (59%) or responding to patients (22%)
The above numbers reveal phenomenal quantum of uncompensated work that is performed by primary care providers. If the metrics used for compensating these providers is not changed quickly, then it is easy to predict that the shortage of family doctors will increase at a rapid pace and the complete primary healthcare ecosystem will start crumbling.
The same study also dealt with implementation of Electronic Health Records and the changes in practice design that this brought forth in a Primary Care setting. Primary Care Physicians play a number of roles in the course of discharging their daily duties - from making diagnoses and providing treatment to ordering tests and filling out forms. How and by whom the work is done is dependent on both the skills of available support (non-physician) staff and the extent of information-technology support.
When EHR Software is implemented in a Primary Care Clinic, roles played by Clinic personnel often change. In this documented case study, the following changes were recorded:
- The job profile of the registered nurse changed significantly after implementation of Electronic Health Records. While the nurse's work could be handled by personnel without any nursing skills, new duties of the nurse included doing "information triage" of incoming laboratory reports, telephone calls, and consultation notes.
- Additional front-desk staff and medical assistants were hired to handle the increased tasks associated with the comprehensive management of chronic diseases like diabetes, etc.
- Productivity metrics of the Physicians were changed from just using total charges (or number of visits) to including telephone calls and e-mails handled.
- Doctors now rely on availability of comprehensive, contemporaneous structured data when responding to telephonic calls and lab results.
- The purpose of documentation has shifted from billing to ongoing clinical care, and the EHR is now used more for 'information management' and 'active support of clinical-practice activities' (rather than mere progress note generation).