Thursday, September 12, 2013

Drudgery in Medical Practice and How to Reduce It

Medical care is very labor intensive.  Most everything about it is, in fact, labor intensive.  Some of that is labor of love, ie the actually delivery of medical care: advice and treatments.  But most of it is drudgery. How can one diminish the amout of drudgery while simultaneously enhancing both the quality of care and the enjoyement of day for the doctors and employees?

The answer: automation, robotics, electronics

  • Data entry: patients can enter their own data via a kiosk system and medical staff/doctor reviews it.  
  • Prescription management: no human should ever place pen to pad.  All prescriptions must be done electronically and either e-prescribed or printed.
  • Charting and filing: no human should ever do this.  EHR is the solution.
  • Phone tag: this is when a patient calls the doc, doc can't talk and when calls back gets voice mail and the cycle repeats.  Drudgery and frustration ensue.  Solution: online secure messaging. 
  • Urine analysis: some practices still manually dip stick urine.  Not only is this a waste of human effort, it is less accurate and reliable then automated analyzers.  Just don't do it.  Same for most other laboratory tests, including semen analysis.
  • Medication history: while it may be easy to just get a list of the patient medications, getting the dosages and strengths can be both difficult and time consuming.  Drudgery.  Fortunately computers can assist here as well.  With proper software, one can download a patient's comprehensive medication history directly from the pharmacy benefit website.  Saves time, reduces errors, and is easy.  
  • Results management:  direct HL-7 connections to all labs enables automatic download of results data into EMR.  Saves time, reduces error.  
  • Scanning: while this may be essential it can be labor intensive.  Keep it too a minimum.  Use high capacity professional grade scanners, never consumer ones.  Scanners ought to be linked into the EHR, if possible.  One can use barcode to ensure that the documents get to the right chart without human intervention.  To reduce scanning, have the documents faxed to your office and configure the fax so that the fax is recieved in an electronic format, such as a PDF file.  All desktop computers already have this capability.  
  • Documenting: handwriting has some many issues and is so fraught with problems that it should never be done.  Plus, it is very tiring for the writer.  Perhaps when doctors were seeing 5 patients a day and could write 2 words as a note it was ok.  But no longer.  Now it is far better to use well designed EMR templates with macros, voice recognition software, and tablet/stylus computing.  Very quick.  very efficiant.  Tireless and effortless.  Plus more accurate.  
While on the above suggestions have high costs, not implementing them has a higher cost in terms of productivity, mistakes, burnout, and unhappiness.