Primary care physicians are overworked and burned out, due in no small part to the burdens of using time-consuming electronic health record systems.
That’s the consensus of a panel of experts at the Cleveland Clinic Medical Innovation Summit who on Tuesday discussed the future of primary care.
According to Anil Jain, MD, a practicing physician at the Cleveland Clinic and chief health information officer for IBM Watson Health, several trends are putting primary care in America under siege.
“I think we would all agree—and if we were to ask ourselves—when we had our last primary care experience, that it wasn’t particularly ideal,” said Jain, who moderated the panel. “The average patient, when they’re talking to their primary care doctor, has about 11 seconds to get their chief complaint out before they get interrupted. The average primary care doctor has about 15 minutes with a patient, and most of them spend more of their time on the EMR than they do with face-to-face. And, they go home every night spending about 90 minutes on the electronic health record—we call that pajama time.”
In fact, a 2017 study found that primary care physicians spend nearly six hours—or more than half of their workday—performing clerical and administrative tasks in their EHR systems.
“Let’s not forget that a lot of what ails primary care is the way it’s paid,” said Nirav Vakharia, MD, vice chair of population management at the Cleveland Clinic. “Our reimbursement is rewarding us for seeing patients every 15 or 20 minutes, so that we have to interrupt them in 11 seconds so that we can get through our day, and then have pajama time to finish our notes.”
While PCPs might have access to EHRs, Jain made the case that this medical workforce is in many ways under-resourced and ill-equipped to meeting the growing demands of a healthcare industry that is currently experiencing unprecedented transformation.
“Primary care doctors and primary care practitioners are being asked to deliver high-quality, high-value care and are not necessarily being given all the necessary tools to do so,” he added. “And, not every organization is as well-equipped as the Cleveland Clinic—for example—with having a well-integrated system.”
Joe Schrick, vice president of the fitness segment at wearable technology vendor Garmin, told the audience that patient-generated data from wearables could help primary care physicians better monitor patients and keep them healthy through prevention.
“We’re actually taking our wearables—the data that’s collected—and we’re moving it into applications for corporate wellness, patient monitoring and population health,” said Schrick. “We are looking at ways to lower the cost of healthcare by empowering the patients with getting their own data, having their own data and having reliable data. Then, we want to find ways to get this data to the physician as well. Moving that data into the healthcare environment is actually where there’s a huge gap right now.”
However, Jain questioned the wisdom of putting more patient data in front of clinicians. He pointed to surveys that show as much as 60 percent of physicians are burned out and are already overwhelmed by the vast amounts of information in the clinical environment, as well as the increasing trend toward consumerization and patient attribution.
Nonetheless, Vakharia observed that patient-generated data is already impacting care delivery.
“Patients are bringing in their own data and asking us to engage around what it means for them,” said Vakharia, who added that “the more that patients engage in primary care the less the overall cost of care is—and, that’s clearly a mandate for our country going forward.” Only the data that requires human intervention should be flagged for the PCPs through analytics, he concluded.
Peter Antall, MD, a pediatrician and chief medical officer of telehealth vendor American Well, told the audience that telemedicine is a tool that could help primary care physicians not only provide cost-effective virtual care to patients but also cut down on in-office visits and long patient wait times.
Bonnie Clipper, vice president of innovation for the American Nurses Association, made the case that telemedicine is a technology that lends itself to “incorporating nurse practitioners into some of the telehealth applications” in primary care.
“I happen to believe that we’re going to see an increase again in retail primary care,” said Clipper. “I think we’re going to see really a resurgence in that. There are a few companies, if you will, that I think are not currently in that space that are probably just on the cusp of it. The other thing for me that’s going to be an absolute wildcard is that the sleeping giants in all of this I think are going to be the Amazon, Apple disruptors of the world. Amazon right now is actually hiring nurse practitioners.”
Date: October 26, 2018