As a physician, I was trained to listen to, examine, diagnose and design a treatment plan for one individual patient at a time. That was the focus of my education, and I considered it my highest calling. I still do. However, as a leader in a healthcare system, while I still consider this absolutely necessary, I also find this paradigm inadequate to provide the best care to my patients.
What I need to do – what we all need to do – is understand the needs of the individual patient and the specific population that we serve.
It is the ability to understand our total patient population that allows us to determine if we have reliable outcomes and at what cost to our patients and the system.
A physician may provide evidenced-based care to a compliant, educated and engaged patient and have a single excellent outcome. The same physician may provide the identical care to another patient and have a poor outcome.
What accounts for this variability? It can be almost anything.
For example, one patient may take prescription medicines as instructed; another may not. Research by Elsevier reports that “medication non-compliance leads to 125,000 deaths annually and is implicated in 10 to 25 percent of all hospitalizations and nursing home admissions at an annual cost of $100 billion to $300 billion.”
Or duplicate patient records within or between health systems can skew a physician’s understanding of any given patient’s health history. If information about a patient is split between multiple records, but the attending physician sees only one of them, it reduces their total understanding of the patient. In one survey, 20 percent of hospital CIOs reported that at least one patient had been harmed at their organizations because of mismatched records.
Other factors – among many myriad issues – that can create variability and dramatically impact the outcomes for our patients:
- Is the patient depressed or perhaps transitioning jobs and without health insurance?
- Does this patient have other co-morbidities such as COPD, CHF or renal disease that limits her ability to follow the prescribed treatment program?
- Is this patient taking herbal medications that interact with the prescribed medications and are causing undiagnosed adverse drug reactions?
- Has the patient failed to undergo evidence-based screening or other diagnostic protocols or to receive evidence-based vaccinations?
- What percentage of physician’s practice live on incomes below the federal poverty line and how many can even read basic instructions?
Questions like these are difficult, if not impossible, for a single provider to answer. Yet, these factors and a host of others will determine both the aggregate outcomes, and most certainly, the cost of care.
This is the fundamental reason the government has spent $36 billion to incentivize and require the use of Electronic Heath Records, often through carrot-and-stick protocols like “meaningful use” that combine both financial incentives and punitive regulations.
Obviously, use of some kind of EHR-type solution is both a cogent and necessary demand if you desire to understand an entire population of patients, but it undoubtedly comes with more than a few unintended consequences. It may produce better outcomes and drive down costs, but it also devours provider hours and creates record-keeping and compliance migraines.
What can be done? See Part 2: The Problem With Electronic Health Records.