This study confirmed prior work done by Ardnt et al. published in the fall in Annals of Family Medicine,2 which demonstrated that “primary care physicians spend more than half their workday, nearly 6 hours, interacting with the EHR during and after clinic hours.” Sadly, despite improving technology, the chasm between interacting with computers and interacting with actual patients only seems to be widening. To preserve the sanctity of the physician-patient relationship, we are forced to consider a completely new approach to how we practice: team-based care.
Team-based care isn’t a new idea, but it is being embraced with new fervor in the era of electronic health records. This is because the blessing — and curse — of the EHR is the vast amount of information that can be stored and accessed while caring for patients. To take advantage of this, doctors have been forced to become the primary agents for data entry and retrieval, something that is nearly impossible to do effectively while performing the cognitive work of a highly educated clinician. Rather than allowing us to take better care of patients, EHRs seem to have a paradoxical effect, limiting “face-to-face” time and squelching our efforts to address anything outside the immediate issues at hand. To improve the experience for us and our patients, we need to begin to rely on others.
To start, consider how a team can help support your documentation. As we’ve written about before, scribe services can be a tremendous benefit but aren’t the only way to improve efficiency. Medical assistants and nursing staff need to be encouraged to operate at the top level of their license, documenting where allowable and even queueing up orders, medication refills, and preventative care interventions when appropriate. This can be tremendously useful during previsit planning and can ensure that nothing is missed during the patient encounter.
Team-based care can also extend far beyond the EHR. For example, care coordinators can be employed to focus on specific high- and rising-risk patient populations. These health care professionals (typically nurses) reach out directly to patients and review their care, and even schedule visits with patients independently of the physician. This establishes therapeutic relationships that have been shown to prevent disease exacerbations and hospital readmissions, greatly reducing the cost of care.