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As physicians, we're trained to dig into a patient's story to make a diagnosis. Ideally, we have time to get to know the person in front of us and get a comprehensive understanding of the reason for their visit. In an ideal world, we have the information we need to make an accurate diagnosis and set them on a treatment pathway that will improve their quality of life.
That's the aspiration. The reality is that most of that visit will be spent trying to determine the basics -- the fundamental pieces of information we should have had before the visit began.
For example, an elderly woman came into my clinic for a visit a few years ago, lugging around a plastic bag near-bursting with pill bottles. Medication management is a major source of frustration among our senior patient population, and sorting through meds was the sole purpose of this particular visit.
The patient dumped the bag of medications on the exam table -- expired medications, the same medications from different doctors, over-the-counter supplements, generics -- and together, we spent the next 20 minutes trying to piece together her regimens. I spent most of that visit waiting for her to get hold of family members on the phone to help clarify why some of these medications were prescribed in the first place.
So much time was wasted trying to obtain the information I should have already had. While I was fortunate enough to have worked in a clinic where we had an hour with each patient, most primary care doctors and their patients are lucky if they can get a solid 20 minutes. Most doctors wouldn't have had time to cover anything else with this patient.
As doctors, we've grown accustomed to this type of exploratory care: patients come in for a scheduled appointment and spend an average of 1 hour waiting for care and filling out a small tome of intake paperwork -- paperwork that barely scratches the surface of what we need to get started, and rarely makes it into the electronic health record (EHR) in time for our visit. We then spend the upfront portion of the appointment confirming that information before we're able to actually practice medicine.
Our patients don't like this. It leaves them generally dissatisfied with their healthcare experience. In the worst cases, it can hamper the quality of their care.
Another example: a patient who comes into the clinic with a fever and body aches. In primary care, where the majority of our patients are seniors, these two symptoms can be difficult to trace back to a single diagnosis. With what little time we have to diagnose and treat, we'll start working down the list of diseases that could potentially be fatal: autoimmune diseases, infectious diseases, and cancer. We'll ask questions about medical history. If we're fortunate, the patient might mention that they went on a recent hiking trip. Then we'll do a physical examination. If luck is again on our side, we might spot the rash that indicates that this patient has Lyme disease.
These are all clues that formulate the puzzle of care. And most of them are pieces that could have been obtained while the patient was still at home.
The modern doctor is operating at a disadvantage. Between documentation, data entry, and time constraints, we find ourselves constantly playing catch-up every day just to be able to treat our patients to the best of our ability. If we could start each visit from a better, more informed place, we could tip the scales.
That's what so many digital health tools have set out to do: streamline documentation, reduce data entry, and give us back the time we need to practice medicine. The vast majority of patients have come to expect us to use this technology. Most of these tools, however, reduce the administrative burden either on the clinical side or the operations side.
The problem is that these are not two completely distinct components of care delivery. The areas where they overlap and meld (think patient touch points like intake paperwork and follow-up engagements) can be just as stifling to the care delivery process as anything else in a clinic.
This is an element of care delivery and patient engagement that is still ruled by antiquated processes and technologies -- by paperwork and portals and by triage bots whose sole purpose is to get patients in the door. The data collected to get patients to this stage rarely make it to the EHR, where it can help inform diagnostics and treatment. And even if that information does, it is typically in an unusable format.
Doctors are already pulled in a million directions. Technology shouldn't be vying for their attention or distracting them any further from their ability to provide quality care. Digital health can do so much more to engage patients and obtain the information doctors need -- information they can actually use -- before an appointment even begins.
In the future, it's easy to envision technology playing a much more responsive and proactive role in the patient-physician relationship -- not just in the realm of communication, which we already see today, but also by actively anticipating what the other will need.
For physicians, patient engagement technology should function like the best medical intern we've ever had. It should be able to discern which information is important, retrieve it from the EHR or directly from patients, and surface it to physicians when we need it.
It should enable us to deliver high-quality, personalized care to each and every patient we see. Slowly but surely, we're approaching that future.
, is a physician executive.
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