Workflow Changes Could Relieve Primary Care Physician Shortage

John Commins, for HealthLeaders Media , November 22, 2013

The study identified these ways to improve efficiency:

  • Teamwork and delegation, because research suggests that staff could perform tasks that consume 15% of the time physicians spend on patient care outside of visits.
  • Redesigned work flow that co-locates physicians with the rest of the healthcare team throughout the day and facilitates "real-time" communication, which can save a physician 30 minutes each day.
  • Acknowledging the double-edge of technology, including the "time sink" that can be created for physicians entering patient data in electronic medical records, while also seeing efficiencies created by software programs that triage patients and guide treatment decisions and don't require an office visit, which can improve care quality and reduce the burden on physicians' time.
  • Re-examining policies ranging from having a computer automatically sign out a user for security reasons, requiring users to sign in recurrently, to limitations in non-clinicians' ability to assist in routine, protocol-driven care.

In a phone interview, Shipman discussed the study and some of the themes that emerged from it. The following is an edited transcript of that conversation.

HLM: Has primary care workflow always been inefficient, or has it gotten worse because of the increased demands and because the practice of medicine has gotten more complicated?

Shipman: It's some of both. There has been an element of inefficiency that hasn't been highly prioritized in medicine. This goes beyond primary care but is certainly relevant for primary care. Because both demographic demands and recognition of the unsustainability of the rising cost of healthcare have become more prominent the focus on where to root out inefficiency becomes more prevalent.

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9 comments on "Workflow Changes Could Relieve PCP Shortage"

Rekha Reddy (11/28/2013 at 11:21 AM)
I would like to take this as an opportunity to talk about partnerships between Tech and medicine! All the Counties in the U.S have a major concern now. There will be a huge influx of new patients enrolled and their need to find a medical home soon, I believe Telemedicine should also be one of our options to help medical providers and the County out. Telemedicine may help by bridging the gaps in health access. Newly enrolled patients need to be seen soon, since they may have been without medical care for several years. They may need extensive work ups and specialty care due to possibility of chronic disease and several undiagnosed conditions. We have a huge mismatch of patient to primary care, including specialty care. I have to emphasize, everyone needs care and timely care. Several appointment slots at both primary care and specialty care do not require an extensive physical examination, these visits could be accommodated by providers who are part time or who wish to work more hours from home via telemedicine, from that particular clinic and its satellite sites, by coordinating internally. This would allow health care providers to have the appointment slots open up for the incoming new patients, allowing them to use their time wisely and avoid delaying care for these individuals. Today it takes about 6 weeks for a new patient to see their PCP, and wait time for most specialty care is 3-6 months or worse. This will not be acceptable when we have those new individuals who are eagerly waiting to be taken care of. Telemedicine allows us to see, examine and talk with the patient via HIPPA complaint technology using an iPhone, lap top or iPad. There are many great companies out there trying to solve the health care cost problem. Our Outpatient clinic sites can use telemedicine services for following up and managing lab results, chronic disease including diabetes, asthma, mental health, for following up several radiological and other studies previously performed. The physical outpatient clinic visits could be accommodated appropriately for those new patients, for pregnancy care, for performing procedures on patients and for those who do not get better or who might need extensive work up. I believe telemedicine is also a great way to take care of children at school based health centers. We can also use Telemedicine to help smokers to quit smoking after they have received counseling, because health care providers can actually prescribe medications and take care of these patients without leaving their homes! We can minimize ER visits most of which are usually unnecessary, if the patients have access to the doctors. There are several doctors who are currently part time due to family issues, such as childcare, and would definitely embrace this option of integrating Telemedicine into their work schedule. If we have telemedicine integrated into our County health systems, each health care provider could be focusing on their own county needs, and other counties could do the same. The services are very affordable. This is truly going to be patient centered medical care. If we integrate telemedicine into the County system, patients do not have to miss work or school, drive in that heavy traffic, and sit in the waiting rooms, just for something the provider could share even by phone. There will be less disease and financial burden on the county, if we consider Telemedicine as an option. We need to hasten seeing these new incoming patients who have delayed care for several years. "

Jane Poulter (11/27/2013 at 9:12 AM)
More visits doesn't necessarily mean more efficiency. If the caregiver only focuses on single concern at each visit and doesn't view the patient holistically, then the patient may require multiple visits to actually receive the care he needs. It might be more efficient to provide more time per visit. Potentially the provider could better address more of the patient concerns at one visit and not require as many return visits - this would be a type of efficiency that could be better health care and more satisfaction for a patient.

Diane E Wallis (11/26/2013 at 11:20 AM)
My partner did a quick study. It took 42 "clicks" to enter data on a simple sore throat visit in EPIC's EMR (CPT 99213). Until the burden of data entry in EMR's are lifted, I don't see anything changing in my lifetime. DW




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