A few weeks ago I needed to visit a family physician in order to complete the requirements for my Australian student visa. Compared to some of my past clinic visits this one went well, but I was still struck by how inefficient the majority of medical clinics still are.
According to a study done in 2007, there is a “60% adoption by primary care physicians in Alberta” of electronic medical record (EMR) systems. This adoption rate will only continue to grow as the older generation retires and a new generation of tech-savvy physicians take their place.
The crucial point that I believe both the AMA and the CMA are missing when they track numbers such as the “technology adoption rate” is that they fail to make note of how the technology is used in each practice. Saying that 60% of Alberta practices have a computer in their office says absolutely nothing about whether (and how well) it is used to save time and money.
The problem I see with most of the EMR systems available and in use today within Alberta is that they tend to stay “within the box” – rather than attempting to use technology to find innovative solutions that simply wouldn’t be possible with pen-and-paper health records, they instead focus solely on replacing the use of paper in the traditional workflow.
One quick example of this: When I arrived at the physician’s office for my appointment, I was handed a clipboard and a pen, and asked to fill out the usual information about myself – name, date of birth, family doctor’s name, etc. Then I handed that back to the receptionist, and she typed my information into the system. What happened there? My time was wasted filling out paperwork that could have been filled in electronically in advance, and her time was wasted typing in that same information.
Bottom line is that there are many ways in which the technology available to us today can be used to save physicians, their staff, and their patients time (and ultimately, money) if only we can “think outside of the box”.
To end, I’d like to present a scenario for my ideal “techno-practice”, using current technology to rethink how primary care is delivered.
John Doe hasn’t been feeling well for the last 3 days, and his fatigue hasn’t gotten any better. He decides that he should see a doctor to make sure it’s not something more serious than a cold or the flu. He remembers reading an article recently about a new doctor in town who has a “technology practice”. John doesn’t really know what that means, but he does remember that he can book at appointment at the new doctor’s website, and that appeals to him. He does a quick Google search for the doctor’s name, and up pops the website for the doctor’s new practice in town.
He clicks on the button that says “book an appointment”, and up pops a window showing him the next 5 appointment slots available with the practice’s 3 family physicians. He’s disappointed to see that tomorrow is all booked up with the doctor from the newspaper article, but the other two doctors in the practice have appointments available the next afternoon. He clicks the button next to one of the two appointments, and then the site asks him if he’s a new patient. He clicks “yes”, and a form pops up asking him to fill in all the information the physician requires, such as name, date of birth, allergies, etc. This information will all be saved in the practice’s database so that if he comes back to see another physician in the same practice he won’t have to fill out any more information. It also gives him a username and password so that he can access electronic versions of any prescriptions and see any lab reports or imaging tests that the doctor has ordered.
He also checks a box to put himself on the cancellation list – if someone cancels an appointment for the next morning, he’ll be notified by Twitter/email/Facebook, and have 15 minutes to respond to snag the cancellation spot for himself.
The next day he receives an email an hour before his appointment, telling him that they are running 15 minutes behind schedule today – the receptionist checks off each patient as they see the doctor, so the system knows if they are ahead or behind schedule, and will notify patients accordingly.
When he arrives at the practice he tells the receptionist his name, and is shortly shown into an examination room to the doctor. The doctor ducks his head in the door to say that he’ll just be another 5 minutes. His hair is slick from the rain pouring down outside – he must have had a housecall to make just previous to my appointment, John thinks.
Soon the doctor has dried off and comes back to the examination room to meet with John. He pulls out his iPhone, and John can see a summary of the information John has already told the system – his past medical history, any drugs/prescriptions/allergies, and the reason for his visit today. The doctor can pull up any information in the system on his iPhone, which makes going out for housecalls almost as convenient as seeing patients in his office.
So, apologies for my storytelling abilities, but you get the point. There’s huge potential here to make primary practice almost fun, and I’m excited to see the current state of technology progress as I make my way through medical school!
