The Physician's New Assistant


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The Physician's New Assistant

  1. 1. The Physician’s New Assistant: An Electronic Patient Manager <ul><li>Massachusetts Software & Internet Council </li></ul><ul><li>Business Opportunities in Bio-IT </li></ul><ul><li>Newton Marriott 10/18/02 </li></ul><ul><li>Thomas E. Sullivan, M.D. President-elect, The Massachusetts Medical Society Chair, Partners Healthcare Confidentiality Committee Chair, AMA eMedicine Advisory Committee </li></ul>
  2. 2. Speaker’s Background <ul><li>33 years of practice experience, both solo and group, Internal Medicine and Cardiology, in community hospital with academic affiliations, and leadership in managed care settings. Local and national involvement in organized medicine. </li></ul>
  3. 3. The Premise-A Software Developer’s Challenge <ul><li>Physicians are very busy and under constant pressure to perform. They will NOT change behavior, unless the new “workflow” is clearly more efficient on a personal, individual level </li></ul>
  4. 4. Incentives to Change Behavior <ul><li>Achieve greater efficiency (aka improves “workflow” - encompasses all others) </li></ul><ul><li>Reduce error rate </li></ul><ul><li>Practice better medicine…improved “outcomes” require the capacity to query personal practice patterns and benchmark individual performance. </li></ul>
  5. 5. Incentives to Change Behavior 2 <ul><li>Increase patient satisfaction </li></ul><ul><ul><li>Automate collection of satisfaction surveys </li></ul></ul><ul><ul><li>Develop automated patient history taking </li></ul></ul><ul><li>Group practice demands sharing information with multiple colleagues…much easier with an EMR. </li></ul><ul><li>Managed care capitation demands for “population” based practice </li></ul>
  6. 6. Incentives to Change Behavior 3 <ul><li>Comply with demands from statutory agencies and “voluntary” organizations </li></ul><ul><ul><li>New requirements for documentation of care: </li></ul></ul><ul><ul><li>NCQA – National Committee On Quality Assurance </li></ul></ul><ul><ul><li>AMAP/Physician Consortium for Performance Improvement </li></ul></ul><ul><ul><li>HIPAA – Health Insurance Portability and Accountability Act </li></ul></ul><ul><ul><li>JCAHO – Joint Commission for the Accreditation of Healthcare Organizations </li></ul></ul>
  7. 7. A Typical Physician’s Daily Workflow/Practice <ul><li>Follow the physician’s footsteps and analyze each segment to determine whether it’s better to “automate” or “remain manual” </li></ul><ul><li>The morning routine - “The Computer is always on” - broadband at home. </li></ul><ul><li>The Hospital - rounds, new admits, meetings, surgery.. . </li></ul><ul><li>The Office - the customized desktop, digital “dashboard” or “ my portal” working seamlessly with patient visits. </li></ul><ul><li>On Call - the need for “ubiquitous computing” -mobile devices - the wireless PDA as an option - cell phones on steroids. </li></ul>
  8. 8. Working with Nurses <ul><li>Success in getting physicians to use computers includes close collaboration in planning, design, implementation and revision of the system. IMHO </li></ul><ul><li>“ Documentation” leans toward tables, columns, and spreadsheets... versus.. </li></ul><ul><li>Communication - which leans toward narration and free text data entry. </li></ul><ul><li>Flexibility is key! </li></ul>
  9. 9. Physicians..Why, the Internet? <ul><li>“Information at your fingertips” </li></ul><ul><li>“Anywhere, anytime on any device” Sun </li></ul><ul><li>“Where do you want to go today?” Microsoft </li></ul><ul><li>The NLM’s contribution to slogans: </li></ul><ul><ul><li>“The More You Know, the Better You Heal” </li></ul></ul><ul><li>Beware, the “Yahoo Factor” </li></ul><ul><ul><li>“Digital Daydreaming” </li></ul></ul>
  10. 10. Physicians, Why the Internet 2 <ul><li>Clem McDonald, M.D. et al. On “Canopy Computing” : </li></ul><ul><li>“ The rain forest canopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. Individual health care computer systems are rich with patient data, but rather than a canopy linking all the trees in the forest, the data ”fruit” come from a diverse forest of individual computer “trees” -- laboratory systems, word processing systems, pharmacy systems and the like. These different sources of patient information are difficult or impossible to reach by individual physicians, especially from their offices. The World Wide Web and other standardization technology provide physicians and </li></ul>
  11. 11. Physicians, Why the Internet? 3 <ul><li>their institutions the tools needed for seamless and secure access to their patients’ data and medical information, when and where they need it. We and others have adopted these tools to combine independent sources of clinical data. Physicians who assist in the purchase of clinical information systems should demand products in their practice settings that are Web enabled, use standard coding systems, and communicate with other computers via broadly accepted protocols. </li></ul><ul><li>JAMA 1998;280:1325-1329 </li></ul>
  12. 12. The “Physician Portal” – an Internet Creature <ul><li>A Customized “Front Page” with many options, e.g. “my Yahoo” </li></ul><ul><li>A Thumbnail view of the office schedule, </li></ul><ul><li>Urgent alerts and reminders, lab, etc. results </li></ul><ul><li>Medical or other news, investment info, weather, medical journal e-mailed TOC </li></ul><ul><li>PubMed/Medline/other search window </li></ul><ul><li>Is it “affordable”? </li></ul>
  13. 13. The MMS Committee on Information Technology <ul><li>Charter and Mission - not for profit - “vendor neutral” </li></ul><ul><li>Annual Goals and Objectives </li></ul><ul><li>The Internet “Free” </li></ul><ul><li>The MMS Outpatient Formulary Guide </li></ul><ul><li>The CPR “Challenge” aka bakeoff </li></ul>
  14. 14. MMS Mission Statement <ul><li>The Massachusetts Medical Society was established as a professional association of physicians by the Commonwealth of Massachusetts in an Act of Incorporation, Chapter 15 of the Acts of 1781. Section 2 of that Act states: </li></ul><ul><ul><li>&quot;The purposes of the Massachusetts Medical Society shall be to do all things as may be necessary and appropriate to advance medical knowledge, to develop and maintain the highest professional and ethical standards of medical practice and health care, and to promote medical institutions formed on liberal principles for the health, benefit and welfare of the citizens of the Commonwealth.&quot; </li></ul></ul>
  15. 15. The Massachusetts Medical Society and NEJM Approach <ul><li>The New England Journal of Medicine Online </li></ul><ul><li>Web component available April 1996 </li></ul><ul><li>Full text launched August 1998 </li></ul><ul><li>52,600 full text access - 65,000 TOC/e-mail - 683,000 page views weekly (early 1999 stats) </li></ul><ul><li>Free to developing nations; free after 6 months elsewhere. </li></ul>
  16. 16. Internet/Medical Issues <ul><li>Quality, Access and cost efficiency of healthcare </li></ul><ul><li>Physician work habits, lifestyle and satisfaction </li></ul><ul><li>“Secure” e-mail </li></ul><ul><li>Organizational attitudes, and priorities </li></ul><ul><ul><li>Major changes ahead </li></ul></ul><ul><li>Security and HIPAA Implementation </li></ul>
  17. 17. A Non Physician View <ul><li>The Massachusetts Medical Society CIO Perspective </li></ul>
  18. 18. <ul><li>Administrative and financial transactions </li></ul><ul><li>Online searching for health information </li></ul><ul><li>Searches of medical literature </li></ul><ul><li>Downloading of educational videos </li></ul><ul><li>Search for a clinician or health plan </li></ul><ul><li>Participation in chat and support groups </li></ul><ul><li>Online access to personal health records </li></ul><ul><li>Completion of patient surveys </li></ul><ul><li>Routine care delivery (e.g., e-visits) and chronic disease management (e.g., periodic reports on health conditions to clinicians) </li></ul><ul><li>Reminders and alerts; decision support systems </li></ul><ul><li>Consultations among clinicians (perhaps involving manipulation of digital images) </li></ul><ul><li>Remote monitoring of patients in home and long-term care settings </li></ul><ul><li>Transfer of medical records and images </li></ul><ul><li>Remote and virtual surgery </li></ul><ul><li>Videoconferencing with real-time sharing of documents </li></ul><ul><li>Enrollment of patients </li></ul><ul><li>Scheduling of appointments </li></ul><ul><li>Billing for services, payment of providers </li></ul><ul><li>Certain aspects of clinician credentialing </li></ul><ul><li>Consumer access to information about health plans, participating providers, eligibility for procedures, covered drugs in formulary, etc. </li></ul><ul><li>Public health </li></ul><ul><li>Professional education </li></ul>
  19. 19. <ul><li>Health services, biomedical, and clinical outcomes research </li></ul><ul><li>Videoconferencing among public health officials during emergency situations </li></ul><ul><li>Incident reporting </li></ul><ul><li>Collection of information from local public health departments </li></ul><ul><li>Surveillance for emerging diseases or epidemics </li></ul><ul><li>Transfer of epidemiology maps or other image files for monitoring the spread of a disease </li></ul><ul><li>Delivery of alerts and other information to providers and health workers </li></ul><ul><li>Accessing reference material </li></ul><ul><li>Distance education with real-time transmission of lectures or prerecorded videos </li></ul><ul><li>Real-time consultations with experts about difficult cases </li></ul><ul><li>Virtual classrooms, distributed collaborative projects and discussions </li></ul><ul><li>Simulation of surgical procedures </li></ul><ul><li>Virtual exploration of three-dimensional environments </li></ul><ul><li>Health services research using administrative and clinical data </li></ul><ul><li>Searching of remote databases and professional literature </li></ul><ul><li>Collaboration among researchers, peer review, interactive virtual conferences </li></ul><ul><li>Control of exp e rimental equipment, such as electron microscopes, visual feedback from remote instrumentation </li></ul><ul><li>Real-time monitoring of compliance with protocols </li></ul><ul><li>Transfer of large datasets between computers for high-speed computation and comparisons </li></ul><ul><li>Enrolling of populations in clinical trials </li></ul>