Doctors Lose Face-Time

New technologies have helped doctors diagnose and treat people more quickly, freeing them up to spend more time on their most complex cases. But many physicians argue that some technological advances have had the opposite effect and are actually costing them face time with their patients.

As the electronic health record (EHR) program enters a new phase this year, few doctors argue against its long-term benefits for improving health, admitting that the EHR makes it easier for authorized people to access a patient's health information. Sharing it collaboratively to improve cooperation between multiple medical professionals is a worthwhile goal, they say.

But now, in a period of mounting regulations, some doctors argue that electronic coding and note taking is rising in priority over human contact. The controversy was the subject of an expert panel discussion Thursday morning in Boston, Mass.

“At this point in time, many physicians are spending too much time dealing with documents instead of patients, and we've reached a tipping point,” Dr. Paul Weygandt, the panel's moderator, tells Healthline.

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Weygandt is vice president of physician services at Nuance, which makes software that lets doctors interact with EHRs. The purpose of the panel was to get doctors talking about ways they can get away from the keyboard and back into the exam room.

A Blessing or a Curse?

Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, believes technology has incredible potential for improving patient care, and as a practicing physician has deployed it in remarkable ways at his own hospital. Emergency-room physicians at Beth Israel even use Google Glass when seeing patients.

When a doctor enters the exam room, Google Glass scans a bar code on the wall. Instantly, the patient's medical information appears in the doctor's line of vision, and he or she can refer to it while examining and speaking with the patient.

Halamka, who also serves on Healthline's medical advisory board, says many aspects of technology increase safety and reduce time spent on administrative tasks.

He does not subscribe to a “doom and gloom” view about how technology will alter healthcare, but, he says, when it comes to the EHR, “We are in the biplane era. We haven't invented the jet engine yet, but we're not in the era of the Wright brothers, either.”

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Halamka compares booking a flight, hotel, and rental car (“It's five minutes on Orbitz," he says) with making three doctors' appointments for a chronically ill elderly parent (which takes "three hours of phone calls, e-mails, faxes, and smoke signals").

When his father was dying in the intensive care unit of a Los Angeles hospital, doctors had plenty of detailed data. But making sense of it proved difficult. “Nobody could tell me how my father was doing,” Halamka says.

However, when Halamka's wife was recently diagnosed with breast cancer, he had—as the IT director at a major hospital—data at his fingertips from 10,000 patients with similar diagnoses. He used the information to help determine the best course of treatment for her. But not everyone has that kind of access, he says.

Coding Confusion

Dr. Steven Stack, a former chairman of the American Medical Association (AMA), tells Healthline he chose to sit on the Boston panel because doctors are dissatisfied with the current environment. If the people providing direct patient care remain unhappy, the results could be disastrous, he says.

A recent study by Rand Corp. and the AMA showed that 80 percent of doctors believe good patient relationships fuels their fulfillment. But face time is getting scarce, the physicians said.

Several factors have created a stressful environment. The international coding system for health conditions, known as ICD-9, is being updated for the first time in more than 30 years.

Doctors will now have to be even more specific when coding for medical conditions. Instead of choosing from 14,000 codes, there will be 68,000. This will be a headache for doctors to figure out, Stack says. He fears that if insurance companies determine coding is incorrect and start denying payment, it could lead to other serious problems.

“I don't wax nostalgic as change is happening, because it leads to progress in many ways," he says. "But the days of a patient going to see a physician and the two having an intimate partnership, where they discuss risks and benefits, and things of value in exchange for services provided ... have evaporated and are nearly all but extinct.”

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The Virtual-Reality Doctor

Some hospitals have begun to experiment with technology that offers virtual face time when it would otherwise be impossible.

Dr. Peter Rasmussen, medical director of distance health for the Cleveland Clinic, tells Healthline that his health system is finding ways to “touch” patients without them even coming in for a visit. Patients are seeing doctors on their televisions at home (through cable lines) and even at public kiosks with high-definition screens.

Rasmussen hopes video technology will also help the Cleveland Clinic better use resources throughout its 14 emergency rooms. If patients come to an ER with no immediately available doctor, a physician at another location may be able to “see” the patient remotely.

He envisions using video technology to sell a package of services to payers. Maybe an insurer would be willing to pay for a year of video-technology services for someone suffering from a condition like Parkinson's disease or chronic pain, he says.

Most people agree that engaging patients is the ultimate goal, says Halamka. “Over time, hopefully, we can turn data into knowledge and wisdom.”

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