We must let doctors be doctors — Many physicians feel that they can no longer practice in the manner they were trained. In too many instances, physicians have lost the authority to determine how many patients they will see, and what the treatment plans will be. The vast majority of physicians don’t see themselves practicing in this way. They need a degree of autonomy and to have the ability to effectively carry out what they believe to be the best evidence-based treatment plan for their patients.
I had the pleasure to interview Christopher Maiona, M.D., SFHM, Chief Medical Officer, PatientKeeper, Inc. Dr. Christopher Maiona is a practicing hospitalist for more than 20 years and PatientKeeper Chief Medical Officer.
Thank you for joining us! Can you tell us a story about what brought you to this specific career path?
I have been a practicing hospitalist for over 20 years and, during that time, I have experienced first-hand the “mainstreaming” of EHR systems. With each new EHR iteration, from multiple vendors, I had high hopes, yet I was always sorely disappointed. In my various capacities — front line hospitalist, hospitalist program director, and hospital medicine executive leader — I have had to deal with the ramifications of systems that fail to appreciate a physician’s thought process, workflow, and needs. As a true believer in the potential for EHRs to actually help providers and patient care, I took on larger roles in the implementation and utilization of these systems in my host hospitals/networks. The challenge, however, was balancing quality benefits (realized and potential) with the negative effect EHRs were having on those of us practicing in the trenches. It was becoming more difficult to justify system utility to a physician population facing increasing census, higher patient acuity, mounting documentation requirements, and a concerning rise in physician burn out. Ironically, as we were seeing some quality gains associated with EHR use, studies began to identify areas where quality was negatively impacted by physician burn out. The profession needed help. That’s what led me to my current role at PatientKeeper, a company whose mission is to advance healthcare through IT, while respecting the role of the physician in the process. I feel fortunate to have a voice in addressing the challenges of my profession, and a role in realizing the EHR’s full clinical potential.
What makes your company stand out? Can you share a story?
PatientKeeper is the only healthcare IT company that focuses on optimizing electronic health records (EHR) systems for physicians. We’re all about improving physician workflow and the physician’s user experience, which are notoriously poor on traditional hospital EHRs — so much so that EHR systems consistently are cited as leading contributors to physician burnout. We improve the physician experience by building software that supports how physicians work, and that complements a provider’s thought process rather than obstructing it. PatientKeeper is used by more than 70,000 physicians across North America and the UK, including at the largest for-profit healthcare system in the U.S.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Healthcare is the one industry in which computerization actually has reduced efficiency — specifically of physicians, who are the scarcest, most valuable resource in the entire system. That has to change. Rather than being impediments to care, computers must become invaluable assets to physicians and help them to provide better, evidence-based patient care. We’re on our way:
- Through the application of artificial intelligence (AI) algorithms to physicians’ orders, where AI can suggest which orders should be considered based on an analysis of treatment patterns in similar patients. At minimum, this saves providers time by putting orders a click away. In some cases, this will help avoid a missed order or delayed order that could make the difference between a great outcome and a less than ideal one.
- Through adaptable user interfaces that have the potential to revolutionize the way providers work. Today’s technology has the ability to tailor clinical data presentation based on a provider’s specialty, personal preferences and the patient’s situation. Highlighting the most important information saves time and reduces the chance a provider will miss an important result. This ensures timely, effective care and ultimately will improve outcomes and reduce cost.
- Through clinical insights driven by “big data” analytics, which will contribute to more efficient, actionable and effective healthcare. One of the first targets for this type of effort is sepsis in the hospital environment. According to The National Institute for General Medical Sciences, severe sepsis strikes more than a million Americans every year, with an estimated 28 to 50 percent of those infected succumbing to the ailment. That accounts for more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. One of the biggest reasons for this high mortality rate among patients is the fact that the disease progresses rapidly and requires quick detection and intervention.
An area ripe for disruption is preventative care. We spend disproportionate time and resources on treating chronic diseases in the hospital, but only a fraction of this on the outpatient preventative care that could decrease hospital admissions by at least one-third. The data on chronic disease is irrefutable:
- The number one cause of disability in the U.S. is chronic disease (e.g. HTN, COPD, diabetes) and 75 percent of all deaths are due to chronic disease.
- Fifty percent of Americans (90 percent of seniors) have at least one chronic disease.
- Inpatient treatment of chronic disease consumes 86 percent of U.S. healthcare spending. Only a small portion of the remaining 14 percent is allocated to preventative care.
- While the federal government has taken steps to emphasize the value of preventative care, health IT must support that effort more aggressively. Top of the list are development of true, wide-spread health information exchange (HIE) and the design of patient portals that empower patients to take a more active and informed role in their care while facilitating communication between patients, families and providers. Both can positively impact home management of chronic disease.
- Another area ripe for disruption is today’s siloed approach to medical care. Physicians want to communicate with each other, but today’s highly computerized environment just doesn’t allow for it, and a lot has been lost as a result. We can and must develop systems that enable physicians to better collaborate on patient care. This entails the development of simple text-based platforms integrated into the local environment’s call schedule and EHR, facilitating communication when it needs to happen vs. when it is convenient or possible. Physician documentation in the digital age remains antiquated; it’s merely a digital version of its predecessor. We can develop systems that incorporate natural language processing (NLP), AI and perhaps even new ways of thinking about documentation (e.g., team based notes) that help physicians efficiently synthesize the ever-growing body of medical knowledge into an individual’s care note while affording the clinician more time at the bedside.
You are a “healthcare insider”. If you had the power to make a change, can you share five changes that need to be made to improve the overall U.S. healthcare system? Please share a story or example for each.
- Respect the physician-patient relationship — It used to be that patients had a direct and familiar (sometimes almost familial) relationship with their physician, which created a level of comfort and confidence that benefitted the patient care dynamic. With the trend toward care administration in multiple venues, the traditional model has changed for many patients. However, there are a few concrete steps healthcare systems can take to reinforce the physician-patient relationship:
- Create environments that allow for thoughtful, reasonably paced care.
- Allow for a patient-doctor interaction that improves care and optimizes patient experience, which begets better outcomes.
- Alleviate physicians’ unnecessary administrative burden by implementing policies and technology tools that are intuitive, and that give providers more time at the bedside to practice their craft.
- Optimize EHRs for physicians — The computerized systems physicians are required to use should be designed and deployed in a way that actually helps physicians care for patients, rather than distracting them and disrupting their workflow (which is too often the case with today’s electronic health records (EHR) systems) in ways that pull physicians away from the patient’s bedside.
- Let doctors be doctors — Many physicians feel that they can no longer practice in the manner they were trained. In too many instances, physicians have lost the authority to determine how many patients they will see, and what the treatment plans will be. The vast majority of physicians don’t see themselves practicing in this way. They need a degree of autonomy and to have the ability to effectively carry out what they believe to be the best evidence-based treatment plan for their patients.
- Improve information access and sharing — It’s often difficult or impossible for members of a patient’s care team, both within a facility and across different care settings (clinic, hospital, rehab, home), to easily access a patient’s medical information; and it is equally challenging for the patient him or herself (and their family members) to access their own medical information.
- Play doctor — Healthcare leaders would learn a lot by walking in a physician’s shoes for a day (or more). Hospital CEOs should shadow their providers to see firsthand the challenges doctors face, learn their struggles, and understand what a day in the life of a physician looks and feels like.
How can our readers follow you on social media?
I regularly contribute to PatientKeeper’s blog, TransforMED.