Breakthroughs in medical technology that reap millions for their investors may be a tantalizing prospect for some practitioners who fancy themselves as Wall Street wizards when they’re not engaged in the actual delivery of patient care. But for most practicing physicians, keeping up with the high-tech medical frontier is a full-time job in itself because the field is constantly in flux. From electronic medical records to the latest diagnostic tools or revolutionary surgical procedures, the medical field requires constant attention to stay au courant and competent—without bankrupting one’s practice in the process.
“How do you maintain proficiency and demonstrate competency to your peers and the public in an era of rapidly changing technology and medical knowledge? I don’t know if anybody knows the answer to that,” says Dr. Ira Nash, senior vice president and executive director of the North Shore-LIJ Medical Group. “For people in independent, small-scale practices, I think those challenges are greater.”
While the Affordable Care Act (ACA) has been getting the most attention recently, another federal mandate for the use of electronic medical records (EMR) has been affecting physician practices directly. Not getting on board with EMR can incur penalties from Medicare, where applicable. Pediatric practices are exempt, but they’re the primary exception. Although the adoption of medical records is spreading fast, there’s still a sizeable percentage—one estimate is that it’s almost 20 percent—of physician practices that are resisting the high-tech mandate. One major reason is that making the shift to EMR can be a serious blow to a medical office’s productivity, especially if it’s a solo practice or a small group.
“If you’re a private practitioner whose living is based on office revenues and not salaries, that productivity hit is not insignificant,” says Dr. Michael Oppenheim, chief medical information officer at North Shore-LIJ Health Systems. “That’s the number one issue.”
According to Dr. Oppenheim, some practices that can afford it hire outside firms or “scribes” to do the bulk of the documentation. It may be a costly investment, but over time they can cover the initial cost and make even more, he says, because they’ve become better at recordkeeping and more efficient in the delivery of care. Smaller practices may need more time to break even. A large health organization like North Shore-LIJ accepts the cost in the required recordkeeping as the price of doing business.
One benefit from having EMR, Dr. Oppenheim says, is that it helps physicians access their patients’ records when they’re not in the office—and another is that their records are legible so their partners don’t need to decipher their handwriting.
“So when Mrs. Jones, whom you haven’t seen in eight months, calls you in the middle of the night and says she’s got a pain in her belly, you can call up her records and see X, Y and Z. That’s a tremendous value!” says Oppenheim. “You wind up with much better documentation... And when your partner needs to take over the patient’s care, she’s not staring at your chicken-scratch, trying to figure out what the hell you were thinking. It’s all right there.”
Another welcome change spurred by the proliferation of new technology is improving the quality of patient care, medical experts say.
“We know a lot more about it, and we’re paying much more attention to it than when I graduated from medical school,” says Dr. Nash, recalling what it was like some 30 years ago. “There was no public reporting, no real movement toward standardize practice, or standard measures of what we mean. It was completely opaque to patients and highly subjective in whatever kind of assessment even those of us in the business were able to make. It was all kind of word of mouth and reputation. We’ve come a long way to recognizing the systematic collection of data, on both processes of care: ‘Did certain things get down that we think should get done?’ And outcomes: ‘Are people actually getting better? Is there a lower mortality with this operation than with that operation?’”
Providing patients with vital information after they’ve been discharged from the hospital inspired Dr. David Langer, chief of neurosurgery at Lenox Hill Hospital in Manhattan, part of the North Shore-LIJ Health System, and IT specialist Ken Court, to create a web- and mobile-based software app that allows patients to access videotaped meetings they’ve had with their physicians as well as other medical information crucial to their recovery. Called CirrusHealth, the app, which is now in clinical trials, is essentially “a highlight reel” of their care, according to Dr. Langer. All the patients need is a cell phone or a computer screen.
He sees the app as a logical way to balance all the money spent on developing expensive diagnostic tools, like MRIs.
“We’re getting these incredible images inside people’s bodies,” says Dr. Langer. “It’s led to new inventions, new surgeries and new devices all because we’ve been able to identify things more carefully and specifically. It’s completely radicalized medicine. But we’ve spent zero dollars on explaining to patients what those findings are.”
Those in the health field know full well that the amount of new knowledge coming out of medical research increases logarithmically every year—if not every day. Keeping up with the flow of scientific information is partially what’s driving the use of specialists, because primary care providers have a hard enough time keeping track of general medicine, let alone what’s going on on the cutting-edge.
“It’s harder in a small group, there’s no doubt about it,” says Dr. Mark Jarrett, senior vice president and chief quality officer at North Shore-LIJ Health System, adding that those small practices working with his health system get backup support and help. Outside the system are some companies who can be hired by small group practices to fulfill needs when they arise.
Adapting to the new technology can also be generational, but not necessarily so, according to Dr. Jarrett.
“For younger physicians, it’s not that foreign,” he says. “The problem comes up more for the older physicians who aren’t really that tech savvy and are getting closer to retirement who would rather take the little bit of loss of income and not bother with all this.”
The spread of knowledge at an astronomical rate is also affecting medical education, doctors say.
“How do you define what everybody you call ‘doctor’ needs to know? I think it’s an extraordinary challenge,” says Dr. Nash. “A forward-thinking organization thinks about what processes of thought and mental practices you need to develop, rather than what set of facts do you need to incorporate, because the facts are going to change rapidly. Most of the drugs that I use in my clinical practice now didn’t exist when I was in medical school.”
Still, being a good doctor is not all about having the latest breakthrough—and that should provide some respite for those predisposed to not making huge investments in technology.
“Being a good doctor has always required a degree of curiosity,” says Dr. Nash. “Curiosity about the patient in front of you, both in a humanistic perspective: Why is this person here and what is this person like? And from a scientific perspective: How do we make symptomatic observations to draw conclusions about illness and disease and use that to think about ways to do things better?”
Those qualities can be found in the smallest practice as well as in the largest healthcare system.
“You still need a stethoscope,” says Dr. Jarrett, “and you still need to talk and listen to the patient.”