Burden of billions: Bringing focus back to caregiving

$4 billion, $1.5 billion, $1.2 billion, $1.0 billion and $700 million. Excluding government contracts, these are among the five largest EMR price tags on record over the last two and a half years. That's four implementations weighing in at more than $1 billion each, and another one not far behind.

When added up, spending on U.S. healthcare IT comes to a whopping $40 billion annually, spending that has been propped up by nearly $30 billion in EMR government subsidies; well-intentioned tax payer dollars that have fallen well short of expectations. And while inflated expectations have tried desperately to keep pace with the price tags attached to the EMR, we're confronted with a divergence in the fundamental principles of our healthcare system and the supporting role of healthcare IT.

No healthcare technology vendor, with a mission rooted in compassion and patient care, should burden providers, payers, patients and tax payers with a total cost of ownership in excess of a billion dollars. But even putting that ideological dissonance aside, and seemingly despite unprecedented levels of investment in healthcare IT, data still show that care delivery and coordination have anything but improved.

  • A recent time in motion study showed that for every hour a doctor spends with a patient, she spends two hours interfacing with an EMR.1
  • Another showed that 56% of nurse time is spent away from the bedside documenting and coordinating care.2
  • And The New England Journal of Medicine recently found that the most significant opportunity for the use of data in healthcare remains improved care coordination.3

Worse still, despite the United States accounting for nearly 40 percent of global healthcare IT spending, our outcomes underwhelm on a global scale. Bloomberg's latest healthcare efficiency index ranks the United States 50th out of the 55 countries evaluated.4 And while we spend nearly twice per capita on healthcare compared to other developed nations, the Commonwealth Fund ranks us amongst the lowest in outcomes and the highest in risk factors.5

Somewhere along this path to technological enlightenment, we forgot that technology was intended to be a driver of productivity, not shackle it. That it was to ease the operational burden, not complicate it. That healthcare IT was supposed to give caregivers more time at the bedside caring for more patients, not more time at a workstation while millions of emergency patients each year average more than six hours waiting for a bed.6

It's time we re-oriented the healthcare IT discussion around the delivery of care, not the documenting of care. While an EMR should follow a patient along the care continuum, it cannot move a patient across that continuum and ensure the timely delivery of care.

It's time to bring focus back to caregivers (a population generally regarded as overworked and in short supply); to enable caregivers to spend more time with their patients, while delivering technology solutions that don't financially overburden provider institutions. It's time we raise our expectations for what healthcare IT should be doing for patients and caregivers, and understand that delivering care starts and ends with a patient; a person that values getting to the right care setting more than how and where we are documenting that care.

At a time where the Congressional Budget Office estimates that absent material gains in productivity, 60 percent of U.S. hospitals would post negative profit margins by 2025, operational improvements remain critical to ensuring the sustainability of U.S. healthcare.7 A recent study found that reducing the average boarding time in our nation's emergency departments from six hours to four hours would create enough capacity to help 9.7 million more patients per year in urban communities, not to mention saving countless lives. Meanwhile other studies suggest that as many as 20 million patient-days are lost each year simply waiting inside our hospitals.8 Not only will a focus on patient flow and efficient care coordination save more lives, but also allow our healthcare system to continue to do so in the future.

And if done right, it won't cost our healthcare system tens of billions of dollars. As we begin to understand patient flow as the core operational process to solving healthcare's productivity challenge, we can overcome the pressures of an aging population in which half already suffer one or more chronic conditions,9 and of a workforce threatening healthcare with a 1.2 million nurse shortage by 2030.10 The only way to overcome such demand and supply constraints is through a focused commitment to understanding patient flow across all care settings, to free up the countless hours lost documenting and coordinating care rather than delivering care. And if done right, for no more (and arguably less) than what we already spend at a national level, we can see to it that patients don't wait unnecessarily for the care they need.

Forbes, For every hour with patients doctors spend two record keeping, Sept. 6, 2016
2 NIH, A 36-hospital time in motion study, Summer 2008
NEJM, Catalyst Insights Report, March 2017
Bloomberg, US Healthcare system ranks as one of least efficient, Sept. 29, 2016
Commonwealth Fund, US Healthcare from a global perspective, 2015
TeleTracking 2016 – The Waiting Game
CBO, Analysis of Financial Pressures facing US Hospitals, Sept. 8, 2016
TeleTracking Testimony to US Congress House Ways and Means, Sept. 14, 2016
CDC, Chronic disease overview
10 Rasmussen College, One million nurses short, 2017

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