By Rajiv Leventhal
In 2003, Peter Anderson, M.D., a primary care physician in practice for more than 20 years at the time, says he hated medicine.
While working as a family physician at Hilton Family Practice in Newport News, Va., Anderson’s practice decided to implement an electronic health record (EHR) in 1998, though he admits he had no idea if he was going to be able to use it or if it was going to work properly. Five years later, Anderson’s practice was $80,000 “in the red,” and he was working 12 to 14 hours a day trying to turn things around. “I couldn’t keep up,” he says. “The EHR cut productivity by about 35 percent, and that was five years into it. I would spend at least as much time on the EHR as I did with patients.”
But Anderson knew he had to make it work. After all, he says, patients were getting more complicated; they would be on 10 to 12 medications rather than two or three, and might have five or six chronic diseases rather than one or two. “Paper cannot take care of patients. We have had a lot of pharmaceutical advances, and patients are living longer,” he says. “That’s where the EHR becomes so valuable. These medicines make such a big difference in the outcome of a patient’s health, and the EHR helps facilitate that improvement by keeping the wealth of data straight and organized.”
But in 2003, Anderson’s practice was “shipwrecked.” “I was up at 3 a.m., finishing patient charts from the previous day. I always had to get back to my computer to finish charts, and that’s what took up my free time. I lost most of my personal life,” he recalls.
Anderson knew he was drowning—he had to find a way to fall back in love with medicine. The big change he made was to change the process in the exam room. Anderson decided to teach his nurses and medical assistants (MAs) to collect and document all of the patient’s current and relevant medical data needed to accomplish a successful patient visit. “We created the ‘inside the exam room team.’ Before, when the doctor walked in, the nurse would walk out. Surgeons are the opposite, though—they won’t go in without the operating room nurse. I said If could get some help inside the exam room, that will save time—not only can I see more patients, but I can do a better job. Patient satisfaction will go through the roof.” Sure enough, in the first full year of his new workflow process, Anderson’s collections rose by $100,000 because of the improvement in access, and patient satisfaction was as high as it’s ever been because he could see all of his patients when they needed to be seen.
The success of his workflow process eventually allowed Anderson to retire from practicing medicine. He has transformed his process into a new business, called the Family Team Care Model, in which Team Care Assistants work with the provider and do many of the functions that do not require a provider (gather data, scribe the visit in the EHR, patient education), which maximizes the provider’s efficiency in seeing patients.
This change in workflow was critical, Anderson says, as patients have too many data points. “I had patients with 200 to 300 data points. It made patient visits at least a half an hour, because you’re spending so much time putting in that data. But we built this team to collect all of the patients’ relevant and current medical data and input it into the EHR. Then the nurse or MA presented that to me verbally in front of the patient. My goal was to never sit down with the EHR when I was with the patient, and they loved that because they knew I was looking them in the eye and they could tell me their story. The number one need of people is to be listened to, and when they heard their story given back to me, they felt better.”
Anderson stresses that this team care model is key to developing patient-centered care, which he says is conceptually embedded in the Affordable Care Act (ACA). “The medical home model is what will fix and restore primary care, as it’s the brokenness of primary care that has caused this healthcare crisis. I got caught in this storm—I couldn’t pay the bills and I hated medicine. We have doctors retiring early and medical students refusing to come into primary care, all while 30 million more people are entering the healthcare system. Primary care physicians have been resistant to change, because no one likes change. But the argument isn’t whether the ACA is good or bad; it’s is primary care going to try to fix the brokenness? If you fix primary care, you will fix the brokenness and turn the ACA into something beneficial for our culture. If not, we’re going to be in real trouble.”
Unfortunately, Anderson believes that physicians across the country are using only 10 percent of an EHR’s capabilities, at most. And that’s because physicians have no time to learn it, he says. “We have a [society] that is aging and we need time to see them. In short, we are just overworked.” But after nurses and MAs started inputting patient data into the EHR before he saw the patients, Anderson started to notice things were changing. “The EHR started giving me accurate charts, which I never had before. I finally stopped worrying about lawsuits because I knew all the data was correct and documented. Instead of letting it destroy you, let it build your practice. And to be honest, the nurses and MAs do a better job with it than I ever could.”
And what’s worse, continues Anderson, is that less than 2 percent of physicians have an idea about what’s on the horizon in regards to the ACA. “Physicians are hoping this all goes away; they are doing their best to ignore it. If they had the money, 60 percent of doctors would retire today. Ultimately, you must get people back to the physician that knows them. If emergency room (ER) or urgent care centers were equal to familiar physicians, we wouldn’t be in this crisis and healthcare wouldn’t be breaking the economy. With a medical home and robust primary care built around a personal physician, you will change healthcare. This will be the rebirth of American medicine, and the EHR has to be a part of that, because patients have too many illnesses and data points. Paper is archaic.”
While Anderson insists the change is necessary, he doesn’t think it’s incredibly difficult or even too time-consuming, estimating that productivity can increase within six months time. He recalls the story of a patient who hadn’t been in the office in nearly two years. Because of the capability of the EHR to keep patient data, an MA called the patient to schedule a mammogram. Because it had been two years, the patient was shocked and amazed that she was called, says Anderson. And it turned out that when she came in, the mammogram revealed that she had carcinoma in situ, an early form of breast cancer. “It got removed, no problem. The EHR helped save her life,” boasts Anderson. “The EHR is the sharpest two-edged sword in medicine. It can do great things if used correctly, and can destroy your practice if used inappropriately.”