May as well face the writing on the wall that independent little PCP's are going to be extinct shortly. All major systems are offering contracts, buyouts, or strangling markets so that it's just simply not practical to practice. Specialty practices are getting bought up wholesale and eventually all MD's are going to be part of a larger system. Some groups are resisting (Radiology, Emergency Medicine, and Anesthesia) but eventually systems will leverage to the point where they'll just hire on staff instead of dealing with independents other than when it's helpful (staffing shortage, holidays, overnights, ect).
Everything is moving to data driven outcomes. Population Health Management, Clinical Decision Support and Pay for Performance are the three big buzz phrases. Population health management is a huge push and basically reviews particular populations of people that are at risk or in risk of particular disease states. Pre-diabetic, heart disease, ect. Patients are tagged based upon problem statements, vitals, lab results and other discrete data associated on their records across their care within a system. Care planners are appointed groups of these people to follow them and make sure they are getting to their visits on time, tracking the effectiveness of therapy and a whole host of other functions. The entire goal is taking huge buckets of data and carving out high cost, high risk groups and going preventative and proactive with them. Sending a $20 taxi to pickup a patient for a visit to a PCP instead of waiting for them to go full cardiac arrest a few months down the road and resulting in a $1000 ambulance bill and associated admission costs.
Clinical decision support is a rules based, data driven model put into the ordering system of EMR's that look at a host of information about that patient and assign risk and appropriateness of various diagnostic procedures. It cuts down on excess labs, excess radiation dosing, unnecessary tests and ultimately cuts down on cost and "volume" in a hospital. Many diagnostic orders in the next 5 years will be required to pass a CDS rule before being allowed to be placed.
Same thing exists for quality measures that directly impact hospital reimbursement. Bouncebacks, response times, antibiotic usage, ect. It's all based on data and would be nearly impossible to accurately mine through paper.
If somebody comes into a hospital complaining of chest pains an EKG is going to be performed and reviewed by a cardiologist prior to hauling them to the cath lab. If it's not a real heart attack they aren't getting hauled to the lab. 20 years ago if a cardiologist was not on staff after hours that EKG would have to be printed. They'd have to page the cardiologist on call. They'd fax a shitty quality read of that EKG over to his house fax line. Then he'd have to look at it and send it back in with his hand written interpretation. Now we took a shitty copy from fax, printed on it, and faxed it back again. Now this copy of a copy is stuck with a pile of papers and shoved *hopefully* in a folder and eventually makes it way back to medical records to be stored in a giant file room that is incredibly expensive, not to mention all that fast to retrieve things from. Any time somebody wants to review that EKG they have to go to medical records and have a copy made *again* of that copy of a copy making for a 3rd copy. It's inefficient, and it's just terrible diagnostic quality.
Plus you have to do a paper billing for the technical performance of that EKG. You have to put a billing person in place on the profession side to bill for the doctors read.
Compare that to today...
EKG is done. It's sent into the EKG system. Doctor gets paged. Signs in from his home computer and reads it in full diagnostic quality. Within seconds of clicking the sign button you've got a reference quality image going back to the EMR's with a typed up result from the physician that can now also be data mined via structured reporting for various clinical significance. That result is now available immediately to anyone within the healthcare system with access to the EMR's. It's available to affiliated clinics who have access to physician portals for the EMR. Tech billing for that EKG is automatically charged against the account with no extra work required by anyone. Same with billing that drops to a billing extract and is picked up by a professional billing system.
Now apply that same logic to radiology, other cardiology studies, labs, ect. There are definitely efficiency gains made with EMR's. Especially so when companies are able to reduce their application portfolio down from 25+ disparaging systems with limited interoptibility to 3-4 systems that are tightly integrated. Data is stored on a singular DB with all of those patient stays and encounter data available in one place.
Yes doctors are put in front of computers more. But you don't have a ton of "behind the scenes" staff running around peddling paper, burning results to CD's, making terrible copies, going through enourmous stacks of paper trying to manually bill for things, ect. That data is all available to them now.
Efficiency is a dirty word.
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