The Healthcare Duality
What is it like to work in healthcare? As a nurse I can tell you what I’ve observed, experienced and now call the healthcare duality. When I sat down to write this blog, I looked up ‘medical provider duality’ and came across a Forbes article written in 2014 by Dr.Robert Pearl. Everything I read in his article corresponds to what I’ve observed. In summary he states, “That’s the duality of being a doctor. There’s the fulfilling personal side and the frustrating impersonal side. The personal side reminds doctors why they love practicing medicine. The impersonal side poses a significant threat to the future of medicine.” With the right technology and training you can shift the duality of healthcare back to personal medicine.
I was a nurse in the operating room and lucky, 90% of the surgeons I worked with were great. I made it my mission to support the success of the provider patient relationship in whatever way I could. Doing that required an observation of clinical workflow patterns for each surgeon and each surgical procedure. It became clear, very early in my nursing career, that what it meant to be a doctor was not at all what I thought it would be. It was incredibly discouraging to see many wonderful providers spending so little time with patients because of the systemic emphasis on: production time, insurance billing, charting and navigating poorly built hospital communication platforms. In order to support these doctors and patients my job revolved around efficiency, not individualized care, the system simply would not allow it. We all knew that no matter how good of a job we did to comply with these systemic demands, our electronic health record systems would ultimately either fail us or more importantly the patient. I never thought as a surgical nurse that I’d spend so much time ringing up all the surgical supplies used in the procedure to appropriately charge patients and their insurances for. How naive I was then.
When I left the operating room and decided to explore outpatient clinics I began to observe the duality of healthcare in another light. The provider/practice owner duality can greatly sway the impersonal to personal patient care ratio. Owning a medical practice AND being the primary provider is a whole different ball game. Often many doctors and nurse practitioners start or build a practice without any sort of business/operations background or training. Experiencing the business side of medicine within a hospital does not correlate to building your own medical practice. My new role as a nurse in the outpatient clinic owned by the primary provider was to support the entire clinical operations i.e. use my systems development background more than my nursing skills. I longed for the personal side of patient care, but the demand for clinical operations development and support outweighed my desires. I decided to dedicate my time to finding a new type of electronic medical record (EMR) system that shifted the impersonal to personal ratio back towards patient care. If I couldn’t make a change in the hospital maybe I could do it for this clinic.
After many months of searching and demos it was a medical rep who introduced me to Eva, the first Interpretive Health Record (IHR). I became the first client of Eva, the beta clinic, and built a system I’m proud of to this day. I believe I actually built myself out of a job because I built myself into their Eva system. I modeled my own clinical workflow into Eva in order to support their front desk, clinical and business teams, because that’s what my job was. Eva as a whole completely changes the nature of what it means to collaborate with an electronic medical records system. With Eva you can shift the duality of healthcare back to personal medicine.