Your Say

Editor's note: This letter is in response to Gienna Shaw's July 22 online column, "By the Numbers: Evidence Mounting of Increased Importance of Patient Experience, Healthcare Consumerism."

Patient Experience a Matter Of Trust
I'm glad to see that healthcare leaders are beginning to focus more on the patient experience. The overarching question on the minds of patients is: Can I trust them? That question is answered during multiple moments of truth throughout a patient experience. The culture, and the experiences that it creates, will determine the answer. The consumer expects clinical competence. Healthcare organizations and the people delivering service (both clinical and nonclinical) play a significant role in creating the experience. The best practices are those that have moved customer service and the patient experience beyond "smile lessons" and into core strategies with clear standards and accountabilities. It's no longer fluff—service and the resulting patient experience is mission critical.

Kristin Baird, RN, BSN, MHA
President, Baird Consulting
Fort Atkinson, WI

Editor's note: This letter is in response to Carrie Vaughan's July 14 column, "Seven Ways to Get Value From Your EMR."

Spending Billions for Effective Billing
Any discussion of EMR that focuses on hospitals is like the drunk looking for his keys under the light post. The real problem is getting process improvement into primary and specialty care. This means physician offices. There are about 750,000 doctors in the country—about half are in groups of three or fewer and about 90% are in groups of fewer than 10. Implementing an EMR in a physician office is extraordinarily expensive, even if the software and hardware are free. Maintenance costs alone are more than these businesses can afford. In a really good physician office EMR implementation, you justify the extraordinary expense by focusing on improving data collection for billing effectiveness. You use IT to improve processes that improve cost, revenue, or both.

But nationally, is there any benefit to paying $19 billion to encourage everyone to get more effective at billing? In the current business model for physicians, if you focus on quality, you lose money. If the objective of "getting rid of paper" seems valuable, you are not an IT implementer. The objective is to decrease the cost of a process for a given outcome.

Toyota does not automate manufacturing shop floors to eradicate paper. They do it to build better cars. As long as we pay for the wrong outcomes, we will get them. We do not pay physicians to obtain outcomes (much). We pay them to see patients. But being ineffective has almost no impact on their revenue. In fact, being ineffective often results in a return visit. That would be a revenue value.

Tim Breaux
Principal, InterCase
Portland, OR