Automation and the Healthcare Cost Curve
Some hospital systems are experimenting with similar labor-saving tools, such as automated readings of radiology scans, at least for the basic work involved. Dragovits is interested.
"Radiology always costs more FTEs because there's another modality all the time," he says. "There are some startups working on early-stage development of automated readings, and over time, that will play an important role—similar to computer-assisted coding. That's another big one for us."
But outside of not-ready-for-primetime technologies, other advancements are cutting labor costs and allowing physicians to provide better, more up-to-date evidence-based care, which is a form of automation.
For instance, Atrius Health, a large ambulatory physician group practice with six practices in 30 locations in Massachusetts, is committed to being an accountable care organization in CMS' Pioneer program. That means big investments in care coordination, part of which necessarily involves keeping its approximately 1,000 physicians well apprised of changes in evidence-based medicine treatment protocols. The change also involves a doubling of the practice's managed Medicare population, which means that saving physicians valuable time and effort is paramount, says Michael Lee, MD, the director of clinical informatics for Atrius.
Physicians use an online service from UpToDate, a clinical decision-support system that uses clinical evidence updated daily to answer clinical questions about dosing or diagnosis at the point of service. Problem was, at the beginning, it was available only through Web browsers, which would require the physician to leave the electronic medical record to perform any search. Three years ago, Atrius was able to get the service installed as a button on its Epic EMR system, which is always available. That move not only saved labor, but also alleviated the problem of physicians declining to use it because of the inconvenience.
Since the change, the physicians have become accustomed to the convenience and the help it provides.
More recently, says Lee, "we had an upgrade where we added a scheduling feature to the toolbar, which pushed UpToDate down on the page. That led to the help desk [phone] ringing off the hook that day. All we did was hide that button, but people were using it so much, they went crazy," he says. "We put it back the next night."
But he says the potential for labor savings with the tool is still not fully realized because further usefulness depends on its ability to share information with Epic. For instance, Lee says, "wouldn't it be great if the order tools would change automatically so nobody would have to read anything? That would be really progressive, but the technology's really not there yet," he says. "If they did it, there is an opportunity to save money by providing better care."
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