Care traffic control

Clinicians are under extreme time pressure to "do it all," from meeting and treating their patients to perfectly documenting each patient's story. These stresses are impacting the Art of Medicine, however, a balanced care traffic control strategy can help.
Halamka reflects on how care traffic control leads to better patient care

Recently, Nuance conducted a study, “Healthcare from the Patient Perspective,” which surveyed 3,000 patients from the U.S., UK and Germany on their perspectives related to technology, engagement and physician relationships.  The overall findings, which were consistent across the countries, reinforced the critical role that the physician-patient relationship plays in keeping people invested in their health.  In a rapidly changing medical world with new reimbursement models, new technology, and new treatment possibilities, it’s critical to understand how patients are reacting to the events occurring around them.

Patient perspectives on care

In the US, clinicians have a few minutes to meet with their patients, document a perfect record, achieve dozens of quality measures, be empathetic, and never commit malpractice.  It’s impossible to balance.  What are the patients saying?

  • 88% of patients say they have a good relationship with their physician;
  • 95% say they are completely honest with their physician;
  • More than 1/3 of patients spend less than 10 minutes with their physician during an average visit; and
  • 40% of patients feel rushed during appointments.

What can we do to better engage patients and families who feel time constrained and are seeking information and technology solutions?

  • 68% of patients bring a list of questions to each doctor’s visit;
  • 39%  have checked an online source in advance; and
  • 20%  bring personal health data from outside organizations

New tools including personal health records, wellness apps, and home monitoring/telemedicine are being rolled out.  How do patients feel about this increase in technology?

  • 97% are comfortable with their physician using technology during a consultation; and
  • 58% feel technology positively impacts their overall experience.

Care traffic control

What can we learn from this study?  It’s clear that a new paradigm for team-based communication and wellness is needed to meet the needs of providers and patients.  Assuming that physician time per patient is unlikely to expand, our best approach is to bring together teams of people all linked with new technology tools and contributing to the patient experience.  A patient’s care team may include a physician, a mid-level, a nurse, a social worker, a pharmacist, and a care traffic controller — a person serving as an orchestra leader, guiding the patient to the right resources at the right time.  Although the primary care giver once could perform this function, the complexity of services available and the demands on primary care giver time, argues for a dedicated professional leveraging the talents of many service providers.

All of this will require new IT tools.

  • *No longer will there be a separate EHR and PHR, there needs to be one single record shared between clinicians and patients, who view and contribute data
  • *The Care Management Medical Record must sit on top of all the individual clinician records providing a registry for quality measurement, benchmarking, and disease management.
  • *A social networking-like model will be needed for the care team to enhance communication and share the responsibilities for clinical record keeping.  I’ve advocated for a new kind of electronic healthcare record that looks more like Wikipedia and FaceBook than today’s EHRs, which digitize the paper processes of a single provider.

I found the Nuance data to be very helpful.  Clearly to deliver the high quality, safe, efficient care our patients demand, we must embrace current technologies while realizing they are insufficient and need to evolve.  We must work in care teams, and grow the number of care traffic controllers serving as the navigators for patient wellness.  We must listen to our patients/families, leveraging their opinions to reform our existing workflow and processes.

Now that we have data to guide us, I look forward to creating the next generation of tools.

Healthcare from the patient perspective

Download this eBook to find out how patients feel about their physicians, their care experience, and the Art of Medicine in a digital world.


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Dr. John D. Halamka

About Dr. John D. Halamka

Dr. Halamka is a Professor of Medicine at Harvard Medical School, and CIO of Beth Israel Deaconess Medical Center where he is responsible for all clinical, financial, administrative and academic information technology serving 3000 doctors, 14000 employees and two million patients. As Chairman of the New England Healthcare Exchange Network (NEHEN), he oversees clinical and administrative data exchange in Eastern Massachusetts. As co-Chair of the national HIT Standards Committee, Dr Halamka facilitates the process of electronic standards harmonization among stakeholders nationwide. Additionally, as a member of the Massachusetts HIT Council, he engages the stakeholders of the Commonwealth to guide the development of a statewide health information exchange. Born in Des Moines, Iowa, he relocated to Southern California where he completed undergraduate studies at Stanford University earning a degree in Medical Microbiology and a degree in Public Policy with a focus on technology issues. Dr. Halamka completed medical school at the UCSF and simultaneously pursued graduate work in Bioengineering at the University of California, Berkeley, focusing on technology issues in medicine. He completed an Emergency Medicine residency at Harbor-UCLA Medical Center. He authors a widely-read blog, Life as a Healthcare CIO, where he writes about a wide span of topics ranging from policies, data governance, technology and regulations to standardization.