Should We Industrialize Medicine?
By Ken Congdon
By Ken Congdon, Editor In Chief, ken.congdon@jamesonpublishing.com
Follow Me On Twitter @KenOnHIT
You don’t have to be a historian to recognize Henry Ford as an influential figure during The Industrial Revolution. Henry Ford didn’t invent the automobile. Nor was he the first to manufacture or sell one. What made Henry Ford unique was the process he created to manufacture the automobile. His use of an assembly line – where manufacturing processes were standardized and waste was eliminated – greatly reduced costs and made cars affordable to common consumers.
It’s been suggested that the concepts embraced during The Industrial Revolution, like the assembly line, could hold the key to driving cost out of the U.S. healthcare system while improving care. However, many healthcare providers balk at this idea. After all, the practice of medicine is an art, not a science. You can’t possibly standardize healthcare as a packaged commodity and still expect the same level of care … can you?
Dr. Simeon Schwartz, CEO of WESTMED Medical Group, believes that you can. “Many physicians believe that industrialization will be terrible for medicine,” he says. “They like to think of themselves as a prestigious guild that delivers personalized care, and that standardization undermines the doctor/patient relationship. In actuality, however, most of these physicians aren’t providing the level of care they should. Instead, they are feeding an inefficient system that prevents them from spending time with their patients. This needs to stop. If you industrialize care, you can empower physicians to be doctors rather than clerks, which can have a profound impact on healthcare.”
Dr. Schwartz uses an odd, yet effective, sneaker analogy to illustrate his point. He states that he can go to a sporting goods retailer, like Dick’s or The Sports Authority, today and pick up a pair of New Balance sneakers in a size 11 for $69. This is an example of an affordable, industrialized product. However, if we bought sneakers the same way we purchased healthcare in the U.S., a consumer would first have to go to the store and be fitted for the sneaker. Once the individual’s precise size was determined, the order would be sent off to a shoemaker. Once manufactured, the sneakers would be delivered back to the store where the consumer would have to return to see if they fit correctly. If they didn’t, further adjustments might need to be made. The second process for manufacturing sneakers would be much more expensive than the first, and, in the end, the two approaches ultimately deliver a product that fits equally as well for the vast majority of the population. According to Dr. Schwartz, the technology tools exist today (e.g. EHRs, data analytics, population health management, etc.) that can allow healthcare providers to “industrialize” the way they deliver care by measuring trends, streamlining processes, and eliminating waste.
Better Healthcare Requires Workflow Re-engineering
Most healthcare providers I’ve spoken with over the past few years have stressed that an IT system must mirror existing clinical workflows in order to be successful. Dr. Schwartz is the first healthcare leader I’ve interviewed to openly dispute this position. According to Dr. Schwartz, one of the main reasons IT implementations fail is due to the fact that providers try to wrap these technologies around inefficient existing workflows.
“Wrapping technology around inefficient existing workflows would have been like a first-time owner of a Model T trying to get the car to go by hitting the engine with a buggy whip,” says Dr. Schwartz in another analogy. “It’s not going to work. Physicians need to be open and willing to change in order to make the best use of the technology available, and ultimately, improve the level of care they provide.”
For example, WESTMED completely reconfigured its office space and re-engineered its patient visit to make best use of its EHR (GE Centricity) and data analytics technologies. “We discovered that there is a fundamental design for how a modern medical office needs to function,” says Dr Schwartz. “There are fundamental roles that doctors, nurses, and other staff members must perform, and standard communication channels that must be followed to optimize efficiency. If you don’t optimize your practice in any of these areas, you’ll be beating that engine with a buggy whip all day long.”
One of WESTMED’s initial problem areas was capturing vital signs. The organization realized that its physicians were spending an average of 3 ½ minutes capturing vital signs for each patient seen. Initially, physicians delegated this responsibility to nurses in an attempt to recoup their time, but this just shifted the time drain to other members of the team. In the end, WESTMED installed new automated blood pressure machines in all of its exam rooms and re-engineered the workflow process to greatly reduce the time it takes to capture vitals. Today, WESTMED physicians can capture vital signs in just 45 seconds with the press of a button on the blood pressure machines. Plus, while the vitals are being captured, the physicians can ask the patient other health related questions or continue their exam.
“We re-engineered this process to make better use of the technology in play, reduced the time of the average patient visit by 15%, and ultimately produce a higher quality result,” says Dr. Schwartz.
Measure Performance For Continuous Improvement
In addition to workflow re-engineering, Dr. Schwartz also champions the use of technology to measure performance and improve outcomes. WESTMED measures its performance on just about everything – from how long it takes a staff member to answer the phone or return an e-mail to diabetes control. In all of these scenarios, the data itself has been instrumental at driving cultural change.
“We don’t tell our doctors what to do,” says Dr. Schwartz. “We show them what they’re doing. For example, the simple act of revealing their diabetes data to them was powerful. We also make this data transparent throughout the enterprise. So, if a doctor isn’t interested in his or her own diabetes data, maybe they are interested in their peer’s diabetes data. This practice has created a culture in our organization where our doctors truly care about their diabetes numbers.”
WESTMED’s performance is definitive of this. The NCQA (National Committee for Quality Assurance) goal for diabetes control is that less than 15% of your patient population be classified as “out of control” (which is defined as a hemoglobin A1c greater than 9). Currently, less than 2 ½% of WESTMED’s patient population is considered out of control.
What About The Patient?
I think there is a common misperception of industrialized medicine, and this misperception is just as unappealing to patients as it is to physicians. Where physicians tend to believe a move toward industrialization will undermine their expertise and delegate their profession to nothing more than mere data crunchers with a hefty medical school debt, patients fear industrialized medicine will strip them of the individual attention they currently receive from their doctors. Let’s face it — nobody wants to feel like a product on an assembly line whose medical treatment is being determined by a computer.
In all fairness, I think it’s clear that this is not what Dr. Schwartz envisions when he refers to industrialized healthcare — nor is it what’s being practiced at WESTMED. In fact, Dr. Schwartz claims his patients regularly comment on how WESTMED’s use of technology has made their office visits more efficient, informative, and engaging. For Dr. Schwartz, industrializing medicine is the act of streamlining processes and eliminating waste so that physicians can actually spend more time with patients, have the data on hand to make more accurate health decisions, and ultimately provide a higher level of care at a lower cost. If that what industrialized medicine is all about, then I’m all for it.