I'm a physician and I don't hate digital health care tools

September 6, 2019 Dr. Doug Kavanagh

A new wave of digital health tools is helping to shift the focus back to the patient

As a physician innovator in the digital health care space, I regularly run into peers who find fault with the digital advances in our profession. It’s understandable. The first wave of digital tools that transformed medical practices—EMRs and digital charting tools—also brought some unintended consequences. EMR charting led to a shift in focus away from engaging with patients, and over to a computer screen. The good news is that there is a new wave of digital health tools that are shifting the pendulum back.

Depending on who you ask, physicians now spend anywhere from one-half to two-thirds of their time on charting and administrative tasks. This isn’t entirely new—after all, paperwork has always been part of the consultation process—but there is broad agreement that the introduction of electronic records generally increased this burden. 

There is no doubt that the digital and detailed nature of “paperwork” today can be taxing. I know many of my peers worry about taking the right notes and often spend long hours after clinic making sure everything is charted correctly. This level of worry and effort is not only frustrating―it also seems to be a contributing factor in some cases of physician burnout.

Fortunately, a growing number of “second wave” digital health technologies are helping to give us back the time to focus on the interpersonal aspects of care that we crave. The solutions below are just some of the tools that I use in my own practice to help reduce the time I spend in front of a screen, and replace it with face-to-face, meaningful patient engagement.

Automated clinical note-taking

Imagine grabbing your patient’s chart and finding it has been updated with a concise history, complete with red flags highlighted, before you even enter the exam room. It’s possible. And it is amazing. Thousands of Canadian physicians are now using smart Ocean forms, sent to patients at home or on tablets in the waiting room, to collect and summarize a patient’s history and symptoms, much like a medical scribe might. This allows them to review a patients’ concerns, in their own words, before even entering the exam room. With the “S” of the SOAP note already completed in the chart, it’s much easier to focus on the patient, face-to-face, while reducing how much time is spent updating the chart at the end of the day.

Digital patient planning tools

As a primary care physician, I frequently see patients that have a long list of concerns they want to address. Others arrive and present with one concern, only to introduce a much more significant issue―“one last thing”―at the end of the appointment.  By inviting patients to complete an agenda setter or a “reason for visit” form on a tablet in the waiting room, patients can gather their thoughts and share their concerns before I see them. In my experience (and there’s evidence to back this up), patients are often more open and honest when sharing their concerns with a tablet. Giving patients this digital “planner” helps us to prioritize concerns during the visit and to engage in more meaningful dialogue. It also has the added benefit of helping to manage patient expectations for the visit. The tablet can even be set up to automatically suggest that a patient book additional appointments if the appointment time allotted isn’t sufficient for the number of concerns indicated. 

Automated patient reminders, screening and clinical decision support tools

When used correctly, digital health tools can help save time by eliminating time-consuming tasks that can easily be automated. In my practice, I rely on automation in the Ocean Platform for things like reminding patients about overdue procedures, screening patients for vaccinations and calculating scores. By “outsourcing” those parts of my job, it’s a lot easier to build best practices into everyday patient care. For example, if one of my patients reports concerns around anxiety, I can invite them to complete a series of validated questionnaires like the PHQ-9 and the GAD-7 that can give me more insight into their mental health. In this preview, you can see what it looks like for the patient on the left, and how it will appear in the EMR on the right. As the patient completes the form, the score is being calculated in real time. If the score is high enough, it also appears red in the clinical note, alerting me to probe into this further.

Electronic messaging for patient-provider communication 

There are often times when a quick email can replace the need for an in-person visit, ease a patient’s concerns about negative test results, or save the patient a trip to the clinic to pick up a lab requisition, letter or form. Until recently, the options available have been more trouble than they were worth. Logging into a dedicated messaging tool that is separate from the EMR (requiring copy-and-pasting from one system to another) was enough to tip the scale away from using electronic messages for most of my peers. Times have changed: I can now send a secure message to my patients, including a form or attachment from the chart, directly from my EMR. Instead of sending a message to my admin staff to ask them to contact my patient, I can send the same message directly to the patient. It’s faster, more efficient, and ultimately better for the patient. 

It’s exciting to watch digital health tools start to deliver on the promise of technology to improve both patient care and the clinical experience for healthcare providers. As this “second wave” of technologies grows to include everything from virtual visits to eReferrals, the future of health care in Canada is indeed looking brighter every day.

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at jouleinquiries@cma.ca.

About the author

Dr. Doug Kavanagh

Dr. Doug Kavanagh is a Toronto-based family physician and digital health technology expert. He has over eighteen years’ experience developing electronic medical records and EMR-integrated solutions for patient engagement, research, and referrals. As Medical Director and Co-founder of CognisantMD, Dr. Kavanagh is best known for his commitment to revolutionizing the way we share medical information between patients and physicians. In 2016, Dr. Kavanagh was awarded a $50,000 Joule innovation grant to further the development of the Ocean Platform in Canada, which is now used by over 4,000 healthcare professionals and over 10,000 patients each day.

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