Utilizing Physician Capacity More Efficiently

The implementation of the reform law and other trends have sparked concern about the adequacy of the physician workforce to deal with patient demand.  An article in Health Affairs discusses how more widespread implementation of health information technology may affect use of physician time.   (HA Article)    The authors begin by noting the substantial growth in use of IT by physician offices, most recently sparked by the meaningful use incentives, but the authors also state that few of these offices are using these systems to their full capability.  They present a model of a future digital office which will encompass both physicians’ and patients’ use of digital communication as well as clinical decision support systems and electronic interaction between all providers treating a specific patient.  They then conducted a research survey to try to ascertain what the effects on physician productivity might be in such a fully digitized world.  They created a range of estimates for physician time demand reductions, in both a 30% adoption rate for the full HIT office or a 70% adoption rate.  Categorizing the types of reductions, on a nationwide basis they found a 4-9% reduction for efficiency gains in the low adoption case and an 8-19% reduction in the high adoption case.  For reductions tied to ability to delegate more, in the low case there was a 6-12% reduced demand and a 12-26% one in the high adoption one.  Finally, for greater use of telemedicine, the decrease in demand would be 4-7% in the low case and 8-15% in the high adoption case.  Although not discussed in detail in the article, the telemedicine example seems to us the one most likely to lead to a rationalization of capacity utilization, based on actual examples in real practice, such as tele-radiology or tele-psychiatry.

The article presents a credible hypothesis, but research suggests that health information technology often disrupts physician workflow and may make them less efficient.  There is very widespread physician discontent with the latest surge of EHR and other technology use, and at least a perception among providers that all this HIT is raising costs and not necessarily improving care.  Some of this may be attributable to characteristics of smaller practices that lack the resources to implement HIT successfully, but real-world experience should raise a red flag about assuming too much of an improvement flowing from greater HIT use or certainly that it will result in reduced demand for physician time.