Vivek Reddy, M.D., current chief health information officer at Salt Lake City, Utah-based Intermountain Healthcare, and formerly chief medical information officer at UPMC Health System in Pittsburgh, has long been a proponent of pushing physician documentation reform ahead.
With recent attention being paid to the amount of time physicians spend in their electronic health records (EHRs)—thus negatively impacting the patient-provider relationship, and also leading to physician frustration and burnout—there is a great desire in the industry to have health IT help the lives of physicians, rather than hinder them. However, Dr. Reddy believes that the bigger issue is that the quality of the documentation is suffering due to the focus shifting away from value. Reddy spoke with Healthcare Informatics at the HIMSS17 conference in Orlando to discuss documentation improvement, changing the dialogue about its value, and more. Below are excerpts of that interview.
How do you feel about the recent federal and national attention that has been put on the documentation burden that EHRs put on providers?
I think the technology we have put into our hospitals and our clinics, right now, has largely been focused on making the burden of documenting easier, because there is a preconceived notion that because I need to get paid, I need to enter all of this information. So what's happening is we have now created a sub-industry that propagates and continues this mythology of "I need to write these notes a certain way and make it super easy for physicians," but what we are really doing is losing so much of that quality documentation. We are our own worst enemy in this space because of our focus on it. When thinking about different digital types of technology, these are things that will take us away from thinking about the note as a construct of some sort of thing that we have to follow or fill out these bullet points, and move into a "I have to document to communicate, to help quality care, and make the right care decisions." If we pivoted that way as an industry, we might take a hit from a financial standpoint for some physicians, maybe a hit of 2 percent, 5 percent or 10 percent, but it could change the dialogue about the value of documentation.
Specifically, how can documenting the "right way" be accomplished?
We all should be taking a step back and asking ourselves why we document what we do. Physicians are trained a certain way to think about clinical problem, but in every other aspect of their life, the way they communicate is totally different. What I would be advocating for is clinicians thinking about communication first, so what if they just wrote two sentences to explain what's going on? What can I do to make things simpler for my patients to understand as they read their notes, or for other caregivers? If we start getting in the habit of brevity, I think you would see the billing loss and the efficiency gain balance each other out.
The only way the federal level can really play into this is if they completely took away the concept of Evaluation and Management coding. Even if they did that, the sense of needing to put everything in the note for a regulatory reason would probably still exist, so we really need to re-imagine, and the term I like to use is the "communication chart and the billing chart," so if we can figure out a way for organizations to do this, I think you will see a groundswell and actually some new technology that comes into play, with less of a focus on notes and more focus on communication. The federal part would have to be a complete payment reform, and I'm not going to wait for that.
For you personally, moving from UPMC to Intermountain, and holding key C-suite executive leadership positions at prominent health systems, what have been the biggest lessons learned of late?
One of the best and most important skills I have learned is to be a really good listener and a really good observer. Most of the problems in healthcare today are not technology-related, and technology sometimes can get in the way. Chasing tools doesn't work; if you listen to what people need, and figure out where their problems are with them, it's a much more engaging strategy. I always pride myself on not being the guy on the mountain, but I want to be where the action is and understand the problems. As I build teams, I always tell my teams not to do so much work in your office or on a whiteboard, but go out and talk to people. You will do just as well if you do that.
What's new about your current role, chief health information officer, compared with your other roles in the past?
The biggest transition is that the CIO and CMIO role of the last 10 years was so laser focused on optimizing and deploying EMRs, and the CHIO role now is saying alright, you have all this technology that is optimized or sub-optimized in areas, maybe that's not where all the play should be. Maybe if I spend less time tweaking and more time thinking about care re-design, I would be much more effective. My biggest epiphany moment has been the fact that we are so stuck in our current models, so for instance, people can't imagine that a nurse can do these three or four other things. CHIOs have to embrace this concept of "get me a sandbox or a a zone where I can try totally different things" and free up people's mind from that existing construct. So I think the next generation of CIOs and CMIOs have to be about that type of transformational work and creativity in order to be successful. If you're just an EMR guy or gal, that won't work.
What's the one main concern you have right now above all others, related to the future of healthcare and healthcare IT?
We are really good at fee-for-service healthcare, and I think that it takes a different type of talent to be able to get past that. When I look at industry trends, I think we have a people-talent conversion that we haven't gone through yet, where just the types of people that gravitate to healthcare are in a certain mindset, and we have to infuse new ways of thinking and new processes. We will always have interesting technology challenges as the world evolves, but we will need a personality transplant for all of healthcare in order to think of things more creatively.
As far as the shift to value-based healthcare, our CEO at Intermountain always says that if you do the right thing, you usually win. This transition is always focused on what our patients need and getting the best outcome. You cannot be focused on if you had a bad quarter or month, and thus have to change strategies. Intermountain is great at staying grounded, and if it's the right thing, great, and we might fail along the way and have to pivot, but just do the right thing.
