Page 16 - Delaware Medical Journal - January 2018

TABLE 3: Use of Electronic Health Record
Effect on Physician Autonomy, Patients and Physicians
CONSEQUENCES OF TREND
EFFECT ON PHYSICIAN AUTONOMY
EFFECT ON PATIENTS
EFFECT ON PHYSICIANS
a. EHR systematizes content and format of medical records.
Reduced: EHR restricts ability
of physician to individualize content and format of medical records.
Unfavorable: If
EHR inaccurately records information, constrains necessary care, guides inappropriate care, or distracts physician’s attention.
Favorable: If well designed, EHR guides more appropriate and effective care.
Unfavorable: If
EHR completion requires increased documentation time or impedes efficient clinical workflow.
b. Legibility, organization and availability of medical information increase.
No effect
Favorable: Availability of patient’s clinical information improves care.
Favorable: Clinical decision making enhanced.
c. Clinical decision support tools made readily available.
Decreased: Physician less able to unilaterally determine care plan.
Favorable: Care improves with use of well-designed clinical support tools.
Favorable: Clinical support tools enable more rapid and confident clinical decision making.
Effects on Patient Benefits Associated with Physician Autonomy
EFFECT ON PATIENT ADVOCACY
EFFECT ON CLINICAL EXPERTISE
EFFECT ON QUALITY AND SAFETY
EFFECT ON INNOVATION
Enhanced: If
EHR facilitates better information concerning patient’s preferences.
Enhanced: If EHR incorporates latest medical knowledge.
Enhanced: If EHR is designed to support safety and quality.
Reduced: Time lags and structure of process to updating protocols can result in lack of timely innovation.
TABLE LEGEND
PRACTICE TREND: MOVEMENT TO TEAM-BASED CARE
It is a well-accepted adage that no modern physician practices alone. While this
has been true for some time, there is a prominent trend to organize clinicians into formal teams. The operating room has long practiced team-based care, with
trauma and transplant care being other notable examples. Programs such as TeamStepps®6 have helped to formalize even these longstanding relationships. In primary care the patient-centered medical home with formal roles and established standards has now rapidly begun to care practice with its more idiosyncratic and less formalized professional roles.7
Our consideration of the trend to team- based practice makes it clear that teams decrease physician autonomy. A team has expectations of its members that necessarily will decrease individual control. Other effects of team-based care are likely to be equally striking. The traditional relationship between an individual physician and an individual patient is made more complicated.
To whom a patient relates becomes
a question of practice design, as the sense of a singular relationship between a patient and his physician becomes blurred. As in other areas of our analysis, the effect of team-based care on both patients and physicians appears mixed. The pooled talent and additional resources of a well-functioning team should result in enhanced patient care and satisfaction. Conversely, a poorly organized team or one that fails to address the basic desire of most patients for a relationship with a caregiver
could easily lead to dissatisfaction,
if not confused care. For physicians
who desire leadership, authority is reinforced by being a team leader, likely enhancing professional satisfaction. For physicians desiring a leadership role
in teams led by others, dissatisfaction would seem likely.
The movement to formal teams would seem to enhance expertise. Quality and safety should improve as the individual expertise of team members is pooled and jointly deployed. It is easy to see how a team-based practice environment with its propensity for multiple opinions could enhance creativity and spawn innovation. Since patient advocacy usually is predicated on a particular practitioner advocating for a particular patient, whether the ability to advocate for a patient’s needs is enhanced or diminished will likely depend on the group norms developed by the team and its expectations of team members to act as advocates. (See Table 4)
Reduced/Unfavorable
Enhanced/Favorable
Mixed
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Del Med J | January 2018 | Vol. 90 | No. 1