More on Redefining the Role of the PCP

In my note yesterday (see: Have PCPs Become Obsolete?), I discussed what I perceive as the need to redefine the role and skill set of PCPs. The Health Care Blog has a long and thoughtful note (see: The Changing of the Guard) about the consequences of the graying and impending mass retirement of baby-boomer physicians. Much of this note focuses on the changing relationship between hospitals in a community and the physicians practicing in that community. It's well worth reading. One paragraph caught my attention and I reproduce it below, with boldface emphasis mine, because of its relevance to the management of a PCP's office practice:

Regardless of what Washington policymakers do about reforming payment, primary care practitioners must also develop a new operational model, which hospitals can help "midwife." Information technology must play a major role in this transition, with larger amounts of non-clinical or minimally-clinical interactions with patients either automated, through voice response technology, handled online through e-mail exchanges (e.g. prescription renewals, office visit follow-up), or supported by nursing personnel (who will also be in scarce supply). Finally, movement to end-to-end electronic adjudication and payment of medical claims will be vital to reducing practice overhead, a process which Medicare could markedly accelerate if the program's managers made the right policy choices.

I realize now that I neglected to discuss in my note about PCPs the need for greater use of e-consultations in their offices. Such technology provides a more efficient way for the professionals in the office to respond to less complex patient problems. I have posted previous notes about  patient email/e-consultations, two of which are as follows: Doctors Slow to Adopt Email with Patients; Email Good for Patients, Not So Good for Docs. I also discovered a web site specifically devoted to the topic of e-consultations, defined as follows: E-consultation is the use of electronic computing and communication technologies in consultation processes and is complimentary to existing practices.

The good news is that the new cohort of physicians that will be replacing the baby-boomers will be more comfortable with electronic communication with patients. The bad news is that physicians in private practice are frequently reluctant or unable to invest sufficient capital in their office computer systems. What is sorely needed, then, is a an inexpensive turn-key patient email/e-consultation system. Perhaps such functionality could be offered as a new EMR-PMS module. E-consultation software would be a logical add-on to patient portals which I discussed in a previous note (see: More on eClinicalWorks: A Successful PMS for Office Practices).

Comments

[bev MD]

E consultations may also be useful for certain types of second opinions. The Cleveland Clinic Heart Center (if not the whole clinic) offers e consultations for around $500-600, in which all the patient's records and tests, imaging, cath results, etc. are sent to them and they render an opinion. Obviously this often results in the patient being referred to their center, but I bet it could also be used for peace of mind for some patients who just want confirmation of their doctors' findings.