Dr Brown re: Bottleneck in training

Dr. Brown, thank you for re tweeting this very interesting article, but I would like to focus on the last paragraph.  Specifically the following, “improving the efficiency of health care delivery with the help of new technologies and new organizational structures.”

On a microcosmic level of primary care out in the trenches of Montana, where the wind howls and the gophers outnumber the people, I have made three significant changes to coalesce with the comment above.

First, my nurse’s station has been incredibly renovated thanks to the technology/structure.

Second, my outside of office communication, the patient portal, has significantly improved thanks to technology.

Third, the interface with my patient at the point of care has been “Lutherized,” my patients not only view, but edit and learn from their chart as we work together on it. So I like to think of this as retro technology.

My nurse, with both the Amazing Charts on her left screen, Updox and Lytec schedule on the right, can easily do the work of 3 staff, and do it better and smarter.  The secure messages, e-faxes, electronic record, telephone, scanner all managed with her dual monitor computer.  Everything intersects at her work station.

The secure portal has changed the dynamics of the office visit, so it is no longer fixed in time or space, but now the patient can start his office visit working on his Lenovo laptop three days before the face to face visit checking on his laboratory results, check on his screening abdominal ultrasound report  as the radiologist sends the report.  After he finishes the face to face visit, the summary transcribed by me with Medical Dragon, will pop on his I phone when he returns to work. He can message our office for questions, refills, appointment or reports.

The newest, and most intriguing addition, has been using a chromebook at the point of care.  Hooked to an HDMI cable the EHR is projected on the TV wall mounted and easily visible, but also connected remotely to the data base, to access the EHR/processing power. So we can go through the chart and work on it together.

So yes, in order to reduce overhead expenditure, and work smarter with less staff, the technology and organizational structure has been modified.  And I never thought I would say this, but the office has never run better.  And maybe the wind howling and gophers whistling have effected my perspective, but I think with the fun tools, this is a great time to be a primary care guy running his own shop.

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