August 6, 2019, 4:30 p.m. — We've all been there -- in an exam room with a patient with whom we have a relationship that, in some cases, goes back decades. This special individual who has entrusted us with his or her care is relating an extremely important story that has great impact on not only the patient, but an entire family. It is a pivotal moment.
Where are we during this crucial time? Are we locked in eye contact with our patient, present in the moment? Or are we instead focused on the "third party" in the room, perhaps with our back turned to the patient, staring at the monitor that is the portal into the electronic health record?
Unfortunately, we are too often focused on the EHR and away from why we ultimately chose family medicine -- the interactions with patients and families that grow into continuing relationships.
We have seen the studies, and we are all too familiar with the conclusions. According to a 2016 study published in Annals of Internal Medicine, primary care physicians spend a mere 27% of a typical day in direct contact with patients. Almost half -- 49% -- of that same day is consumed by administrative activities. Documentation in the EHR makes up a large portion of those activities. In fact, 37% of physician time in the exam room is spent on EHR and desk work.
The frustration that this causes doesn't end in our office. As reported in a 2017 Annals of Family Medicine report, family physicians spend an average of 86 minutes of work in the EHR outside of the office setting. Known as "pajama time," this further leads to disengagement and is a detriment to physician well-being.
AAFP members are letting us know how this has impacted their practices. In the most recent Member Satisfaction Survey, the No. 1 priority that respondents asked the Academy to address was administrative burden. Of those who chose this as their top priority, 72% said work related to their EHR contributed a great deal to overall administrative burden -- the No. 1 response.
Simply put, we are suffering professional death by a thousand clicks.
Your AAFP has heard you. In October 2018, the Board of Directors approved a 42-month special project to address issues related to EHRs -- and, more importantly, to work toward solutions. The project will focus on driving innovations utilizing the latest health IT, addressed from a family medicine perspective to improve and optimize our experience and truly enhance the delivery of patient care. The goals include decreasing overall administrative burden and leveraging the integration of emerging fields of artificial intelligence and machine learning.
Development of an innovation lab will allow the testing of these new technologies within actual family medicine practices. One of the first pilots, which began in July, is a collaborative with Suki, a health IT company. Work during the next two to three months at family medicine practices in three Midwestern cities will focus on development of a virtual assistant. This sets a path for physicians to move away from the keyboard and utilize voice recognition with artificial intelligence to navigate the EHR, document in real time, enter orders and complete billing requirements. In short, physicians will leverage the tool to enhance their workflows rather than having to adjust their workflows to fit the tool.
Physicians who come to the Family Medicine Experience in Philadelphia next month will have an opportunity to hear more about this pilot from Suki representatives who will be participating in our popular Office of the Future exhibit.
Another initiative is our AI Health Outcomes Challenge partnership with the Center for Medicare and Medicaid Innovation and the Laura and John Arnold Foundation. This challenge program is similar to the XPrize, with the intent of leveraging AI to utilize claims and EHR data to predict outcomes and allow for meaningful disease burden prediction and outcomes. This will ultimately decrease the burden of quality measurement and quality reporting in our practice.
The challenge received more than 300 applications. Due to the volume of responses, CMS announced Aug. 1 that the judging period had been extended, and Stage 1 participants will be announced in October.
Key outcomes of this pilot and others to follow will address important questions regarding whether the innovations offered are practical, effective and adoptable. Deployment in "real world" practices will also provide crucial feedback as to how they can improve patient care workflows. Pre- and post-deployment practice assessments will help inform the final conclusions.
EHR vendors are working on similar solutions, especially around the use of virtual assistants utilizing AI and machine learning. The environment is ripe for movement away from the current generation of EHR technologies. However, the solutions they are working on may not be as disruptive as needed. In fact, one representative of a large EHR vendor was heard to say that we must consider the EHR "as a new member of the care team."
What is needed now is leadership from family medicine. The AAFP Health IT Innovation Special Project, headed by AAFP Vice President and Chief Medical Informatics Officer Steven Waldren, M.D., M.S., is a venue to provide that leadership. We must lend our voice to ensure the EHR is meaningful for patient care, not simply an electronic repository for office notes and bullets for billing. It will be a step in reducing administrative burden. Perhaps most importantly, it will be a step toward improving physician well-being and getting our focus back where it should be -- on our patients.
Michael Munger, M.D., is Board chair of the AAFP.