A Commonwealth Fund-Supported study published in Health Affairs in November 2013 says that the proliferation of health information technology (HIT) across physician offices will substantially reduce the future demand for physician services in the U.S. Health information technology adoption includes EHR, clinical decision support, provider order entry and patient Web portals with secure messaging. A commentary in the Journal of the American Medical Association (JAMA) also pointed out that with mobile health apps and home monitoring, physicians will end up seeing only occasionally for minor acute problems and follow-up visits than at present.
Around 72 percent of office-based physicians had adopted electronic health record (EHR) as of 2009, up from about 10 percent a decade ago. The authors of the Health Affairs study opine that HIT on its own and as part of an overall transformation in healthcare system will cause a considerable decrease in the demand for generalist and specialist physicians in the future.
However, the comprehensive use of HIT by even 30% of office-based physicians will take at least five years, says this study. A higher level of transformation can be expected by 2020. Here are the key findings of this research:
- Health information technologies such as interoperable EHRs, clinical decision support, patient web portals and more can raise efficiency to a great extent. The study estimates 4 to 9 percent decrease in the demand for physicians in future if such technologies are completely implemented in 30 percent of physicians’ offices and 8 to 19 percent decrease in demand if implemented in 70 percent.
- Many duties from physicians will be delegated to nurse practitioners and physician assistants and from specialists to generalist physicians owing to the efficient HIT support. This kind of practice can cause 6 to 12 percent decrease in the demand for physician care (specialist physicians if delegating care to generalist physicians) in case of 30% penetration of HIT, and 12 to 26 percent decrease in demand if HIT adoption is 70%.
- The study says 5% to 10% of real-time office-based care could be provided remotely for patients with health information technologies if they are not able to present in a physician’s office. About 5% to 15% care would encompass communication between patients and health care providers from both separate locations and different points in time. HIT involving remote and asynchronous care could reduce the regional shortages of physicians by 12 percent though there would be 7 percent decrease in demand for physicians in case of 30% penetration of HIT and 15 percent decrease for 70% penetration of HIT.
According to the health care experts, full-service acute care hospitals do not need to depend on a long-term physician-patient rapport since they are well-equipped with facilities for comprehensive healthcare services without needing to maintain a team of specialty physicians. This study says that such hospitals will become much more independent due to the decrease in demand for physicians. However, they to stay competitive they would need to find solutions to resolve the challenges related to the effective adoption of EHR and other HIT technologies:
- EHR adoption is itself posing a problem and there is evidence of decrease in provider productivity since its introduction. Physicians are finding it difficult to capture meaningful conversations with EHR drop-down boxes and templates.
- When information is copied from one file to another in the EHR system it could result in the entry of irrelevant or wrong information.
- Speech recognition software does not guarantee accuracy in clinical documentation. The software does not recognize grammatical mistakes and understand the rules of punctuations. It also does not have the ability to expand acronyms.
Future predictions on the demand and supply of physicians should take all of these factors into account. It will be also necessary to train physicians in using new technologies – they will have to become computer savvy as well. Busy physicians have other viable options too. They can employ medical scribes to enter information into the EHR. They also make use of the services of professional outsourcing companies for medical transcription that offer EHR-integrated documentation solutions.